Chapter 152: Soft tissue Infections Flashcards
most common cause of skin and soft tissue infections presenting to the ED regardless of patient risk factors
Community-acquired methicillin-resistant Staphylococcus aureus}
- second: B-hemolytic streptococcal infection
- Third: Gram-negative aerobic bacilli
Cellulitis or Erysipelas?
tender, warm, erythematous, and swollen, and typically does not exhibit a sharp demarcation from uninvolved skin
Cellulitis
Cellulitis or Erysipelas?
- onset of symptoms is usually abrupt, with fever, chills, malaise, and nausea representing the prodromal phase
- the affected skin becomes indurated with a raised border that is distinctly demarcated from the surrounding normal skin
Erysipelas
distinguishing feature of erysipelas
Milian ear sign
*ear does not contain deeper dermis tissue typically involved in cellulitis
general treatment for Cellulitis and Erysipelas
- elevation of the affected area (helps drainage of edema)
- incision and drainage of any abscess found
- antibiotics for cellulitis
- treatment of underlying conditions
- treat skin dryness with topical agents
Treatment for mild disease (Drainable abscess found with no signs of systemic infection)
- None required for healthy immunocompetent patients where abscess drainage is complete after procedure
- Presence of an abscess should be carefully investigated clinically and drained; consider use of US
Oral antibiotics for moderate disease (Purulent cellulitis* without signs of systemic infection OR drainable abscess in the presence of mild to moderate signs of systemic infection)
1) Trimethoprim-sulfamethoxazole double strength 1–2 tablets twice per day PO for 7-10 d
2) OR doxycycline 100 milligrams PO twice per day for 7–10 d
3) OR clindamycin, 300–450 milligrams PO our times daily for 7–10 d
*wound culture is recommended in cases where antibiotics are given
IV antibiotics for severe disease (Purulent cellulitis* with signs of systemic infection Or drainable abscess in the presence of moderate to severe signs of systemic infection or sepsis Or an immunocompromised patient)
For MRSA coverage:
1) Vancomycin 15mg/kg IV every 12h
2) Or linezolid 600 milligrams IV every 12 h
3) OR daptomycin 4 milligrams/kg IV every 24h
4) OR clindamycin 600 milligrams IV every 8h
for patients with SEPSIS, or for unclear etiology, add:
1) Piperacillin-tazobactam 4.5 grams IV every 6 h
2) Or meropenem 500–1000 milligrams IV every 8 h
3) Or imipenem-cilastatin 500 milligrams IV every 6 h
*for FRESH WATER exposure (Aeromonas species) or for SALT WATER exposure (Vibrio species)
- Doxycycline 100 mg IV every 12 hours PLUS Ceftriaxone 1 gram IV every 12 hours
If indicated, Prophylaxis for endocarditis un patients undergoing incision and drainage
Clindamycin 600mg IV or Vancomycin 1 gram IV 30 to 60 mins before the procedure
Type II infections are most commonly caused by what organism
group A streptococcus
*Type I (Polymicrobial)
*Type II (monomicrobial)
*Type III - Vibrio vulnificus
*Type IV - Fungal imfections
Rapid spread of infection can occur as fast as
1 inch/h
single most important feature to make the diagnosis early in Necrotizing soft tissue infection
Pain
TRUE or FALSE: The lack of crepitus does not rule out the diagnosis of necrotizing soft tissue infection
TRUE
Hard signs of necrotizing fasciitis
crepitus, skin necrosis, bullae, hypotension, or gas on radiograph
TRUE or FALSE: In necrotizing soft tissue infections, antibiotics alone are rarely effective, and immediate surgical consultation and intervention remain the cornerstone of successful management.
TRUE
*The tissue ischemia produced in necrotizing skin infections impedes immune system destruction of bacteria and prevents adequate delivery of antibiotic
