CBL - Skin & Soft Tissue Infections

Question 1

Define Systemic Inflammatory Response Syndrome (SIRS) [5]

Answer 1

• 2 or more of:
  
  1. Temperature >38°C or <36°C
  2. Tachycardia >90 bpm
  3. Tachypnoea RR>20/min
  4. WBC >12x10⁹/L

Question 2

How should you initially treat a patient with cellulitis with an SIRS status? [4]

Answer 2

• due to the SIRS status, IV antibiotics are warranted
  
  • IV Flucloxacillin
  • IV Benzylpenicillin
  • give IV Vancomycin if penicillin allergic
• low-molecular weight heparin should also be given

Question 3

When a patient presents with cellulitis, how should this be monitored? [2]

Answer 3

the area of erythema should be marked and monitored closely overnight

Question 4

Define necrotising fasciitis [1]

Answer 4

a life-threatening bacterial infection of the layer of fascia beneath the skin, usually by streptococcus type A

Question 5

What are the characteristics in terms of presentation of necrotising fasciitis? [6]

Answer 5

1. disproportionate pain initially
2. NSAIDs use
3. mild preceding trauma
4. SIRS/Sepsis
5. rapid progress over a few hours
6. dusky discolouration

Question 6

Describe the 4 types of necrotising fasciitis

Answer 6

• Type 1:
  
  • Synergistic infection with anaerobes (e.g. bacteroides, peptostreptococcus) and aerobes (streptococci, enterobacteriaciae).
  • More common in elderly diabetic patients.
  • This is why very broad antibiotic cover is required.
• Type 2:
  
  • Infection with Group A Streptococci (S. pyogenes or occasionally S.aureus),
  • mediated by toxin production

(Type III- Vibrio vulnificus- after trauma in sea water).

(Type IV- Fungal)

Question 7

Which antibiotics are used for treatment of necrotising fasciitis? [5]

Answer 7

Broad spectrum antibiotics are commenced:

1. IV Flucloxacillin
2. IV Benzylpenicillin
3. IV Metronidazole
4. IV Gentamicin
5. IV Clindamycin