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BCPS > Cellulitis, Osteomyelitis > Flashcards

Cellulitis, Osteomyelitis Flashcards

1
Q

Non MRSA Cellulitis treatment

A

Penicillin G (if definitively streptococcal)
Cefazolin/cephalexin
Ceftriaxone
Clindamycin

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2
Q

Empiric MRSA coverage needed for cellulitis with these factors

A

Penetrating trauma
IVDU
Purulent drainage
Nasal colonization with MRSA
Evidence of MRSA elsewhere or SIRS w/ nonpurulent cellulitis

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3
Q

Outpatient empiric MRSA therapy for cellulitis

A

Clindamycin
Bactrim (+ B lactam to cover streptococcus)
Doxycycline (+ B lactam to cover streptococcus)

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4
Q

Inpatient empiric MRSA therapy cellulitis

A

Vancomycin
Linezolid
Daptomycin
Telavancin

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5
Q

Treatment duration for celluitis

A

5-10 days

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6
Q

Erysipelas

A

Skin infection that spreads through lymphatic system in skin
Usually occurs in infants, older adults
Warmth, erythema, pain
Edge of infection is elevated and sharply demarcated
Systemic signs common but blood culture rarely positive (5%)

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7
Q

Erysipelas common organism

A

Group A Streptococcus (G, C, B also seen)

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8
Q

Erysipelas treatment

A

Penicillin G
Cefazolin
Clindamycin

5 days

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9
Q

Necrotizing fasciitis

A

Involves subcutaneous fat and superficial fascia
Severely alters surrounding tissue, leads to gangrene or cuteanous anesthesia

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10
Q

Streptococcol nec fasc

A

Streptococcus pyogenes (type 2)

Spontaneous
Varicella
Minor trauma (cuts, burns splinters)
Surgical procedure

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11
Q

Mixed infection nec fasc

A

Facultative and anaerobic bacteria (type 1)

Secondary infection to:
Perianal abscess
Abdominal surgery
Trauma
Decubitus ulcer
IVDU

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12
Q

Most important part of nec fasc treatment

A

Surgical debridement

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13
Q

Empiric ABX therapy for nec fasc

A

Vancomycin or linezolid
PLUS
Zosyn or carbapenem or ceftraixone + metronidazole

If GAS, S. aureus, or Clostridium spp suspected:
Add Clindamycin or linezolid

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14
Q

Clindamycin and LInzeolid in nec fasc

A

Suppress toxin and cytokine production

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15
Q

Streptococcal nec fasc treatment

A

High dose IV penicillin
PLUS
Clindamycin or linezolid

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16
Q

Varicella cellulitis

A

Maculopapules, vesicles, scabs with clear fluid. On trunk/face then spread elsewhere

  1. Acyclovir 800mg PO 4-5 times daily x5 days
  2. Valacyclovir 1g PO TID x5-7 days
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17
Q

Diabetic Foot Infection organisms

A

Polymicrobial

S. aureus, GAS, GBS, Enterococcus, Proteus, E. coli, Klebsiella, Enterobacter, P aeruginosa, Bacteroides, Peptostreptococcus

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18
Q

Mild Diabetic Foot Infection

A

Local infection involving only the skin and subcutaneous tissue. No SIRS criteria. Erythema of 2cm or less

No antibiotics in the past month

19
Q

Mild DFI treatment, no MRSA risk factors

A

Dicloxacillin
Nafcillin
Oxacillin
Cephalexin
Cefazolin
Levofloxacin
Doxycycline
Bactrim (if sulfa allergy)
Moxifloxacin
Clindamycin

20
Q

Mild DFI treatment, high risk for MRSA

A

Previous MRSA infection or colonized

Linezolid
Cilndamycin
Doxycyline
Bactrim

21
Q

Moderate to severe DFI definition

A

Local infection with erythema > 2cm OR
involves structures deeper than skin & subcutaneous tissue w/ or w/o SIRS criteria

22
Q

Moderate to severe DFI treatment

A

Unasyn
2nd or 3rd generation cephalosporins (cefuroxime, cefotaxime, ceftriaxone)

23
Q

Moderate to severe DFI treatment if recent antibiotics

A

Zosyn
2nd or 3rd generation cephalosporins
Ertapenem

24
Q

Moderate to severe DFI treatment if macerated ulcer or warm climate

A

Zosyn
Dicloxacillin or nafcillin or oxacillin PLUS ceftazidime or ciprofloxacin
Meropenem
Imipenem

25
Q

Moderate to severe DFI if ischemic limb/necrosis/gas forming

A

Augmentin
Unasyn
Zosyn

26
Q

Moderate to severe DFI if risk for gram-negative organisms

A

Ertapenem
Meropenem
Imipenem
Ciprofloxacin
Aminoglycoside
Polymyxin

27
Q

Moderate to severe DFI if risk of MRSA

A

Risks: prolonged hospitalization, ICU admit, recent hospitalization, recent ABX use, invasive procedure, HIV, nursing home, open wound, hemodialysis, discharge w/ long-term central venous access

Vancomycin
Linezolid
Doxycycline
Bactrim
Daptomycin

28
Q

DFI treatment duration

A

1-2 weeks, can prolong 3-4 weeks if slow response, severe PAD

6 weeks if osteomyelitis

29
Q

DFI treatment duration if amputation needed

A

2-5 days post op if no remaining infected tissue/bone

1-2 weeks if residual infected tissue

3 weeks if residual infected bone

30
Q

Empiric osteomyelitis treatment for children

A

Cefazolin
Nafcillin/oxacillin

If MRSA community prevalence is >10%:
Clindamycin
Vancomycin (if high resistance to clindamycin)

31
Q

Empiric osteomyelitis treatment for adults

A

Gram - coverage (cefazolin, ceftriaxone, cefepime, meropenem)
+
Anti-staph agent (clindamycin, doxycycline, vancomycin, linezolid, daptomycin)

32
Q

Empiric osteomyelitis treatment for sickle cell patients

A

High risk for Salmonella

Ceftriaxone/cefotaxime
OR
ciprofloxacin/levofloxacin

33
Q

Osteomyelitis with prosthetic joint & retention of prosthesis or one-stage exchange

A

Staph: staph coverage + rifampin 300-450mg BID x2-6 weeks
THEN
rifampin + cipro/levo for 3-6 months

If no staph, then IV or PO tx for 4-6 weeks, followed by indefinite oral suppression therapy

34
Q

Osteomyelitis with prosthetic joint and removal of prosthesis

A

IV or PO therapy x4-6 weeks

35
Q

Osteomyelitis treatment duration if amputation

A

If all infected tissue removed: 24-48 hours

36
Q

Acute osteomyelitis treatment duration

A

3-6 weeks

37
Q

Chronic osteomyelitis treatment duration

A

6-8 weeks IV or PO abx
May extend if high risk of failure (MRSA, extensive infection)

38
Q

Osteomyelitis criteria to switch to PO

A
  1. Highly bioavailable PO abx available
  2. PT can be adherent
  3. Identified organism is highly susceptible to PO abx
  4. C-reactive protein <2.0
  5. Adequate surgical debridement
  6. Resolving clinical course
39
Q

Impetigo mild treatment

A

Topical mupirocin or retapamulin ointment for 5 days

Mild = focal and few lesions

40
Q

Impetigo oral treatment

A

If ecthyma or multiple lesions, outbreak

MSSA: dicloxacillin, cephalexin
MRSA: bactrim, doxycycline, clindamycin
Strep: penicillin

41
Q

Risk factor for MRSA surgical SSTI infection

A

Prior MRSA infection
Nasal carrier MRSA
Recent hospitalization
Recent antibiotic admin

42
Q

Gram neg/anaerobe coverage needed if surgical SSTI involve these areas

A

Axilla
GI tract
Perineum
Female GU tract

Use zosyn, carbapenem, or ceftriaxone + metronidazole

43
Q

Animal bite treatment

A

First line: Augmentin

If immunocompromised, mod-severe injury, penetrated into joint, treat preemptively for 3-5 days

BCPS (27 decks)

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