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Block G -- Infection > Dr. Puligandla -- Soft Tissue Infections > Flashcards

Dr. Puligandla -- Soft Tissue Infections Flashcards

1
Q

Common and primary goal of surgical team

A

Prevention of surgical site infections in the OR

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2
Q

Goal of anti-sepsis

A

Prevent the contamination of the open surgical wound by isolating the operative site from the surrounding non-sterile environment

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3
Q

7 uncomplicated soft tissue infections

A
  • Cellulitis
  • Erysipelas
  • Abscess
  • Folliculitis
  • Furunculosis
  • Impetigo
  • Ecthyma
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4
Q

9 complicated soft tissue infections

A
  • Traumatic wound infectoin
  • Bite-related wound infection
  • Postop wound infection
  • Secondary infectio nof a diseased skin (i.e. eczema)
  • Diabetic foot infection
  • Vanous stasis ulcer/ infected pressure sores
  • Perianal skin infection
  • Necrotizing infection
  • Myonecrosis
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5
Q

Layers of skin involved in cellulitis

A
  • Epidermis
  • Dermis
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6
Q

3 organisms responsible for cellulitis

A
  • S. pyogenes
  • S. aureus
  • H. influenzae
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7
Q

3 symptoms of cellulitis

A
  • Pain
  • Erythema
  • Swelling
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8
Q

2 treatments for cellulitis

A
  • Antibiotics
  • Incision and drainage (I+D)
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9
Q

Define erysipelas

A

Superficial infection of skin that spreads rapidly and involved dermal lymphatics

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10
Q

Cause of erysipelas

A

GAS

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11
Q

4 symptoms of erysipelas

A
  • Fever
  • Pain
  • “Aches”
  • Adenitis
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12
Q

Usual location of erysipelas

A

Legs > face

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13
Q

Erysipelas treatment

A

Penicillin G

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14
Q

Skin layers involved in skin abscess

A
  • Epidermis
  • Dermis
  • Occasionally deeper structures
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15
Q

Usual cause of skin abscess

A

S. aureus

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16
Q

Treatment for skin abscess

A

I+D; antibiotics reseved for those with an associated cellulitis

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17
Q

4 antibiotics for mild cellulitis

A
  • TMP/SMX DS (160/800 mg) 1 - 2 tablets bid plus cephalexin 500 mg qid
  • Clindamycin 300 mg qid
  • Minocycline 100 mg bid (first dose 200 mg)
  • Doxycycline 100 mg bid
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18
Q

Define felon

A

Hand infection wherein distal pulp space of finer is compartmentalized by fibrous septa and infection arises from direct innoculation wtih bacteria (puncture wound; less commonly hematogenous spread)

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19
Q

Clinical manifestation of felon

A

Intensely painful throbbing pulp space

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20
Q

Potential complciation of felon

A

Pressure can lead to necrosis with spread to tendons, ligaments and bone

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21
Q

Treatment for felon

A
  • I+D
  • Antibiotics against common strep and staph species
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22
Q

Define paronychia

A

Infection of skin over the mantle of the nail or of the lateral nail fold

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23
Q

Clinical manifestation and potential complication of paronychia

A

Swollen, tender, with progression to felon is untreated

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24
Q

Treatment for paronychia

A
  • I+D
  • +/- removal of the nail
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25
Q

Define tenosynovitis

A

Hund infection due to a penetrating injury to volar surface involving tendom sheath

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26
Q

4 Kanavel’s signs

A
  • Finger held in mild flexion
  • Fusiform swelling
  • Tender along tendon sheath
  • Pain with passive extension
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27
Q

4 complications of tenosynovitis

A
  • Tendon necrosis
  • Tendon sheath disruption
  • Contracture
  • Proximal extension
28
Q

Treatment for tenosynovitis

A
  • Antibiotics
  • Surgical debridement
29
Q

Organisms that can lead to infection due to a human bite

A

Aerobic and anaerobic

30
Q

Treatment for human bite

A
  • Antibiotics
  • Possible debridement
  • DO NOT close punture site due to high risk of infection
31
Q

3 antibiotics for outpatient therapy for dog, cat and human bites

A
  • Amoxicillin/clavulanate 875/125 mg bid
  • Moxifloxacin 400 mg daily
  • Clindamycin 300 mg qid plus Ciprofloxacin 500 mg bid
32
Q

2 antibiotics for dog, cat, and human bite inpatient parenteral therapy

A
  • Ampicillin/sulbactam 1.5 g - 3 g IV q 6 h
  • Moxifloxacin 400 mg IV qd
33
Q

Define diabetic foot

A

Glove and stocking neuropathy with compromised vascular supply +/- microvascular disease

34
Q

Progression of diabetic foot

A

Cellulitis to chronic osteomyelitis

35
Q

Why is diabetic foot difficult to treat?

A

Poor microcirculation

36
Q

Treatment for diabetic foot

A
  • Antibiotics, debridement +/- amputation
  • Revascularization
37
Q

3 organisms responsible for diabetic foot infection

A
  • GAS
  • S. aureus
  • Pseudomonas (deep)
38
Q

Inpatient parenteral antibiotics for moderate-to-severe cellulitis or abscess (2)

A
  • Clindamycin 600 mg - 900 mg IV q 8 h
    • Monotherapy only for moderate
  • Vancomycin 1 g IV q 12 h +/- cefazolin 1 g IV q 6 h
    • May replace cefazolin with nafcillin or oxacillin 1 g-2 g every 4 h
    • Addition of beta-lactam may provide enhanced activity against MSSA or strep (pref. if S. aureus)
39
Q

2 outpatient antibiotic therapies for diabetic foot infection

A
  • Clindamycin 300 mg qid plus Ciprofloxacin 500 mg bid
  • Amoxicillin/clavulanate 875/125 mg bid +/- TMP/SMX DS (160/800 mg) 1 - 2 tablets bid
40
Q

3 inpatient parenteral antibiotics for diabetic foot infection

A
  • Ceftriaxone 1 g IV q 24 h + metronidazole 500 mg IV q 6 - 8 h +/- Vancomycin 1 g IV q 12 h
  • Ertapenem 1 g IV q 24 h +/- vancomycin 1 g IV q 12 h
  • Tigecycline 50 mg IV q 12 h (first dose 100 mg IV)
41
Q

4 necrotizing infections

A
  • Clostridial infections
  • Necrotizing fasciitis
  • Bacterial synergistic gangrene
  • Streptococcal gangrene
42
Q

Bacteriology of NI’s (5 organisms)

A
  • Rarely single organism (except GAS)
    • B-hemolytic strep
    • Anaerobic GPC
    • Aerobic GNR
    • Bacteroides
  • NOTE: Synergy between aerobic and anaerobic organisms for the necrosis of skin, soft tissue and fascia
43
Q

How to diagnose NI’s (6)

A
  • Often lack any diagnostic external signs of necrotizing infection (maybe cellulitis or small ulcer)
  • Gold standard = tissue biopsy (frozen section, gram stain)
  • Plain radiographs
  • CT scan
  • MRI
  • Surgical debridement
44
Q

Most frequent spontaneous site of NI

A

Perineum

45
Q

Most frequent site overall for NI

A

Limbs (due to wound, puncture, injury)

46
Q

7 predisposing events that put one at risk for NI

A
  • Minor trauma
  • Insect bites
  • IVDU
  • Drug reactions
  • Perirectal abscesses
  • Major trauma
  • Surgical procedures
47
Q

8 associated conditions to NI

A
  • DM
  • Cancer
  • Immune suppression
  • Renal insufficiency
  • Older age
  • Malnutrition
  • Obesity
  • Arteriosclerosis
48
Q

Define bacterial synergistic gangrene

A
  • Rare form of gangrene affecting trunk and limbs (Meleney’s ulcer).
  • Slow infection affecting skin and soft tissues but not fascia
49
Q

3 organisms responsible for bacterial synergistic gangrene

A
  • Streptococci
  • S. aureus
  • GNR
50
Q

Treatment for bacterial synergistic gangrene

A
  • Antibiotics
  • Radical debridement
51
Q

Define necrotizing fasciitis

A

Aggressive necrotizing infection involving the skin, soft tissue and fascia but not the muscle

52
Q

3 symptoms associated with necrotizing fasciitis

A
  • Hypotension
  • Fever
  • Decreased level of consciousness
53
Q

3 supportive treatments for necrotizing fasciitis

A
  • Resuscitation
  • Antibiotics
  • IVIG
54
Q

3 surgical treatments for necrotizing fasciitis

A
  • Fascial probing
  • Radical debridement
  • Reconstruction
55
Q

6 extracellular products of GAS capable of tissue destruction

A
  • Erythrogenic toxins A, B, and C
  • Streptolysins O and S
  • Streptokinases A and B
  • Ribo and deoxyribonucleases
  • Hyaluronidases, proteinases
  • Exotoxin A “superantigens”
56
Q

3 supportive therapies for GAS infection

A
  • Mechanical ventilation
  • Fluid resuscitation
  • Inotropic medication for hypotension
57
Q

Antibiotic therapy for GAS infection

A

Penicillin

58
Q

Surgical management of GAS infection

A

Wide surgical debridement to normal tissue –> amputation

59
Q

Define clostridial cellulitis

A

Slow progressive infection of the soft tissues sparing the muscle

60
Q

Clinical manifestation of clostridial cellulitis

A
  • Crepitus (gas) in subcutaneous tissues
  • Foul-smelling exudate
61
Q

2 organisms responsible for clostridial cellulitis

A
  • C. perfringes
  • C. sporogenes
62
Q

Treatment for clostridial cellulitis

A
  • Wide debridement
  • Broad spectrum antibiotics (penicillin-based)
63
Q

Define clostridial myonecrosis

A

Rapidly progressive infection involving dermis, fascia and muscle but sparing epidermis (no inflammation)

64
Q

Clinical manifestation of clostridial myonecrosis

A
  • “Mousy smell”
  • Bronzing of skin
65
Q

Treatment for clostridial myonecrosis

A
  • Rapid debridement often requiring amputation
  • Penicillin G = mainstay of treatment
66
Q

2 antimicrobial treatment regimens for necrotizing soft tissue infections

A
  • Vancomycin 1 g IV q 1 h + Clindamycin 900 mg IV q 8 h + Pip/tazo 3.375 g IV q 6 h
    • Can replace vancomysin with daptomycin
    • Can replace pip/tazo with imipenem or meropenem
  • Linezolid 600 mg IV q 12 h + pip/tazo 3.375 g IV q 6 h
67
Q

9 uses for hyperbaric oxygen treatment

A
  • Chronic non-healing wounds
  • Osteomyelitis (bone infections)
  • Thermal burns
  • CO poisoning
  • Smoke inhalation
  • Industrial accidents/crush injuries
  • Necrotizing fasciitis
  • Gas gangrene
  • Decompression sickness/diving accidents

Block G -- Infection (23 decks)

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