Exam 2

Question 1

What’s good and not good for an antibiogram?

Answer 1

Anything 80% or higher is good
Anything 50% and below is not good

Question 2

Bactericidal vs Bacteriostatic

Answer 2

Bactericidal kills all bacteria
Bacteriostatic prevents bacteria growth (doesn’t kill existing bacteria)

Question 3

What antibiotics can you use for MSSA and MSSE (3)?

Answer 3

Nafcillin, Dicloxacillin, Cephalexin

Question 4

What antibiotics can you use for MRSA and MRSE (6)?

Answer 4

Vancomycin, Daptomycin, Linezolid, Clindamycin, Ceftaroline, TMP/SM (Bactrim)

Question 5

What is therapeutic balancing?

Answer 5

To maximize efficacy (increase bacterial killing and improve patient outcomes) and minimize toxicity and resistance

Question 6

What are purulent SSTIs mainly caused by?

Answer 6

S. aureus

Question 7

What are the different classifications of purulent SSTIs?

Answer 7

Mild = infection without systemic signs of infection
Moderate = infection with systemic signs of infection
Severe = patients who fail I&D and oral antibiotics and are septic

Question 8

Would you do gram staining and culturing for purulent SSTIs?

Answer 8

Only in severe infection

Question 9

How would you treat purulent SSTIs?

Answer 9

I&D done for all cases (gram staining and culturing is recommended if I&D performed except for cysts)

Use antibiotics for 5 - 10 days if patient has systemic signs of infection, immunocompromised, has multiple abscesses, or doesn’t respond to I&D

Question 10

What antibiotic is used first line for severe purulent infections?

Answer 10

Vancomycin IV 15 mg/kg q12h
- Monitor trough level if used > 3 - 5 days (goal = 10 - 15 mcg/ml)

Question 11

What are non-purulent infections mainly caused by?

Answer 11

Streptococcus species (a small subset is caused by S. aureus)

Question 12

What are the different classifications of non-purulent infections?

Answer 12

Mild = infection without systemic signs of infection
Moderate = infection with systemic signs of infection
Severe = deep tissue involvement/penetrating trauma, failed prior treatment, septic, immunocompromised

Question 13

How would you treat non-purulent SSTIs?

Answer 13

Antibiotics

Question 14

What qualifies a person to have systemic signs of infection (SIRS)?

Answer 14

Has at least 2 of the following:
- Temp > 38 or < 36 C
- RR > 24 breaths/min
- HR > 90 bpm
- WBC > 12,000 or < 4,000

Question 15

How would you treat mild purulent SSTI?

Answer 15

I&D

Question 16

How would you treat moderate purulent SSTI?

Answer 16

1) I&D and C&S
2) Empiric antibiotics (TMP/SMX or doxycycline)
3) Defined antibiotics (if MRSA use TMP/SMX, if MSSA use dicloxacillin or cephalexin)

Question 17

How would you treat severe purulent SSTI?

Answer 17

1) I&D and C&S
2) Empiric antibiotics (vancomycin, daptomycin, linezolid, telavancin, or ceftaroline)
3) Defined antibiotics (if MRSA use empiric agents, if MSSA use nafcillin, cefazolin, or clindamycin)

Question 18

How would you treat mild non-purulent SSTI?

Answer 18

Oral antibiotics (penicillin VK, cephalosporin, dicloxacillin, or clindamycin) for 5 days

Question 19

How would you treat moderate non-purulent SSTI?

Answer 19

IV antibiotics (penicillin, ceftriaxone, cefazolin, or clindamycin) for 10 - 14 days

Question 20

How would you treat severe non-purulent SSTI?

Answer 20

1) Surgical inspection/debridement
2) Empiric antibiotics (vancomycin + piperacillin/tazobactam)
3) C&S
4) Defined antibiotics (if monomicrobial use penicillin + clindamycin, doxycycline + ceftazidime, or doxycycline + ciprofloxacin, if polymicrobial use vancomycin + piperacillin/tazobactam)