Bacterial Skin and Skin Structure Infection Flashcards

Question

ABx treatment for necrotizing fasciitis

Answer 1

``` Combo for Empiric broad spectrum _ Vancomycin (MRSA and gram (+)): needs LD because it is a severe condition _ Clindamycin (Anaerobic and toxin inhibition): 600mg TID IV _ FQ (gram (-)): Cipro 400mg Q8h IV ```

Answer 2

Continue until surgery no longer needed and no signs of systemic inflammation (10-14 days after the surgery)

Answer 3

``` daily foot examination forcallus, blister, trauma properly fitting shoes look in shoes no barefoot walking clean, dry feet properly manicured toenails ```

Answer 4

``` Superficial infxns: aerobic GPC (S. aureus, S. agalactiae, S. pyogenes, CoNS) ``` Ulcerations/chronic infxns: may include gram negative: enterobacteriaceace, Pseudomonas Extensive wounds, necrosis, toxic: may further include anaerobes (Bacteroides, Clostridium, Streptococci spp)

Answer 5

Received antibiotics in the past month? Yes = include gram-negative bacilli coverage No = target aerobic gram-positive cocci only mild to moderate (OUTPATIENT) & no recent antibiotics, targeting aerobic GPC sufficient First, Mild and NO Abx past month: use Keflex Then, Mild and Abx past month: use Augmentin If Mild and purulence (MRSA) use Bactrim, Clinda, Dox most severe infections (HOSPITALIZED), broad-spectrum empiric antibiotic therapy, pending culture results Amp-Sulbactam 3gm IV Q6h + Vancomycin wt based dosing (Severe need LD)

Answer 6

Often a nonpathogenic colonizer when isolated from wounds P. aeruginosa is isolated in <10% of wounds Risk factors: patients who have been soaking their feet or prolonged water exposure. (remember: Pseudomonas inhabits moist environments) who have failed therapy with nonpseudomonal therapy Recommended agents for empiric coverage are: Piperacillin/Tazobactam: 4.5g Q6h Ciprofloxacin

Answer 7

Mild-moderate (Oral): 1-3 weeks Severe (Initial parenteral, switch to oral when possible): 2-4 weeks Bone/Joint (Initial parenteral, switch to oral when possible): >3 months

Answer 8

Diabetes --> Low vascularization to foot --> Low blood supply --> Low ABx concentration --> Needs longer time to reach optimal concentration

Answer 9

open, exposed fracture ability to probe bone at base of ulcer local swelling with bone pain on examination

Answer 10

elevated ESR and CRP: inflammation | infectious signs: WBC, temp, HR, RR

Answer 11

``` plain films (x-ray) may be falsely negative early blurred margins MRI/CT- may reveal destruction if x-ray normal ```

Answer 12

Intravenous Route and Long Duration Empiric coverage in adults vancomycin + Gram negative coverage if: IVDU/surgical (pseudomonas risk)- cefepime; if allergy cipro vertebrae- ceftriaxone; FQ if allergy vascular insufficiency- refer to diabetic foot

Answer 13

Acute therapy – parenteral therapy x 6-8 weeks | Best to prevent recurrence

Answer 14

fever, HR, RR WBCs skin/clinical improvement/progression serum creatinine- renally adjusted medication cultures specific drug tolerance, side effects, interactions

Answer 15

Keep draining wounds covered with clean, dry bandages Maintain good personal hygiene with regular bathing and cleaning of hands with soap and water or an alcohol-based hand gel, particularly after touching infected skin or items that have directly contacted draining wound Avoid reusing or sharing personal items that contact skin (razors, towels, linens)