Exam 2 Flashcards
What’s good and not good for an antibiogram?
Anything 80% or higher is good
Anything 50% and below is not good
Bactericidal vs Bacteriostatic
Bactericidal kills all bacteria
Bacteriostatic prevents bacteria growth (doesn’t kill existing bacteria)
What antibiotics can you use for MSSA and MSSE (3)?
Nafcillin, Dicloxacillin, Cephalexin
What antibiotics can you use for MRSA and MRSE (6)?
Vancomycin, Daptomycin, Linezolid, Clindamycin, Ceftaroline, TMP/SM (Bactrim)
What is therapeutic balancing?
To maximize efficacy (increase bacterial killing and improve patient outcomes) and minimize toxicity and resistance
What are purulent SSTIs mainly caused by?
S. aureus
What are the different classifications of purulent SSTIs?
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
Would you do gram staining and culturing for purulent SSTIs?
Only in severe infection
How would you treat purulent SSTIs?
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
What antibiotic is used first line for severe purulent infections?
Vancomycin IV 15 mg/kg q12h
- Monitor trough level if used > 3 - 5 days (goal = 10 - 15 mcg/ml)
What are non-purulent infections mainly caused by?
Streptococcus species (a small subset is caused by S. aureus)
What are the different classifications of non-purulent infections?
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
How would you treat non-purulent SSTIs?
Antibiotics
What qualifies a person to have systemic signs of infection (SIRS)?
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
How would you treat mild purulent SSTI?
I&D
How would you treat moderate purulent SSTI?
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)
How would you treat severe purulent SSTI?
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)
How would you treat mild non-purulent SSTI?
Oral antibiotics (penicillin VK, cephalosporin, dicloxacillin, or clindamycin) for 5 days
How would you treat moderate non-purulent SSTI?
IV antibiotics (penicillin, ceftriaxone, cefazolin, or clindamycin) for 10 - 14 days
How would you treat severe non-purulent SSTI?
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)
