Exam 3 - Skin & Soft Tissue Infection Flashcards
what are the 3 types of SSTIs
Non-purulent
Purulent
Necrotizing Fasciitis
describe non purulent
epidermis + no pus
tender, erythema, swelling, warm to touch
orange peel skin
cultures in non purulent?
non routine, saved for severe or immunocompromised
what are the classifications of non purulent
mild, moderate, and severe
how to classify mild non-purulent
no systemic signs of infection
how to classify moderate non purulent
systemic signs
how to classify sever non purulent
2 or more SIRs criteria
what is SIRs criteria
Temp >38 or <36
HR > 90 BPM
RR > 24 BPM
WBC > 12k or < 4k
what are the causative pathogens of non purulent
streptococcus spp.
MRSA if needed
how long do you treat non purulent
5 days at least
how to treat mild non purulent
oral ABXs
pen VK
cephalosporins
clindamycin
how to treat moderate non purulent
IV ABXs
penicillin
ceftriaxone
cefazolin
clindamycin
how to treat severe non purulent
surgery/debride then empiric vanc + pip/tazo
describe purulent
abscesses/furuncles/carbuncles
tender, red nodules, erythema
cultures for purulent?
wound is recommended if systemic and get an image to confirm abscess
what is the classification of purulent
same as non purulent
what are the causative pathogens for purulent
MRSA
MSSA
Streptococcus
how long to treat purulent
at least 5 days
how to treat mild purulent
I&D
how to treat moderate purulent
empiric: TMP/SMX or doxy
MRSA: TMP/SMX or doxy
MSSA: Cephalexin
how to treat severe purulent
empiric: vanc or dapto or linezolid
MRSA: same as empiric
MSSA: nafcillin or cefazolin or clindamycin
describe necrotizing fasciitis
profound systemic toxicity
changing color of skin, cracking, edema, pain
cultures for nec?
do blood and wound cultures w/ imaging
what are the causative pathogens for nec
either monomicrobial or polymicrobial
-strep spp.
-CA MRSA
-Vibrio vulnificus
-Aeromonas hydrophila
-Peptostreptococcus
-Clostridium perfringens
treatment duration of nec
treat until no more debridement, improved clinically, fever absent 48-72 hours
how to treat nec
empiric: vanc + pip/tazo
s. pyogenes: penicillin + clindamycin
polymicrobial: vanc + pip/tazo
why is clindamycin used in nec
inoculum effect
clears path to cell wall for penicillins
are cultures needed for impetigo
no
what are you trying to cover in impetigo
strep and staph aureus
how to treat impetigo w/ few lesions
topical x5 days
mupirocin
how to treat impetigo w/ many lesions
oral x7 days
- first line: cephalexin
- strep only: penicillin
- allergies or MRSA: doxy, clinda, bactrim
do you get cultures for animal bites
yes especially with cats
what are you trying to cover with animal bites
mostly anaerobes
how to treat animal bites
first line: augmentin
alternate: 2/3 gen ceph
bL allergy: cipro/levo + anaerobe or moxi
get shots
how long to treat animal bites
established infection: 7-14 days
preemptive infection: 3-5 days
