Acute Bacterial Skin and Skin Structure Infections Flashcards
What are characteristics of purulent ABSSSI
Cutaneous abscessess, furuncles, carbuncles
What is the 1st line treatment of purulent ABSSSI
Incision and drainage
T/F: MSSA and MRSA are just as prevalent for one another and therefore MSSA should be covered
False: MRSA and MSSA are seen at identical rates therefore MRSA coverage should be used
What are the most common IV Anti-MRSA agents
Vacnomycin, Daptomycin, Quinupristin/dalfopristin
What are the most common oral Anti-MRSA agents
Bactrim, Clindamycin, Linezolid, Doxycyline
What organism usually causes cutaneous abscesses
Staphylococcus aureus
When does it become appropriate to give a patient antibiotics if they have a purulent ABSSSI
Immunocompromised (transplant patient/HIV), multiple abscessses, very young or very old, lack or response after incision and drainage, systemically ill
T/F: Furuncles are boils and cabuncles are multiple smaller boils that is deeper
True
What is the best way to treat a furuncle, carbuncle
moist heat, incision and drainage
What is the best treatment of recurrent purulent ABSSI
Repeated incsion and drainage, decolonization with intranasal mupirocin, clorhexidine bathing and daily washing
T/F: Purulent (pus) infections require antibiotics more than non-purulent infections
False: Non-purulent ABSSSI are more likely to need antibiotics as first line treatment
What is erysipelas and cellulitis
Diffuse, superficial, spreading skin infections, cellulitis is this but not on the face and is usually in the lower extremities
What is the 1st line therapy for non-purulent ABSSSI
Antibiotic therapy
How does cellulitis usually occur
Microbes breach cutaneous skin surfaces due to breaks in small and unapparent breaks in skin
When is the risk for cellulitis higher
Obesity, trauma/surgery, previous cellulitis, venous stasis, lymphedema
What is recurrent cellulitis, what are the underlying causes
3-4 episodes of cellulitis per year/ obesity and tinea pedis (athletes foot)
What is antibiotic prophylaxis for recurrent cellulitis
Oral penicillin VK BID
What are factors that make antibiotic prophylaxis for recurrent cellulitis almost non effective
3 or more previous cellulitis episodes, previous edema, BMI greater than or equal to 33
What is necrotizing fasciitis
Aggressive deep infection involving fascia an/or muscle compartments
How can necrotizing fasciitis be differenciated from cellulitis
Check every few hours instead of every day, systemic toxicity, crepitus under the skin, wood hardness, gangrene, anesthesia, disproporional pain
T/F: Cellulitis has systemic toxicity very rarely
True
What is the number 1 treatment option for necrotizing fasciitis
Prompt surgery is essential
T/F: Antibiotics will be used for necrotizing fasciitis until the patient is clinically improved which could take months
True
What are the organisms that cause necrotizing faciitis
S. pyrogenes, S. aureus, aeromonas hydrophilia, vibrio vulnificus, polymicrobial
When using antibiotics for necrotizing fasciitis what should be targeted
Streptococci, stpahylococci (MRSA), gram negatives, anaerobes
What are the agents used for gram positive organisms in necrotizing fasciitis
vancomyin, linezolid, or daptomycin
What are the agents used for gram negative organisms in necrotizing fasciitis
Piperacillin-tazobactam, carbapenem or cefriaxone PLUS metronoidazole
If group A step is suspected what antibiotics should definitely be used, why
Protein synthesis inhibitors (linezolid and clindaymycin), decrease the toxin production
What is necrotizing fasciitis of the genetials called, what cause it, what are risk factors
Fourneir’s gangrene, pseudomonas originosa, age in between 50-60 years old and patients with diabetes
What determines whether a purulent infection is mild or not
Systemic infection
T/F: If a patient has a non mild purulent infection they can receive incision and drainage plus culture and susceptibility while also being given empiric MRSA covering agents
True
What MRSA covering agents can be given IV for a severe/moderate purulent infection
Vancomycin OR Daptomycin OR, Linezolid OR Ceftaroline
What MRSA covering agents can be given by mouth for a severe/moderate purulent infection
Bactrim OR Doxycyline
If MSSA is what is seen to cause the severe/moderate purulent infection what IV anti-MSSA agents can be given, oral anti-MSSA
Nafcillin OR Cefazolin OR Clindamycin/ Dicloxacillin or Cephalexin
What oral antibiotics would be used with mild nonpurulent infections
Pencillin VK OR Cephalosporin OR Clindamyin OR Dicloxacillin
What IV antibiotics would be used with moderate infections
Penicillin OR Ceftriaxone OR Cefazolin OR Clindamycin
T/F: When a necrotizing infection is present antimicrobial therapy should have at least one agent
False: When a necrotizing infection is present antimicrobial therapy should have at least two agents
T/F: When using antibiotics for purulent and non-purulent ABSSI MRSA coverage is always first line
False: For purulent infections if antibiotics are needed choose anti-MRSA agents emperically but for Non-purulent ABSSSI MRSA coverage is not needed
