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Therapeutics P3 Semester 2 > Exam 3 - Lecture 4 (SSTI/DFI) > Flashcards

Exam 3 - Lecture 4 (SSTI/DFI) Flashcards

1
Q

risk factors for SSTI/DFI

A

hx of ssti
PAD
CKD
DM
IV drug use

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2
Q

complications due to ssti/dfi

A

ulcers
bacteremia
endocarditis
osteomyelitis
sepsis

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3
Q

3 types of ssti

A

non purulent
purulent
necrotizing fasciitis

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4
Q

most common organisms for ssti

A

staph
strep

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5
Q

non purulent SSTIs are also called

A

cellulitis
erysipelas

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6
Q

characteristic non-purulent

A

no pus
-orange peel like skin may occur

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7
Q

in non-purulent, are cultures taken?

A

no, not routinely

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8
Q

classifications of non purulent SSTIs

A

mild: NO systemic signs
moderate: systemic signs present
severe: meets SIRS criteria
-temp: >38 or <36
-HR >90
-RR>20
-WBC >12k or <4k

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9
Q

causative pathogens for non-purulent SSTIs

A

strep
-pyogenes most common (must cover empirically)
-cover MRSA if risk factors exist:
1. penetrating trauma
2. evidence of MRSA elsewhere
3. nasal colonization with MRSA
4. IVDU
5. SIRS/severe infection
6. failed non-MRSA abx regimen

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10
Q

tx duration of non-purulent SSTI abx therapy

A

5 days

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11
Q

mild non-purulent SSTI abx tx options

A

PO only
-pen VK or
-cephalosporin or
-clindamycin

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12
Q

moderate non-purulent SSTI abx tx options

A

IV abx needed
-penicillin or
-ceftriaxone or
-cefazolin or
-clindamycin

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13
Q

severe non-purulent SSTI abx tx options

A

emergent surgical inspection/debridement

empiric abx:
-vanco PLUS zosyn

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14
Q

purulent SSTIs other names

A

abscesses
furuncles
carbuncles

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15
Q

purulent SSTI characteristics

A

pus

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16
Q

abscess

A

collection of pus within the dermis and deeper skin tissues (deeper than non-purulent)

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17
Q

furuncle (boil)

A

small abscess that forms in the hair follicle (systemic s/sx seen much less with these)

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18
Q

carbuncle

A

infection involving several adjacent follicles (systemic s/sx can be seen)

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19
Q

are wound cultures recommended for purulent SSTIs

A

yes, for all abscesses, carbuncles and pts showing systemic signs of infection

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20
Q

classifications of purulent SSTIs

A

mild: NO systemic signs
moderate: systemic signs present
severe: meets SIRS criteria
-temp: >38 or <36
-HR >90
-RR>20
-WBC >12k or <4k

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21
Q

purulent SSTI causative agents

A

MRSA (must cover with empiric abx)
MSSA
Streptococcus spp.

22
Q

purulent SSTI tx duration

23
Q

purulent SSTI tx done regardless of severity

A

I&D
-incision and drainage

24
Q

mild purulent SSTI tx

25
moderate purulent SSTI tx
I&D empiric: -bactrim or -doxycycline targeted: -MRSA: --bactrim and --doxycycline -MSSA: --dicloxacillin or -cephalexin
26
severe purulent SSTI tx
I&D empiric: -vanco or -dapto or -linezolid targeted: -MRSA --same as empiric -MSSA --Nafcillin or --cefazolin or --clindamycin
27
necrotizing fasciitis is classified as what?
medical emergency, is technically a severe, non-purulent SSTI
28
necrotizing fasciitis characteristics
-profound systemic toxicity -change in skin color to black/purple
29
are cultures recommended in necrotizing fasciitis
yes blood cultures are always recommended given severe infection -surgery equally important as Abx in this case
30
necrotizing fasciitis causative agents
if monomicrobial: -streptococcus spp. -CA MRSA if polymicrobial: -peptostreptococcus spp. -clostridium perfringens if somewhere in the middle: -vibrio vulnificus -aeromonas hydrophila
31
necrotizing fasciitis tx options (always treat as severe non purulent, Abx differ tho)
emergent surgical debridement + broad spectrum Abx targeted Abx: -strep pyogenes --PCN PLUS clindamycin -polymicrobial --vanco PLUS zosyn
32
necrotizing fasciitis tx duration
NO SET TIME 1. further debridement not necessary 2. pts clinical improvement 3. fever has been absent 48-72 hr
33
reason for clindamycin in necrotizing fasciitis
-inhibits streptococcal toxin production -inoculum effect: diagram of clindamycin clearing path for PCN
34
impetigo characteristics
highly contagious superficial skin infection caused by skin abrasions -'thick golden crusts' -cultures from pus/exudates are recommended but not required
35
impetigo tx plan for few lesions
topical mupirocin for 5 days
36
impetigo tx plan for many lesions/outbreaks
oral abx for 7 days options: -dicloxacillin or cephalexin -streptococcus only: PCN -allergies/MRSA: doxycycline, clindamycin, bactrim
37
are blood cultures recommended in animal bites?
yes
38
animal upper respiratory and mouth flora often include _______
anaerobes, need to cover with abx
39
animal/human bites tx plan w/ DOC
established infection x 7-14 days OR preemptive x 3-5 days treat same way: DOC: Augmentin (DAWGmentin)
40
animal/human bites tx plan alternatives if can't use DOC
ALTERNATIVE: 2/3rd gen cephalosporin + anaerobic coverage BETA-LACTAM allergy: cipro/levo + anaerobic coverage OR moxifloxacin VACCINES: tdap if due +/- rabies
41
risk factors for DFI
neuropathy angiopathy/ischemia immunologic defects poor wound healing
42
DFI ulcer characteristics causative agents - infected ulcer
staph. aureus streptococci spp.
43
DFI ulcer characteristics causative agents - chronic infected ulcers
staph. aureus streptococci spp. enterobacteriaceae spp. anaerobes
44
DFI ulcer characteristics causative agents -macerated ulcer due to soaking
staph. aureus streptococci spp. Pseudomonas aeruginosa
45
DFI ulcer characteristics causative agents - chronic non-healing ulcers
staph. aureus streptococci spp. enterococcus spp. Pseudomonas aeruginosa anaerobes
46
when to add MRSA coverage in DFI
-if pt in major hospital ED in INDY -previous MRSA infection last year -recent hospitalization -failed non-MRSA abx
47
when to add pseudomonas coverage in DFI
-hx of pseudomonas infection -soaking feet in water -warm climate -severe infection -failed non-pseudomonal abx
48
mild DFI tx options
MUST COVER: MSSA and streptococci DURATION: 1-2 weeks 1st line: dicloxacillin, cephalexin, clindamycin
49
mild DFI tx alternative options
recent abx? switch to: -augmentin or -levo or -moxi MRSA risk factors? switch to: -bactrim -doxycycline
50

Therapeutics P3 Semester 2 (17 decks)

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