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PHRM 865 > Exam 3: Skin and Soft Tissue/Bone and Joint/Endocarditis > Flashcards

Exam 3: Skin and Soft Tissue/Bone and Joint/Endocarditis Flashcards

1
Q

What are most skin and soft tissue infections caused by

A

beta hemolytic strep and/or staph aureus

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2
Q

Mechanisms of defense against SSTIs

A
  1. Skin as physical barrier
  2. Continuous renew of epidermal layer
  3. Low pH
  4. Dry
  5. Normal bacterial flora that inhibit growth of pathogenic bacteria and compete for nutrients
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3
Q

Contents of normal skin flora

A
  1. beta hemolytic strep

2. coagulase negative staph

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4
Q

what is impetigo

A

superficial skin infection involving the epidermis consisting of multiple, coalescing erythematous papules that evolve into pustules or vesicles that rupture and form a dried, honey-colored crust/dischard on an erythematous base

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5
Q

impetigo symptoms

A

maculpapular lesions that rupture leaving superficial erosions that are occasionally prutic or painful with honey-colored-crust –> non-bolus

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6
Q

impetigo pathogenesis

A

organism can directly invade healthy skin (primary) or can be introduced into superficial layers of the skin (epidermis) during trauma or abrasion (secondary); non-bullous form is highly contagious

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7
Q

main at risk group for impetigo

A

children

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8
Q

impetigo bacteriology

A

staph aureus and/or strep pyogenes (group a strep)

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9
Q

impetigo mild treatment

A

topical:

mupirocin 2% or retapamulin 1% bid x5

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10
Q

when to give systemic treatment for impetigo

A

patients with numerous lesions or during outbreaks affecting several people to help decreased transmission

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11
Q

length of systemic impetigo treatment

A

7 days

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12
Q

impetigo antibiotics

A 
docloxacillin
cephalexin
erythromycin
clindamycin
augmentin
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13
Q

dicloxacillin impetigo dosing

A

500 mg q 6

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14
Q

cephalexin impetigo dosing

A

500 mg q 6

25-30 mg/kg/day in 3-4 doses

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15
Q

erythromycin impetigo dosing

A

500 mg q 6

40 mg/kg/day in 3-4 doses

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16
Q

clindamycin impetigo dosing

A

300 mg q 8

20mg/kg/day in 3 doses

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17
Q

augmentin impetigo dosing

A

875mg q 12

25 mg/kg/day bid

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18
Q

what is cellulitis

A

acute, diffuse, spreading infection involving the skin and subcutaneous tissue, with or without fascial involvement

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19
Q

cellulitis symptoms

A

rapidly spreading area of redness, tenderness, warmth, and swelling in the skin with a poorly defined border

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20
Q

cellulitis pathogenesis

A

organism is introduced into the skin during trauma, wounds, athlete’s feet, dry/cracked skin, injection drug use, ulcers, or surgery

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21
Q

how many extremities does cellulitis cover

A

usually on one

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22
Q

what is erysipelas

A

variant of cellulitis caused by beta hemolytic strep involving only the upper dermis and superficial lymphatics with intense erythema and clearly defined borders

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23
Q

erysipelas characteristics

A

peau d’orange (orange peel) appearance due to superficial cutaneous edema surrounding the hair follicles
most often involves the FACE

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24
Q

common causative organisms of MRSA

A

s. pyogenes

s. aureus

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25
CA-MRSA characteristic
cellulitis AND abscess
26
when should CA-MRSA be suspected
in any patient with a skin and soft tissue infection that includes an abscess or drainable focus of infection, or not responding to beta lactams
27
cellulitis diagnostic factorssh
redness, pain, warmth poorly defined border increased WBC
28
cellulitis empiric therapy recommendation
empiric therapy should be directed against BOTH staph aureus and group A strep
29
adult treatment mild /moderate cellulitis
dicloxacillin 250-500 q 6 h or cephalexin 500 q 6 h
30
adult treatment mild /moderate cellulitis if MRSA suscpected
``` bactrim 2bid or clindaycin 300-450 QID or Linezolid 600 BID ```
31
pediatric treatment mild /moderate cellulitis
dicloxacillin 25-50mg/kg/day QID or cephalexin 25-50 mg/kg/day QID
32
pediatric treatment mild /moderate cellulitis if MRSA suspected
``` Bactrim 8-12 mg/kg/day BID or Clindamycin 8-20 mg/kg/day TID or Linezolid 10mg/kg BID ```
33
adult treatment moderate to severe cellulitis
Nafcillin 1-2g q 4-6 or Cefazolin 1-2g q 8
34
adult treatment moderate to severe cellulitis if mrsa suspected
vanc 10-15mg/kg q 12 or linezolid 600 q 12
35
pediatric treatment moderate to severe cellulitis
nafcillin 150-200 mg/kg/day q 4-6 (max 12g/day) or cefazolin 50-100mg/kg/day TID
36
pediatric treatment moderate to severe cellulitis if mrsa suspected
vanc 10-15 mg/kg q 12 | or linezolid 10 mg/lg q 12
37
what is CA-MRSA resistant to
beta lactams
38
treatment duration for cellulitis
5 days
39
what is necrotizing fasciitis
rare, agressive skin/sq infection that also involves the fascia characterized by progressive destruction of fascia, sq fat, and muscle
40
necrotizing fasciitis symptoms
symptoms of cellulitis and intense pain, bullae, crepitus, wooden-hard induration, cutaneous gangrene and systemic toxicity
41
necrotizing fasciitis pathogenesis
same as cellulitis but caused by toxin producing organism(s) that progressively destroys superficial fascia and sq fat
42
necrotizing fasciitis diagnosis
Wooden hard induration, pain out of proportion to PE elevated WBC culture of deep tissue obtained during surgery blood cultures CT or MRI document fascial edema
43
primary treatment of necrotizing fasciitis
surgical intervention and repeat surgical debridement and drainage 1 24-36 hours until infected/necrotic material is no longer present
44
necrotizing fasciitis antibiotic therapy
vanc pip/tazo or meopenem clindamycin
45
what is preferred antibiotic therapy for necrotizing fasciitis and why
clindamycin --> suppresses toxin and cytokine production of strep
46
length of antibiotic therapy for necrotizing fasciitis
Therapy should be administered until further surgical debridement is no longer necessary, the patient has shown clinical improvement, and fever has been absent for 48-72 hours.
47
DFI pathogenesis
caused by the presence of neuropathy, angiopathy with ischemia, dry skin, decreased wound healing, and immune defectes associated with DM
48
are all diabetic foot wounds infected?
No
49
what classifies a DFI
At least 2 of: | erythema, warmth, swelling/induration, tenderness, pain, purulent discharge, systemic signs
50
mild DFI wound classification
< 2cm cellulitis around wound infection only in skin/superficial tissue patient WITHOUT SIRS
51
moderate DFI wound classification
cellutlitis extends >2 cm or involves structures deeper than skin/sq tissue patient WITHOUT SIRS
52
severe DFI wound classification
local infection with signs of SIRS
53
DFI diagnosis
S/s and wound classificatin Increased WBC, ESR, CRP Radiography for osteo
54
overall treatment approach to treat DFI
comprehensive approach --> optimal wound care (debridement, whirlpool, dressing changes), glucose control, restriction of activities (bed rest), antibiotics
55
Mild DFI empiric therapy non MRSA
PO cephalexin PO dicloxacillin PO augmentin
56
Mild DFI empiric therapy MRSA suspected
PO Clindamycin | PO bactrim
57
Moderate DFI empiric therapy
IV cefazolin
58
Moderate DFI enterobacteriacae empiric therapy
IV ceftriaxone
59
Moderate DFI obligate anaerobes empiric therapy
PO metronidazole
60
Severe DFI empiric therapy
``` Vanc PLUS pip/tazo or meropenem or ceftazidime/cefepime with PO metronidazole or levo/cipro with metronidazole ```
61
duration of therapy mild DFI
1 to 2 weeks, may extend up to 4 weeks if slow to resolve
62
duration of therapy moderate DFI
1 to 3 weeks
63
duration of therapy severe DFI
2 to 4 weeks
64
what side of the heart is the tricuspid valve at
right
65
what side of the heart is the mitral valve at
left
66
what is IE
syndrome resulting in colonization or invasion of the endocardium by various types of microorganisms
67
etiologic agents in IE
staph (30-70%) s. aureus | strep (10-28%) viridans
68
valvular endothelium pathophysiology IE
valvular endothelium undergoes trauma causing platelet-fibrin deposition, which allows for adherence and colonization
69
bacterial growth in IE
bacterial growth in vegetation in unimpeded due to lack of host defenses
70
valvular tissue in IE
may lead to acute heart failure via perforation of valve leaflet or rupture of the chordae tendinae or papillary muscle
71
cardinal symptom in IE
heart murmur
72
important laboratory test in IE
blood cultures --> bacteremia is continuous and low grade
73
how long does it take for complete eradication in IE
weeks | min 2 weeks, but can be up to 4-6 weeks
74
surgical intervention IE requirement
- persistent vegetation after systemic embolization - anterior mitral valve leaflet vegetation >10mm - > 1 embolic event during first two weeks of antimicrobial therapy - increased vegetation size despite appropriate antimicrobial therapy - valve rupture - caused by resistant organisms - abscess
75
Highly penicillin susceptible Virdians Group Strep and S. gallolyticus: NVE treatment preferred in patients >65 years or with renal or hearing dysfunction
- pen G for 4 weeks or | - ceftriaxone for 4 weeks
76
Highly penicillin susceptible Virdians Group Strep and S. gallolyticus: NVE treatment not intended for patient with known cardiac or extracardiac abscesses or ClCr <20 Peak of 3-4; trough <1
-pen g for 2 weeks + | gentamicin for 2 weeks
77
Highly penicillin susceptible Virdians Group Strep and S. gallolyticus: NVE treatment Peak of 3-4; trough <1
ceftriaxone for 2 weeks + gentamicin for 2 weeks
78
Highly penicillin susceptible Virdians Group Strep and S. gallolyticus: NVE treatment only for patients unable to tolerate beta lactams; target trough 10-15
vanc for 4 weeks
79
penicillin relatively resistant Virdians Group Strep and S. gallolyticus: NVE treatment
pen g OR ceftriaxone for 4 weeks PLUS | gentamicin for 2 weeks
80
penicillin susceptible Virdians Group Strep and S. gallolyticus: PVE treatment
Pen G OR ceftriaxone for 6 weeks WITH OR WITHOUT gentamicin for 2 weeks
81
penicillin relatively resistant Virdians Group Strep and S. gallolyticus: PVE treatment
Pen G OR ceftriaxone for 6 weeks PLUS gentamicin for 6 weeks
82
Staph NVE oxacillin susceptible strains treatment
nafcillin or oxacillin for 6 weeks
83
Staph NVE oxacillin susceptible strains treatment for pen-allergic non anaphylaxis
cefazolin for 6 weeks
84
Staph NVE oxacillin resistant strains treatment
vanc for 6 weeks
85
Staph NVE oxacillin resistant strains treatment right sided IE only
daptomycin
86
Staph PVE oxacillin susceptible strains treatment
``` nafcillin or oxacillin x 6 wk PLUS rifampin x 6 wk PLUS gentamicin x 2 wk ```
87
Staph PVE oxacillin resistant strains treatment
``` gentamicin x 6 wk PLUS rifampin x 6 wk PLUS vanc x 2 wk ```
88
Enterococci- N/PVE treatment penicllin/gentamicin suscpeptible; able to tolerate beta lactam therapy
ampicillin x 4-6 wk PLUS gentamicin x 4-6 wk
89
Enterococci- N/PVE treatment penicllin/gentamicin suscpeptible; able to tolerate beta lactam therapy when ClCr > 50
penicillin x 4-6 wk PLUS gentamicin x 4-6 wk
90
Enterococci- N/PVE treatment penicllin/gentamicin suscpeptible; able to tolerate beta lactam therapy when ClCr <50
ampicillin x 6 wk | ceftriaxine x 6 wk
91
Enterococci- N/PVE treatment penicllin suscpeptible/ AG resistant normal renal functin
ampicillin x 6 wk PLUS ceftriaxone x 6 wk
92
Enterococci- N/PVE treatment penicllin suscpeptible/ AG resistant/ strep susceptible
Ampicillin x 4-6 wk PLUS streptomycin x 4-6 wk
93
Enterococci- N/PVE treatment unable to tolerate beta lactam therapy; vanc and AG susceptible strains
vanc x 6 wk PLUS gentamicin x 6 wk
94
Enterococci- N/PVE treatment intrinsic resistance to penicllin or beta lactamase producer
vanc x 6 wk PLUS gentamicin x 6 wk
95
Enterococci- N/PVE treatment penicillin/AG/vanc resistant strains
daptomycin >6 wk | linezolid > 6 week
96
HACEK organisms N/PVE preferred therapy
ceftriaxone x 4-6 wk
97
most common cause of osteomyelitis
staph aureus
98
standard duration of treatment for acute osteomyelitis
4 to 6 weeks
99
what is osteomyelitis
purulent inflammation of the bone marrow and surrounding bone associated with an infection
100
osteomyelitis hematogenous spread
pathogen reaches bone via bloodstream
101
osteomyelitis contiguous spead
pathogen reaches the bone from an adjacent soft tissue infection or direct inoculation during trauma, puncture wounds, surgery
102
osteomyelitis vascular insufficiency
subset of contiguous spread: infection develops as an extension of existing localized infection
103
best way to diagnose osteomyelitis
Culture of infection bone an blood and MRI
104
treatment needed for osteomyelitis
combo of medical and surgical
105
newborn osteomyelitis empiric treatment
nafcillin or oxacilli + cefotaxime
106
children < 5 osteomyelitis empiric treatment vaccinated
nafcillin or cefazolin
107
children < 5 osteomyelitis empiric treatment not vaccinated
cefotaxime
108
children >5 osteomyelitis empiric treatment
nafcillin | cefazolin
109
adults osteomyelitis empiric treatment
nafcillin | cefazolin
110
injection drug users osteomyelitis empiric treatment
pip/tazo cefepime meropenem
111
post-op osteomyelitis empiric treatment
pip/tazo cefepime meropenem
112
vascular insufficiency osteomyeltis empiric treatment
pip/tazo meropenem beta lactcam or FQ + metronidazole
113
s. aureus osteomyelitis empiric treatment
naficillin | cefazolin
114
strep pen susc osteomyelitis empiric treatment
aqueous pen G | ceftiaxone
115
enteroocci or streptococci osteomyelitis empiric treatment
aqueous pen G | ampicillin
116
gram negative bacilli osteomyelitis empiric treatment
ceftriaxone cefepime cipro
117
p. aeruginosa osteomyelitis empiric treatment
cefepime pip/tazo cipro
118
polymicrobial osteomyelitis empiric treatment
meropenem ertapenem pip/tazo
119
what is septic arthritis
inflammatory reaction within the synovial membrane, synovial fluid, articular cartilage and joint space caused by presence of a microorganism
120
bacterial septic arthritis urgency
rheumatologic emergency due to potential for rapid joint destruction and irreversible loss of function
121
septic arthritis is primarily caused by what
s. aureus
122
septic arthritis clinical presentation
monoarticular
123
septic arthritis classic triad
dermatitis, tenosynovitis, polyarthralgia
124
gram postive cocci septic arthritis empiric therapy
vanc
125
gnc septic arthritis empiric therapy
ceftriaxone
126
gnb septic arthritis empiric therapy
cefepime pip/tazo meropenem
127
gnb septic arthritis empiric therapy if severe allergy
aztreonam cipro levo
128
gsn septic arthritis empiric therapy
vanc + ceftriaxone or cefepime OR FQ OR AG
129
septic arthritis s. aureus, gram negative duration of treatment
4 weeks
130
septic arthritis streptococci duration of treatment
min 2 weeks
131
septic arthritis gonococci duration of treatment
7-10 days
132
what is a PJI
infection occurring in prosthetic joint with the presence of a sinus tract that communicates with the prosthesis
133
do you use surgery as a treatment option for PJI
yes
134
preferred PJI treatment MSSA
nafcillin cefazolin ceftriaxone
135
alternative PJI treatment MSSA
vanc dapto linezolid
136
preferred PJI treatment MRSA
vanc
137
alternative PJI treatment MRSA
dapto | linezolid
138
preferred PJI treatment pen-s enterococcus
penicillin | ampicillin
139
alternative PJI treatment pen-s enterococcus
vanc dapto linezolid
140
preferred PJI treatment pen-r enterococcus
vanc
141
alternative PJI treatment pen-r enterococcus
dapto | linezolid
142
preferred PJI treatment p. aeruginosa
cefepime | meropenem
143
alternative PJI treatment p. aeruginosa
cipro | ceftazidime
144
preferred PJI treatment enterbacter
cefepime | ertapenem
145
alternative PJI treatment enterbacter
cipro
146
preferred PJI treatment enterobacteriaceae
IV beta lactam | cipro
147
preferred PJI treatment beta hemolytic strep
penicillin | ceftriaxone
148
alternative PJI treatment beta hemolytic strep
vanc

PHRM 865 (59 decks)

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