Case 1

Question 1

postop infection (no implants)

Answer 1

staph aureus

-risk MRSA if high at hospital or prior MRSA infection

Question 2

postop infection with implant use

Answer 2

staphlococcus epidermidis

Question 3

puncture wound w/OM

Answer 3

pseudomonas

Question 4

puncture wound w/cellulitis

Answer 4

staph or strep

Question 5

diabetic ulceration

Answer 5

staph aureus

Gr B strep

Question 6

tx puncture wound- soft tissue infection only

Answer 6

ie if no risk pseudomonas (No OM, not DM shoe wound)
PO
amoxicillin/clavulonic acid 875mg bid
clindamycin 300 mg tid
cephalexin 500 mg bid-qid
levofloxacin 500 mg bid

IV
cefazolin 1g q6h
amicillin/sulbactam 3g q6h
piperacillin/tazobactam 3.375 q6h
clindamycin 600-900 mg q8h

Question 7

puncture wound tx

Answer 7

US to image FB
SX debridement if deep tissue infection

abx to cover gram + and -
staph and strep

later sx mean deeper infection

Question 8

Patzakis zones of the foot

Answer 8

zone 1 - toes to MTPJ (met neck)
2- distal calc to mTPJ (met neck)
3-under calc

cx risk: 1>3>2
1- OM , pyarthrosis

Question 9

puncture wound if OM (staph and pseudomonas)

Answer 9

PO
ciprofloxacin 750 mg q12h

IV
cefepimine 2g q12h
ceftazidime (fortaz) 2g q12h
piperacillin/tazobactam (zosyn) 3.375 g q6h

Question 10

imaging for puncture wound

Answer 10

near bone- US
far from bone- CT

long duration -MRI

Question 11

tx animal, human bite

Answer 11

empiric abx

beta-lactamase:
amoxicillin/clavulonic acig (Augmentin) 875 mg PO

IV
piperacillin/tazobactam (zosyn) 3.375 g q6 h or 4.5 q8h
ampicillin/sulbactam (unasyn) 1.5-3 g q6h
ticaracililn/clavulonic acid (timentin) 3.1 qi6h, heed Na loading

Question 12

actineobacter baumanii

Answer 12

aerobic
gram - coccobacillus (rod)

soldier iraq
ICU
community infection- trauma

unasyn (ampicillin/sulbactam) 1.5-3 g qi6h
sulbactam have activity

broad spectrum cephalos
ceftazidime (fortaz) 2g q12 h
carbapenem, now some resistance
imipenem, meropenem

tigecycline- for actineobacter

Question 13

ekinella corrodens

Answer 13

aerobic
gram - rod

human bite
needle licker- DM, IV user

beta lactam:
amoxicillin/clavulonic acid 800 mg (augmentin) bid PO

Question 14

pseudomonas aeruginosa

Answer 14

gram - rod
aerobic
oxidase positive

puncture wound w/OM
moist shoes (DM) wound

tx

*ciprofloxacin 400 mg q8h

IV
zosyn (piperacillin/tazobactam) 3.375 q6h or 4.5 q8h

Question 15

tetanus protocol

Answer 15

if 3, skip Tdap

give TIG (immunoglobulin) if high risk for tetanus and unsure/5yrs since last

risk: >6hr wound
>1cm
contaminants
devitalized tissue

Question 16

pasturella multocida

Answer 16

gram - aerobic rod
animal bites

cellulitis
septic arthrits
OM
abscess

*augmentin (amox/clav) 800 mg bid

Question 17

clostridium tetani

Answer 17

gram + rod
endospore release toxin- little use abx

PCN
metronidazole

Question 18

carbapenems

Answer 18

seizure, n/v cross PCN
beta lactam, broad (gram + and -)

imipenem/cilastin (primaxin)
gram + aerobes/anaerobes
actineobacter
500 mg q6-8h
limb threatening

meropenem
gram -, pseudomonas
1.2 g q8h
limb threatneing

**ertapenem (Ivanz)
once daily DM foot infection
NO pseudomonas
1g IV 24h

Question 19

aminoglycosides

Answer 19

aerobic gram -
pseudomonas, actineobacter

gentamycin
tobramycin- pseudo best
amikacin

nephro
neurotoxic
ototoxic