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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
Q

3 main causative pathogens for purulent SSTIs

A

MRSA
MSSA
strep spp

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26
Q

first line in managing any form of SSTI

A

incision and drainage

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27
Q

does not require culture
A. purulent SSTIs
B. non-purulent SSTIs
C. necrotizing fasciitis

A

B

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28
Q

2 empiric antibiotics for moderate purulent SSTIs

A

bactrim
doxy

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29
Q

two targeted antibiotics for MRSA in purulent SSTIs

A

bactrim
doxy

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30
Q

2 targeted antibiotics for MSSA in purulent SSTIs

A

diclox (not on market still)
cephalexin*

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31
Q

3 empiric antibiotics for severe purulent SSTIs

A

vanco
dapto
linezolid

32
Q

targeted antibiotics for MSSA in severe purulent SSTI (3)

A

Naf or
Cefazolin or
Clindamycin

33
Q

2 things under pt pres for necrotizing fasciitis

A
  • profound systemic tox
  • change in color of skin to maroon/purple/black, crepitus, edema, severe pain
34
Q

cultures for necrotizing fasciitis ?

A
  • blood cultures recommended
  • wound cultures likely obtained
35
Q

imaging for necrotizing fasciitis

A

CT/MRI duh

36
Q

pearl for imaging in necrotizing fasciitis

A

if you see anything that says GAS think of necrotizing fasciitis !!!

37
Q

1 causative pathogen for necrotizing fasciitis

A

streptococcus spp (mostly pyogenes)

38
Q

highlighted causative pathogens for necrotizing fasciitis

A
  • strep spp
  • vibrio vulnificus
  • peptostreptococcus spp
  • aeromonas hydrophila
  • clostridium perfringens
39
Q

empiric biotics for necrotizing fasciitis

A

Vanc + piper/tazo **

40
Q

targeted antibiotics for S. pyogenes in necrotizing fasciitis

A

PCN + clindamycin!!

41
Q

targeted antibiotics for polymicrobial infection in necrotizing fasciitis

A

Vanc + piper/tazo (same as normal empiric)

42
Q

2 reasons we would use clindamycin in necrotizing fasciitis

A
  • inhibits streptococcal toxin production
  • inoculum effect (maintains efficacy regardless of the amount of bacteria present unlike beta lactams)
43
Q

2 features for impetigo

A
  • highly contagious superficial skin infxn caused by skin abrasions
  • common in children and in hot/humid weather
44
Q

pt pres for impetigo

A
  • small, painless, fluid filled vesicles that can lead to thick golden crusts
  • systemic signs of infection are rare
45
Q

cultures for impetigo?

A

recommended from pus/exudates but NOT required

46
Q

Management of impetigo if few lesions

A

topical mupirocin for 5 days

47
Q

management for impetigo w/ many lesions/outbreak duration for any tx option

A

oral and 7 days

48
Q

management of impetigo with many lesions/outbreak (2)

A

diclox or cephalexin

49
Q

management of impetigo with many lesions/outbreak IF streptococcus ONLY

A

Drug of choice: PCN

50
Q

management of impetigo with many lesions/outbreak IF allergies/MRSA (3)

A

doxy
clinda
bactrim

51
Q

cultures for animal bites?

A

blood cultures recommended

52
Q

DOC for animal bites

53
Q

situations under preemptive for animal bites (5)

A
  • immunocompromised
  • asplenia
  • mod/sev bites
  • bites on face/hand
  • bites that penetrate joints
54
Q

alternative tx options for animal bites

A
  • 2nd/3rd gen cephs + anaerobic coverage
55
Q

tx of animal bites if B-lactam allergy

A
  • cipro/levo + anaerobic coverage or moxi
56
Q

vaccines for animal bites?

A

tdap
maybe rabies

57
Q

how long is the duration of preemptive tx for animal bites

58
Q

4 risk factors for DFI

A
  • neuropathy
  • angiopathy/ischemia
  • immunologic defects
  • poor wound healing
59
Q

cultures for DFI?
wound cultures?
bone cultures?
blood cultures?

A

wound: not rec for mild infection
bone: typically obtained after I&D
blood: may be considered

60
Q

2 common causative pathogens for each type of DFI ulcer

A

s. aureus
streptococci spp

61
Q

2 additional bacteria for chronic infected ulcers

A

enterobactere
anaerobes

62
Q

1 special bacteria for ulcers due to soaking in DFI

A

pseudomonas*** (water bug)

63
Q

4 risk factors for MRSA in DFI

A
  • previous MRSA infxn in last year
  • local MRSA prevalence >30-50%
  • recent hospitalization
  • failed non-MRSA antibiotics
64
Q

4 risk factors for pseudomonas in DFI

A
  • hx of pseudo infxn
  • soaking feet in water*
  • warm climate
  • severe infxn
  • failed non-pseudo antibiotics
65
Q

she said something about what to do if a pt presents to ED in indianapolis for DFI, what was it?

A

add MRSA coverage

66
Q

first line for mild DFI (3)

A

diclox
cephalexin
clindamycin

67
Q

duration of tx for mild DFI

68
Q

treatment for mild DFI if pt has had recent antibiotics (3)

A

SWITCH to augmentin, levo, or moxi

69
Q

treatment for mild DFI if MRSA risk factors (2)

A

SWITCH to bactrim, doxy

70
Q

first line for moderate DFI

A

moxi, augmentin, cipro/levo + clinda or metro *

71
Q

duration of therapy for mod DFI

72
Q

treatment for mod DFI if pseudo risk factors

A

SWITCH to cipro/levo +clinda or metro (isnt that the same as first line?)

73
Q

treatment for mod DFI if MRSA risk factors

A

ADD:
doxy, linezolid, vanc, or bactrim

74
Q

first line tx in severe DFI

A

piper/tazo, carbapenem, cefepime + clinda or metro*

75
Q

duration of tx for severe DFI

76
Q

treatment of severe DFI fi MRSA risk factors

A

ADD:
vanc, linezolid, or dapto? weird

PHRM 865 (34 decks)

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