Clinical Treatment: Skin, Soft Tissue, Bone, and Bloodstream Infections Flashcards

1
Q

What would be some risk factors for expecting MRSA over MSSA?

A

Recent hospitalization, previous Abx exposure, indwelling lines, hemodialysis, nursing homes, etc

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2
Q

Since the rise of community-acquired MRSA, in what type of infections is MRSA coverage always warrented?

A

Purulent cellulitis, or abscesses

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3
Q

What are some oral options for MSSA?

A

Amoxicillin/clavulanic acid
Dicloxacillin (second generation pen)
Cephalexin (1st generation cephalo)

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4
Q

What are some oral options for MRSA?

A

Doxycycline / minocycline
TMP / SMX
Linezolid
Clindamycin -> but remember inducible resistance

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5
Q

Why might TMP / SMX not be able to be given alone for skin infections?

A

Poor S. pyogenes coverage, although MRSA is covered. Need to give with cephalexin

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6
Q

What is the most important thing to do when giving a patient an antibiotic therapy?

A

The 48 hour call to assess their condition, to see if their Abx regimen needs to be changed

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7
Q

What is the standard of care for MSSA or MRSA in severe cellulitis? What is meant by severe?

A

MSSA: Nafcillin or cefazolin
MRSA: Vancomycin, cover empirically

severe: oral abx failed, irrigation and debridement is necessary, or systemic symptoms are present

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8
Q

What is necrotizing fasciitis commonly associated with? What is another necrotizing infection?

A

S. pyogenes
Recently MRSA, Vibrio and aeromonas

Gas gangrene is considered necrotizing

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9
Q

What is vital for treatment of necrotizing infections?

A

Prompt surgical intervention

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10
Q

What is the treatment for severe GAS or clostridial infections? Why?

A

IV penicillin + clindamycin (due to toxin suppression activities) -> inhibits protein synthesis

Penicillin will cover GAS + clostridium

Clinda: staph, strept, and anaerobes

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11
Q

What bug must be empirically covered in animal bites?

A

Pasteurella

Also comes with staph, strep, and anaerobes

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12
Q

What is the mainstay of therapy for animal bites (and human bites)? Alternatives?

A

B-lactam / B-lactamase inhibitors

I.e. amoxicillin/clavulanic acid

Alternately: Doxycycline, moxifloxacin, or ceftriaxone

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13
Q

What is the empiric therapy for infected diabetic foot ulcers?

A

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

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14
Q

When is Rifampin used for bone infections?

A

When complicated by prostheses which could have biofilm

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15
Q

What is suppressive therapy for bone infection?

A

Long-term doxycyclline, TMP/SMX, or clindamycin use when the infection cannot be fully cleared

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16
Q

What are common antibiotic therapy durations?

A

Mild: 1-2 weeks
Moderate to severe: 2-4 weeks
Osteomyelitis / prosthetic implant infection: 4-6 weeks

17
Q

When are fluoroquinolones best used?

A

As an oral stepdown therapy following IV beta-lactam therapy

18
Q

What is the pseudomonal treatment for joint vs bone?

A

IV beta-lactam for 4-6 weeks
4 weeks for joint
6 weeks for bone

Some add antipseudomonal aminoglycoside (gentamicin, tobramycin, amikacin) or fluoroquinolone (ciprofloaxacin, levofloxacin)

19
Q

What is the drug of choice for gonorrhea?

A

Ceftriaxone or azithromycin

20
Q

What is antibiotic lock therapy?

A

Soaking your catheter in antibiotics to stop bloodstream infections (bacteremia), associated with both gram +, gram -, and candida spp.

21
Q

What is the treatment for streptococcal endocarditis?

A

4 weeks penicillin or ceftriaxone, or vancomycin if penicillin allergy

6 weeks with prosthetic valve

Add gentamicin for synergistic action, especially among resistant strains (2-6 weeks)

22
Q

What is used in treatment of staphylococcal endocarditis? What if prosthetic valve?

A

MSSA:
Nafcillin x 6 weeks
Cefazolin if non-severe penicillin allergy
Vancomycin if severe penicillin allergy

MRSA: High dose vancomycin

Add rifampin if prosthetic valve?

23
Q

What is the drug of choice for enterococccal endocarditis?

A

Ampicillin 4 weeks, gentamacin can be added

If amp-resistant, 6 weeks Vanco

Do at least 8 weeks if VRE (use daptomycin)

24
Q

What is a common saying for Clindamycin / Metronidazole?

A

Clindamycin above the diaphragm, metronidazole below

Clindamycin is good at treating Bacteriodetes and anaerobic species from mouth anaerobes leading to aspiration pneumonia

Metronidazole is good at treating anaerobic species in the gut and pelvis (C. difficile, Trichomonas)