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ID > Bone/Joint/Skin/Soft-Tissue Infections > Flashcards

Bone/Joint/Skin/Soft-Tissue Infections Flashcards

1
Q

Folliculitis. What is it and how to treat?

A

Inflamed hair follicle. Topical agent for 7 days.

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2
Q

Carbuncle/Furuncle: What is it and how to treat

A

> 1 cm lesion that extends beyond hair shaft. I&D may be enough. May need an oral agent for 5-7 days.

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3
Q

Impetigo: What is it and how to treat

A

Superficial. Common on face in peds. Highly contagious. Topical mupirocin BID for 5 days. PO agent for 7 days if multiple lesions. Don’t use Bactrim due to lack of GAS activiy.

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4
Q

Cellulitis: What is it and how to treat

A

Acutely spreading, skin infection (epidermis, dermis, and subcutaneous). PO if SIRS 0-1. IV if SIRS >1. Treat for 5-14 days.

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5
Q

Nectrotizing Fascitis: What is it and how to treat

A

Acute, often rapidly spreading infection in the fascia, subcutaneous fat, or muscle. Wooden-hard induration. Braod spectrum IV abx until definitive therapy via C&S.

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6
Q

Pyomyositis: what is it and how to treat.

A

Pain, tenderness, edema overlying a major muscle. Empirical treatment with vancomycin (90% of cases are Staphylococcus)

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7
Q

What are the SIRS criteria?

A

T > 38 or <36
HR > 90
RR > 20
WBC > 12k or < 4k

*Systemic Inflammatory Response Syndrome.

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8
Q

What causes Cat Scratch disease and how to treat?

A

Bartonella henselae: macrolides or doxy

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9
Q

Nectrotizing toxic shock: Cause and treatment

A

Streptococcus pyogenes: Penicillin + clindamycin

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10
Q

Necrotizing, gas gangrene: Cause and treatment

A

Clostridium perfringens: Penicillin + clindamycin

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11
Q

Bubonic plague: Cause and treatment

A

Yersinia pestis: Streptomycin (may substitute gentamicin) or Doxycycline

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12
Q

Which candida are fluconazole resistant and what do you treat with?

A

C. krusei and C. glabrata have fluconazole resistance. Echinocandin.

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13
Q

What’s first line for aspergillus (fungus) infxn

A

voriconazole is first line, duration 6-12 weeks

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14
Q

________ is shown to suppress toxin and cytokine production in clostridial and streptococcal infections

A

Clindamycin

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15
Q

First line preop prophy?

A

Anceft: 2 grams within 30 minutes of cut time (3 grams if > 120 kg).

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16
Q

Preop prophy: What if BL allergy?

A

Vanco (15 mg/kg within 1 hr) or clinda

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17
Q

What’s the preop dose for gent?

A

5 mg/kg

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18
Q

_______ should be added in addition to cefazolin for surgeries where anaerobic pathogens are a concern

A

Metronidazole: Biliary tract, appendectomy, colorectal, clean-contaminated procedures associated with head and neck or urologic tract

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19
Q

When do redose intraop prophy abx?

A

After 2 half-lives

20
Q

How long should you give surgical prophy?

A

Less than 24 hours.

21
Q

How should you treat a surgical site infection with no systemic signs?

A

I&D is usually sufficient

22
Q

What systemic sign of infection warrant treatment of a surgical site infection?

A

T > 38.5 (high fever!)
WBC > 12k
HR > 110 (higher than the SIRS criteria)
> 5 cm erythema or induration

23
Q

How long to treat surgical site infection that shows systemic signs?

A

24-48 hours. Use the same types of ABX as preop.

24
Q

Is an actively draining sinus tract or purulence communicating directly with the prosthesis enough to diagnose a PJI (prosthetic joint infection)?

A

Yes, that alone is enough.

25
Q

When is a PJI considered Early?

A

1-3 months after implantation

PJI = prosthetic joint infection

26
Q

What two factors determine the treatment and duration of PJI’s?

A

Whether hardware was retained or not. And Staph vs non-staph offending organism

27
Q

Are all staphylcocci biofilm producers (in PJI’s)?

A

Yes, yes they are. Harder to treat.

28
Q

What is DAIR?

A

Debridement and Implant Retention (talking about PJI’s)

29
Q

How long to treat staph PJI if DAIR or 1 stage exchange?

A

Induction with 2-6 weeks of IV abx + rifampin followed by PO (keflex or dicloxacillin) QS to 3 months (unless knee and DAIR, then 6 months).

Follow that with indefinite suppression.

30
Q

How to treat Staph PJI if 2 stage or permanent removal

A

4-6 weeks of IV or PO abx (no rifampin).

31
Q

How to treat non-staph PJI?

A

No induction phase with IV abx is required. 4-6 weeks total therapy with either IV or highly bioavailable PO. Regardless of DAIR vs 1 stage exchange vs 2 stage vs removal.

  • DAIR and 1 stage: follow-up with indefinite PO suppression
  • Amputation: 24-48 hours total therapy.
32
Q

How long to treat PJI if ampuation?

A

24-48 hours only. Regardless if staph or non-staph.

33
Q

How important is bone abx penetration?

A

Not that important. Pay more attention to clinical cure rates. Don’t get distracted by that.

34
Q

What is the role of rifampin in osteomyelitis and joint infections?

A

For staph only. Always in combination with another agent. It aids in penetrating staph biofilm.

35
Q

What agents are commonly used for long-term suppression in PJI when hardware is retained?

A

FQ +/- RIF
Doxy
TMP/SMX

36
Q

What is Vancomycin Mech of Action?

A

Cell wall synthesis inhibitor. Binds to alanine termini of PG chains preventing crosslinking. It is bactericidal usually, but against staph, it’s mostly static.

37
Q

What infections is ceftaroline currently approved to treat?

A

CAP and SSTI’s: 600 mg IV q8-12h

38
Q

What are some potential complications of Linezolid therapy?

A

Bone marrow suppression
Neuropathies (peripheral, optical)
Serotonin stuff (not as bas as once thought)

39
Q

What is tedizolid?

A

A newer oxazolidinone with activity against linezolid-resistant strains, once-daily dosing, and fewer adverse effects and serotonergic drug interactions

40
Q

What is Oritivancin and Dalbavancin?

A

New vancomycin alternatives. Can give just one dose for Skin infections. Not recommended for bone infections.

41
Q

What’s the deal with Omadacycline?

A

A new broad-spectrum tetracycline approved for SSTI’s. Has MRSA activity along with other stuff. Oral dosing requires 4 hours fasting! Take with water, then wait 2 hours before any food or drink (4 hours for dairy). Due to sequestration by divalent cations.

42
Q

Duration of therapy for diabetic foot infections?

A

Depends on depth and what’s been removed:
SSTI only: 2-5 days
Osteo but infected bone resected and only SSTI remains: 1-3 weeks
Osteo and not all infected bone resected: 4-6 weeks

43
Q

Define Mild, moderate, and severe diabetic foot infections:

A

Mild: No systemic symptoms, skin and soft tissue, < 2 cm erythema
Moderate: Local, but deeper tissues (abcess, osteo). > 2 cm erythema. < 2 SIRS criteria (systemic sx)
Severe: Deep tissues. 2 or more SIRS criteria.

44
Q

What is the most common pathogen for Native Vertebral Osteomyelitis (NVO)?

A

Staph Aureus. It’s hematogenous.

45
Q

How long to treat Native Vertebral Osteo

A

6 weeks. Easy! IV or PO

ID (20 decks)

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