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Therapeutics P3 Spring > Exam 3 Lecture 3 > Flashcards

Exam 3 Lecture 3 Flashcards

1
Q

Describe the prevalence of SSTI (skin and soft tissue infections)

A

5.4 million patients have 9.1 million SSTI episodes

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2
Q

What are some risk factors for SSTI

A

Hx of SSTI (most common)
Peripheral artery disease patients
CKD
Diabetes mellitus
IV drug use

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3
Q

What are some complications that SSTI could lead to

A

Ulcers
Bacteremia
Endocarditis
Osteomyelitis
Sepsis

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4
Q

What are the 3 different types of SSTIs

A

Non purulent
Purulent
Necrotizing fascilitis

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5
Q

What are the non-purulent SSTIs? what does it mean? WHat does it affect?

A

Cellulitis and erysipelas
Superficial infection infecting only epidermis

NO PUS

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6
Q

patient presentation of non purulent SSTIs

A
  • tender, erythema, swelling, warm to touch, unilateral

-orange peel like skin

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7
Q

What cultures are considered/recommended for diagnosis of non purulent SSTIs

A

skin/blood cultures not routinely done
Blood cultures CONSIDERED if: Immunocompromised, animal bites

Blood cultures RECOMMENDED if, severe infection or immunocompromised

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8
Q

What imaging is used for diagnosis of non purulent SSTIs

A

CT/MR imaging to rule out necrotizing fascilitis or presence of abscess

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9
Q

Describe the classification of non purulent SSTIs (EXAM)

A

Mild- no systemic signs of infection
Moderate- Systemic signs of infection
Severe- Meets SIRS criteria

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10
Q

What are the SIRS criteria that make non purulent SSTIs severe

A

Temp>38 or <36
HR>90
RR>24
WBC> 12K or < 4K

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11
Q

What are causative pathogens for non purulent SSTIs? Most common?

A

Strep spp
S.pyogenes most common

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12
Q

What are certain situations in non purulent SSTIs that worry us about MRSA (when would we add on MRSA coverage)

A
  • penetrating trauma
  • Evidence of MRSA elsewhere
  • Nasal colonization with MRSA
  • IVDU (IV drug use)
    -SIRS/Severe infection (2/4 met)
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13
Q

What do we use to treat mild non purulent SSTIs

A

Oral antibiotics
-Pen VK
-Cephalosporin
- Clindamycin

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14
Q

WHat do we use to manage non purulent SSTIs for moderate infection

A

IV antibiotics
- Penicillin
- Cefytriaxone
-Cefazolin
- Clindamycin

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15
Q

What do we use to manage non purulent SSTIs severe infections

A
  • emergent surgical inspection/debridement
    Empiric antibiotics
  • Vancomycin + Piperacillin/tazobactam

Culture and susceptibility (blood culture)
- Narrow based on culture and sensitivity

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16
Q

duration of treatment of non purulent SSTIs

A

5 days

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17
Q

What are some purulent SSTIs

A

Abscess, furuncles and carbuncles

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18
Q

What are some characteristics of purulent SSTIs

A

Abscess- collection of pus within dermis and deeper skin tissues

Furuncles (boils)- small abscess that forms around hair follicle

Carbuncles-infection involving several adjacent follicles

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19
Q

use of cultures in purulent SSTIs

A

Wound cultures are recommended for all abscess, carbuncles and patients with systemic signs of infection regardless of severity

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20
Q

classofy purulent SSTIs

A

same as non purulent

Mild- no systemic signs of infection
Moderate- systemic signs of infection
Severe- SIRS criteria (temp>38, HR>90, RR>24bpm, WBC>12K)

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21
Q

What are some causative pathogens for Purulent SSTIs

A

MRSA (most common)
MSSA
Strep spp

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22
Q

How to manage mild purulent SSTIs

A

Incision and drainage to clean out pus (no antibiotics)

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23
Q

How to manage moderate purulent SSTIs

A

Incision and drainage + Culture and susceptibility

Empiric antibiotics
- TMP/SMX
-Doxycycline

Targeted antibiotics
MRSA- TMP/SMX, Doxycycline
MSSA- Dicloxacin or cephalexin

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24
Q

How to manage severe purulent SSTIs

A

Incision and drainage + Culture and susceptibility

EMpiric antibiotics
- IV antibiotics like vancomycin, daptomycin, linezolid

Targetted antibiotics
MRSA- see empiric therapy
MSSA- Nafcillin, cefazolin, clindamycin

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25
Q

Describe nexrotizing fascilitis

A

MEDICAL EMERGENCY
associated with high morbidity and mortality

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26
Q

presentation of necrotizing fascilitis

A

Profound systemic toxicity
Change in color of skin of maroon/purple/black, edema severe pain

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27
Q

Use of cultures in necrotizing fascilitis

A

Blood cultures are recommended given severe infection
Wound cultures likely obtained from surgery

28
Q

Use of imaging in necrotizing fasciitis

A

CT/MR imaging done to confirm necrotizing fasciilitis or presence of abscess

29
Q

Causative opthogens for necrotizing fasciitis

A

Number 1 cause- strep species, specifically s. Pyogenes

  1. Anaerobes
  2. staph aureus
30
Q

What does the management of necrotizing fascilitis look like

A

Emergent surgical
Inspection/debridement

Empiric antibiotics
-Vanc + Piperacillin/tazobactam

Culture and susceptibility

Targeted antibiotics
S. pyogenes- PCN + clindamycin

Polymicrobial
Vanc + Piperacillin/tazobactam

31
Q

After culture and susceptibility testing of necrotizing fascilitis, what do we use to target S. pyogenes?

A

PCN (penicillin) + Clindamycin

32
Q

After culture and susceptibility testing of necrotizing fascilitis, what do we use to target polymicrobial infection

A

Vamcomycin + Piperacillin/tazobactam

33
Q

What are some other SSTIs not covered under purulent, non purulent or necrotizing fasciitis

A

Impetigi and animal/human bites

34
Q

What are some characteristics of impetigo? Patient presentation?

A

Highly contagious superficial skin infection caused by abrasion

Small, painless, fluid filled vesicles that can lead to thick golden crusts. systemic signs of infection are rare

35
Q

How to treat impetigo with few lesions

A

Mupirocin topical X 5 days

36
Q

How to treat impetigo with many lesions/outbreak

A

Dicloxacillin or cephalexin

37
Q

How to treat impetigo with streptococcus only

A

Penicillin

38
Q

How to treat impetigo with B lactam allergy or founf to have MRSA

A

Doxyxyxline
Clindamycin
TMP/SMX

39
Q

Patient presentation in human/anima bites? Culture use?

A

Cat bites- deep, sharp puncture wound
Dog/human- Cellulitis signs and symptoms

Blood cultures are recommended in animal bites

40
Q

how do we treat an established infection after an animal/human bite. (redness, looks infected)

A

Augmentin (amox clav)

41
Q

When would we use pre emptive therapy for animal/human bite

A

Immunocompromised
Asplenia
Moderate to severe bites
Bites on face/hand
Bites that penetrate joints

42
Q

What is the duration for treatment of established infection? Preemptive infection?

A

X7-14 days for established

3-5 days for preemptive treatment

43
Q

What do we use for established infection due to animal/human bite if we can not use amox/clav

A

2nd/3rd gen cephalosporin + Anaerobic coverage

44
Q

What do we use for Animal/uman bites if B lactam allergy

A

Cipro/levo + anaerobic coverage OR moxi

45
Q

Risk factors for diabetic foot infections

A

Neuropathy
Angiopathy/ischemia
Immunologic defects
Poor wound healing

46
Q

patient presentation for diabetic foot infections

A

Typical local signs of infection +/- purulent secretions, foul odor

47
Q

For diabetic foot infections, how are wound cultures, bone cultures and blood cultures handled

A

Wound- Not recommended for mild infection
Bone cultures- typically obtained following I and D
Blood culture- may be considered

48
Q

For infected ulcers of diabetic foot infections, what are common pathogens

A

S. aureus
Streptococci spp

49
Q

For chronic infected ulcers of diabetic foot infection, what are common pathogens

A

S. aureus
streptococci spp
Enterobacterales spp
Anaerobes

50
Q

What are macerated ulcer due to soaking common pathogens

A

P. aeruginosa
S. aureus. Streptococci spp

51
Q

Risk factors in diabetic foot infection for MRSA

A

Previous MRSA infection within past uear
Local MRSA prevalence > 30-50%
Recent hospitalization
Failed non-MRSA antibiotics

52
Q

Risk factors for diabetics foot infection for pseudomonas

A
  • history of psedomonas infection
  • Soaking feet in water
  • Warm climate
    -Severe infection
  • failed non psuudomonas antibiotics
53
Q

FOr exam, if question says indianapolis ED, we always ADD MRSA coverage

54
Q

Overall management for diabetic foot infection

A

Surgical intervention
Glycemic control
Antibiotics

55
Q

What are bugs that we need to cover for mild diabetic foot infections

A

MSSA, streptococci spp

56
Q

First line treatment for mild diabetic foot infections. Duration.

A

Dicloxacillin, cephalexin, clindamycin.

1-2 weeks

57
Q

What to use in mild diabetic foot infections if patient was on recent antibiotics

A

Amox/clav
Levofloxacin or moxifloxacin

58
Q

What to use in mild diabetic foot infections if MRSA risk factors are present

A

Switch to sulfamethoxazole/trimethoprim
Doxycycline

59
Q

For moderate diabetic foot infections, what organisms need to be covered

A

MSSA, strep spp, enterobacteriaceae, anaerobes

60
Q

What are 1st line therapies for moderate diabetic foot infections? Duration

A

Moxifloxacin, amoxicillin/clavulanate, cipro/levo + clindamycin or metronidazole

2-3 wks

61
Q

For moderate diabetic foot infections with pseudomonal risk factors what should we switch to

A

Cipro/levo + clindamycin or metronidazole

62
Q

For moderate diabetic foot infections with MRSA risk factors, what agents should we add

A

Doxycycline, linezolid, vancomycin, TMT/SMX

63
Q

For severe diabetic foot infections, what organisms do we need to cover

A

MSSA, streptococci spp, enterobacteriaceae, anaerobes pseudomonas

64
Q

What is 1st line for severe diabetic foot infection? Duration?

A

Piperacillin/tazobactam, carbapenem, cefepine + Clindamycin or metronidazole

2-3 wks

65
Q

MRSA drugs for severe diabetic foot infections

A

Add vancomycin, lineolid, daptomycin

Therapeutics P3 Spring (24 decks)

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