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PHRM 865 > E3 SSTI + DFI > Flashcards

E3 SSTI + DFI Flashcards

skin and soft tissue + diabetic foot infections

1
Q

5 risk factors for SSTI
and most common one

A
  • hx of SSTI *
  • PAD
  • IV drug use
  • CKD
  • DM
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2
Q

what are the 3 types of SSTIs

A
  • non-purulent
  • purulent
  • necrotizing fasciitis
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3
Q

patient presentation non-purulent SSTi

A
  • tender, erythema, swelling, warm to touch
  • orange peel like skin *
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4
Q

when are blood cultures recommended for non-purulent SSTIs (3)

A

immunocompromised, severe infection, animal bites

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5
Q

T or F:
most non-purulent SSTIs appear bilaterally

A

no

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6
Q

imaging for non-purulent SSTIs

A

CT/MRI -> mostly reserved for pts not improving on tx

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7
Q

mild classification criteria for non-purulent SSTIs

A

NO systemic signs of infection

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8
Q

moderate classification criteria for non-purulent SSTIs

A

systemic signs of infection

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9
Q

severe classification criteria for non-purulent SSTIs

A

meets SIRS criteria**
- temp >38 or < 36
- HR >90
- RR >24
- WBC > 12K or <4K

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10
Q

2 causative pathogens for non-purulent SSTIs

A

streptococcus spp. (mostly pyogenes)
MRSA

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11
Q

Causative pathogens for non-purulent SSTIs:
MRSA if:
(6 things)

A
  • penetrating trauma
  • evidence of MRSA elsewhere
  • nasal colonization with MRSA
  • IVDU
  • SIRS/ severe infection
  • failed non-MRSA antibiotic regimen
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12
Q

duration of treatment regardless of classification for non-purulent SSTIs

A

5 days*

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13
Q

4 drug options for tx of mild non-purulent SSTI

A
  • pen VK
  • Cephalosporin
  • diclox (not on market ig)
  • clinda
    ALL ORAL
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14
Q

4 tx options for tx of moderate non-purulent SSTI

A

pen
ceftriaxone
cefazolin
clinda
ALL IV

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15
Q

drug choice for severe non-purulent SSTI

A

emergent surgical inspection first THEN
vanc + piper/tazo***

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16
Q

Cellulitis and Erysipelas
A. non-purulent SSTI
B. purulent SSTI
C. necrotizing fasciitis

A

A

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17
Q

Abscesses, furuncles, carbuncles (pus)
A. non-purulent SSTI
B. purulent SSTI
C. necrotizing fasciitis

A

B

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18
Q

purple/black skin, crepitus, edema
A. non-purulent SSTI
B. purulent SSTI
C. necrotizing fasciitis

A

C

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19
Q

small abscess at formation of hair follicle
A. furuncle
B. carbuncle

A

A

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20
Q

infection involving several adjacent follicles
A. furuncle
B. carbuncle

A

B

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21
Q

patient pres for purulent SSTIs

A
  • tender, red nodules, erythema, warm to touch
  • systemic signs of infection
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22
Q

culture uses for purulent SSTIs

A

rec in all patients regardless of severity

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23
Q

imaging for purulent SSTIs

A

CT/MRI

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24
Q

classification of purulent SSTIs

A

exact same as non-purulent -> not making more cards

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25
3 main causative pathogens for purulent SSTIs
MRSA MSSA strep spp
26
first line in managing any form of SSTI
incision and drainage
27
does not require culture A. purulent SSTIs B. non-purulent SSTIs C. necrotizing fasciitis
B
28
2 empiric antibiotics for moderate purulent SSTIs
bactrim doxy
29
two targeted antibiotics for MRSA in purulent SSTIs
bactrim doxy
30
2 targeted antibiotics for MSSA in purulent SSTIs
diclox (not on market still) cephalexin*
31
3 empiric antibiotics for severe purulent SSTIs
vanco dapto linezolid
32
targeted antibiotics for MSSA in severe purulent SSTI (3)
Naf or Cefazolin or Clindamycin
33
2 things under pt pres for necrotizing fasciitis
- profound systemic tox - change in color of skin to maroon/purple/black, crepitus, edema, severe pain
34
cultures for necrotizing fasciitis ?
- blood cultures recommended - wound cultures likely obtained
35
imaging for necrotizing fasciitis
CT/MRI duh
36
pearl for imaging in necrotizing fasciitis
if you see anything that says GAS think of necrotizing fasciitis !!!
37
#1 causative pathogen for necrotizing fasciitis
streptococcus spp (mostly pyogenes)
38
highlighted causative pathogens for necrotizing fasciitis
- strep spp - vibrio vulnificus - peptostreptococcus spp - aeromonas hydrophila - clostridium perfringens
39
empiric biotics for necrotizing fasciitis
Vanc + piper/tazo **
40
targeted antibiotics for S. pyogenes in necrotizing fasciitis
PCN + clindamycin!!
41
targeted antibiotics for polymicrobial infection in necrotizing fasciitis
Vanc + piper/tazo (same as normal empiric)
42
2 reasons we would use clindamycin in necrotizing fasciitis
- inhibits streptococcal toxin production - inoculum effect (maintains efficacy regardless of the amount of bacteria present unlike beta lactams)
43
2 features for impetigo
- highly contagious superficial skin infxn caused by skin abrasions - common in children and in hot/humid weather
44
pt pres for impetigo
- small, painless, fluid filled vesicles that can lead to thick golden crusts - systemic signs of infection are rare
45
cultures for impetigo?
recommended from pus/exudates but NOT required
46
Management of impetigo if few lesions
topical mupirocin for 5 days
47
management for impetigo w/ many lesions/outbreak duration for any tx option
oral and 7 days
48
management of impetigo with many lesions/outbreak (2)
diclox or cephalexin
49
management of impetigo with many lesions/outbreak IF streptococcus ONLY
Drug of choice: PCN
50
management of impetigo with many lesions/outbreak IF allergies/MRSA (3)
doxy clinda bactrim
51
cultures for animal bites?
blood cultures recommended
52
DOC for animal bites
augmentin
53
situations under preemptive for animal bites (5)
- immunocompromised - asplenia - mod/sev bites - bites on face/hand - bites that penetrate joints
54
alternative tx options for animal bites
- 2nd/3rd gen cephs + anaerobic coverage
55
tx of animal bites if B-lactam allergy
- cipro/levo + anaerobic coverage or moxi
56
vaccines for animal bites?
tdap maybe rabies
57
how long is the duration of preemptive tx for animal bites
3-5 days
58
4 risk factors for DFI
- neuropathy - angiopathy/ischemia - immunologic defects - poor wound healing
59
cultures for DFI? wound cultures? bone cultures? blood cultures?
wound: not rec for mild infection bone: typically obtained after I&D blood: may be considered
60
2 common causative pathogens for each type of DFI ulcer
s. aureus streptococci spp
61
2 additional bacteria for chronic infected ulcers
enterobactere anaerobes
62
1 special bacteria for ulcers due to soaking in DFI
pseudomonas*** (water bug)
63
4 risk factors for MRSA in DFI
- previous MRSA infxn in last year - local MRSA prevalence >30-50% - recent hospitalization - failed non-MRSA antibiotics
64
4 risk factors for pseudomonas in DFI
- hx of pseudo infxn - soaking feet in water* - warm climate - severe infxn - failed non-pseudo antibiotics
65
she said something about what to do if a pt presents to ED in indianapolis for DFI, what was it?
add MRSA coverage
66
first line for mild DFI (3)
diclox cephalexin clindamycin
67
duration of tx for mild DFI
1-2 weeks
68
treatment for mild DFI if pt has had recent antibiotics (3)
SWITCH to augmentin, levo, or moxi
69
treatment for mild DFI if MRSA risk factors (2)
SWITCH to bactrim, doxy
70
first line for moderate DFI
moxi, augmentin, cipro/levo + clinda or metro *
71
duration of therapy for mod DFI
2-3 weeks
72
treatment for mod DFI if pseudo risk factors
SWITCH to cipro/levo +clinda or metro (isnt that the same as first line?)
73
treatment for mod DFI if MRSA risk factors
ADD: doxy, linezolid, vanc, or bactrim
74
first line tx in severe DFI
piper/tazo, carbapenem, cefepime + clinda or metro*
75
duration of tx for severe DFI
2-3 weeks
76
treatment of severe DFI fi MRSA risk factors
ADD: vanc, linezolid, or dapto? weird

PHRM 865 (40 decks)

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