Clinical Treatment: Skin, Soft Tissue, Bone, and Bloodstream Infections Flashcards
What would be some risk factors for expecting MRSA over MSSA?
Recent hospitalization, previous Abx exposure, indwelling lines, hemodialysis, nursing homes, etc
Since the rise of community-acquired MRSA, in what type of infections is MRSA coverage always warrented?
Purulent cellulitis, or abscesses
What are some oral options for MSSA?
Amoxicillin/clavulanic acid
Dicloxacillin (second generation pen)
Cephalexin (1st generation cephalo)
What are some oral options for MRSA?
Doxycycline / minocycline
TMP / SMX
Linezolid
Clindamycin -> but remember inducible resistance
Why might TMP / SMX not be able to be given alone for skin infections?
Poor S. pyogenes coverage, although MRSA is covered. Need to give with cephalexin
What is the most important thing to do when giving a patient an antibiotic therapy?
The 48 hour call to assess their condition, to see if their Abx regimen needs to be changed
What is the standard of care for MSSA or MRSA in severe cellulitis? What is meant by severe?
MSSA: Nafcillin or cefazolin
MRSA: Vancomycin, cover empirically
severe: oral abx failed, irrigation and debridement is necessary, or systemic symptoms are present
What is necrotizing fasciitis commonly associated with? What is another necrotizing infection?
S. pyogenes
Recently MRSA, Vibrio and aeromonas
Gas gangrene is considered necrotizing
What is vital for treatment of necrotizing infections?
Prompt surgical intervention
What is the treatment for severe GAS or clostridial infections? Why?
IV penicillin + clindamycin (due to toxin suppression activities) -> inhibits protein synthesis
Penicillin will cover GAS + clostridium
Clinda: staph, strept, and anaerobes
What bug must be empirically covered in animal bites?
Pasteurella
Also comes with staph, strep, and anaerobes
What is the mainstay of therapy for animal bites (and human bites)? Alternatives?
B-lactam / B-lactamase inhibitors
I.e. amoxicillin/clavulanic acid
Alternately: Doxycycline, moxifloxacin, or ceftriaxone
What is the empiric therapy for infected diabetic foot ulcers?
Initially IV therapy with vancomycin +/- ceftriaxone to cover gram negative in case of deep tissue infiltration
DONT WAIT FOR ULCER TO FULLY HEAL TO STOP
When is Rifampin used for bone infections?
When complicated by prostheses which could have biofilm
What is suppressive therapy for bone infection?
Long-term doxycyclline, TMP/SMX, or clindamycin use when the infection cannot be fully cleared