Cellulitis and MRSA Flashcards
What is cellulitis?
Skin infection usually of one of the lower limbs caused by infection of a cut. Presents as acute onset of fever, malaise, nausea, shivering, and rigors. Severe cellulitis an cause blisters, ulceration, and deep-seated tissue damage.
Before treatment of cellulitis, what should be done?
Draw around the extent of infection with permanent marker to track spread of infection.
What are the classifications of cellulitis?
Class I: no signs of systemic toxicity or uncontrolled comorbities.
Class II: systemically unwell OR systemically well + comorbidity
Class III: significant systemic upset such as tachycardia, hypotension or tachypnoea OR unstable comorbidities which may interfere with response to treatment.
Class IV: sepsis or severe life-threatening infection such as necrotising fasciitis.
What is first line treatment of cellulitis?
Flucloxacillin 500-1000mg qds for 5-7 days, review after 2-3 days.
If after 7 days there is no improvements, continue for a further 7 days or obtain sensitivity results fro swab.
Lifestyle advice for cellulitis?
Encourage paracetamol/ibuprofen for fever
Drink plenty of fluids
Avoid using compression garments.
What are some things to look out for with flucloxacillin use?
Anaphylaxis (penicillin)
Cholestatic jaundice/hepatitis - more common in elderly or >2 weeks treatment. Use with caution in hepatic impairment.
Hypokalaemia - monitor serum potassium.
For cellulitis, what are some alternatives to flucloxacillin?
Clarithromycin 500mg bd 5-7 days.
Doxycyline 200mg 1 day, then 100mg od 5-7 days total
Erythromycin (pregnancy) 500mg qds 5-7 days
Linezolid (if sensitive/MRSA) 600mg bds 10-14 days
What are some considerations when prescribing Erythromycin?
Associated with increased risk of cardiotoxicity (QT interval prolongation) so avoid in patients with this, ventricular arrythmia, or electrolyte disturbances.
Interaction with rivaroxaban – bleeding.
What are some considerations when prescribing Linezolid?
Requires weekly FBC including platelet count as associated with blood disorders due to bone marrow suppression, especially in patients with 14+ days, existing myelosuppression, or renal impairment.
Severe optic neuropathy may occur in long courses. Warn patients to report any symptoms of visual impairment such as blurred vision or impaired colour vision.
Risk of serotonin syndrome so avoid use with SSRIs or MAOis.
When would MRSA be suspected?
Same symptoms as any other staphylococcal infection, so risk factors:
No response to first line abx
Recurrent skin or soft tissue infections, or non-healing ulcer.
Recent hospitilisation or nursing home contact
Surgical wounds, open ulcers, IV line, or urinary catheters
Recent antibiotic use.
Previous MRSA infection.
What does MRSA decolonisation entail?
Nasal Mupirocin (Bactroban) tds OR Naseptin qds
+
Clorhexidine 4% skin scrub and hair wash.
5 days followed by screening on day 8.
If screening negative, repeat for total of 3x. If positive, 2nd decolonisation protocol. If positive following 2nd decolonisation and screening, seek further testing.
What are some counselling points for MRSA decolonisation?
Wear gloves when applying Bactroban to inside of nostril to avoid MRSA contamination of finger.
When using clorhexidine, wet body and hair in shower, then apply solution undiluted to a wash cloth and apply evenly over body hair, especially under arm pits and in crotch area. Rinse off thoroughly.
Ensure reassessment to ensure eradication.
Avoid contact with people with weakened immune system.
