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Therapeutics V Spring 2019 (P3 Spring) > Exam 3 - Skin/Soft Tissue Infections > Flashcards

Exam 3 - Skin/Soft Tissue Infections Flashcards

1
Q

Most skin and soft tissue infections are caused by what bugs?

A

Beta hemolytic streptococci
or
Staphylococcus aureus

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2
Q

what does SSTI stand for

A

skin and soft tissue infections

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3
Q

what are the 3 main layers of skin

A

outer most –> inner most layers

epidermis – dermis – subcutaneous tissue

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4
Q

epidermis, dermis or subcutaneous tissue?

non-vascular layer composed of continuously dividing cells and the stratum corneum

A

epidermis

also the outermost layer

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5
Q

epidermis, dermis or subcutaneous tissue?

consists of connective tissue, blood vessels, lymphatics, sensory nerve endings, sweat and sebaceous glands, hair follicles and smooth muscle fibers

A

dermis

also layer directly beneath epidermis

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6
Q

epidermis, dermis or subcutaneous tissue?

layer of loose connective tissue primarily containing adipose cells

A

subcutaneous tissue

innermost layer

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7
Q

what is fascia and where is it located?

A

located beneath subcutaneous tissue layer – separates skin from underlying muscle
(deep fascia forms sheath that surrounds the muscle)

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8
Q

what is some important patient history info to gather about SSTIs?

A 
immune status
geographic locale
travel history
recent trauma or surgery
lifestyle
hobbies
animal exposure/bites
previous antimicrobial therapy
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9
Q

Impetigo symptoms?

A

superficial skin infecetions: maculopapular lesions with a dried, honey colored crust – usually on face around mouth

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10
Q

Impetigo:
Typically/most common form is Non_____ type
other is ______ type

A

Non-bullous type
or
Bullous

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11
Q

Impetigo
Non-Bullous type: usually what bug causes infection?
vs
Bullous type: usually what bug causes it?

A

Non-bullous – Group A strep

Bullous: MSSA

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12
Q

Risk factors for impetigo?

A 
KIDS!!
Hot/humid climates
poor hygiene/day care settings (aka kids)
crowing
malnutrition 
diabetes
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13
Q

Topical treatment for impetigo

A

Mupirocin 2% or retapamulin 1% ointments BID x5

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14
Q

Oral options for Impetigo (systemic treatment)

A 
Dicloxacillin
Erythromycin (good if PCN allergy)
Clindamycin (good if PCN allergy)
Cephalexin
Amox/Clav
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15
Q

Symptoms of Cellulitis?

A

Rapidly spreading erythema,
edema
tenderness
warmth in skin with a poorly defined border

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16
Q

common pathogenesis of cellulitis?

A

introduced to skin during trauma, lacerations, abrasions — FISSURED TOE WEBS FROM FUNGAL INFECTIONS OF FEET, cracks in dry skin

aka any cut in the skin……

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17
Q

What patients are at risk for cellulitis

A

anybody!! happens in healthy ppl because just any cut can cause this

(common in IV drug users, arterial/venous insufficiency, pts with diabetes or obesity, immunocompromised pts)

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18
Q

Erysipelas:
variant of ______ – caused by ____________
has ________ appearance; often involves the face
Only in _____ dermis and has clearly ________

A

variant of cellulitis – caused by beta hemolytic streptococci
has peau d’ orange appearance; often involves the face
Only in upper dermis and has clearly defined borders

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19
Q

most likely causative pathogens for cellulitis

A 
S. Aureus (including MRSA)
Streptococus Pyogenes (group A strep)
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20
Q

who is at hight risk for CA-MRSA with cellulitis infections

A 
recent tattooed people
inmates
injection drug users
Native American Populations
Gat men
Contact sport participants
kids
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21
Q

Patients with skin infections due to CA-MRSA often have cellulits AND ________

A

abscess/pustules

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22
Q

why does CA-MRSA cause cellulitis AND abscesses/pustules?

A

CA-MRSA has genes for PVL (a virulence factor) been associated with TISSUE NECROSIS and ABSCESS FORMATION

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23
Q

CA-MRSA with cellulitis often susceptible to what drugs

A

doxycycline
Clindamycin
SMZ-TMP

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24
Q

Treat cellulitis like it has MRSA when?

A 
in populations specified before like: recent tattooed people
inmates
injection drug users
Native American Populations
Gat men
Contact sport participants
kids

AND

if pt has an abscess!!

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25
Q

Cellulitis Treatment:

if no abscess or if gram stain/culture is inconclusive: empiric therapy should cover what bugs?

A

Group A strep AND staphylcoccus aureus

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26
Q

Cellulitis Treatment:

What drugs should be used for MILD infection/no MRSA suspected

A

dicloxacillin

cephalexin

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27
Q

Cellulitis Treatment:

What drugs should be used for MILD infection/MRSA suspected

A

SMZ-TMP
Clindamycin
Linezolid

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28
Q

Cellulitis Treatment:

What drugs should be used for MODERATE-SEVERE infection/no MRSA suspected

A

Nafcillin

Cefazolin

29
Q

Cellulitis Treatment:

What drugs should be used for MODERATE-SEVERE infection/MRSA suspected

A

Vanc

Linezolid

30
Q

Cellulitis Treatment:

What drugs should be used if patient has severe PCN allergy

A

Clindamycin
Vanc
Linezolid

31
Q

Cellulitis Treatment:

how long to treat it

A

minimum 5 days!!

32
Q

Cellulitis Treatment:

DIRECTED therapy towards strep. pyogenes — use what drug

A

PCN

33
Q

Cellulitis Treatment:

DIRECTED therapy for MRSA

A

Vanc, Clindamycin, or SMZ-TMP

34
Q

Cellulitis Treatment:

DIRECTED therapy for Gram - bacilli

A

3rd gen cephs
extended spectrum PCN (piperacillin
FQs

35
Q

Cellulitis Treatment:

DIRECTEd therapy for Polymicrobial with anaerobes

A 
beta lactamse inhibitor combo (pip tazo)
OR 
3rd gen ceph
OR
FQ w/ metronidazole 
OR
Carbapenem alone.......
wtffff
36
Q

Necrotizing Fasciitis:

Symptoms?

A

INTENSE pain
wooden hard
systemic toxicity!!

37
Q

Necrotizing Fasciitis:

Risk factors?

A

same as cellulitis!!

like any cut….

38
Q

Necrotizing Fasciitis:

Common bugs?

A

Monomicrobial: group A strep (streptococcus pyogenes)
Polymicrobial: Gram - bugs AND anaerobes

39
Q

Necrotizing Fasciitis:

Treatment – must have what two things

A 
SURGICAL intervention (surgical debridment)
and Broad AF spectrum drug coverage
40
Q

Necrotizing Fasciitis:

Empiric Therapy?

A

Vanc + Pip/Tazo
meropenem
ceftriaxone/metronidazole
fluoroquinolone/metronidazole

41
Q

Necrotizing Fasciitis:

Directed therapy for strep pyogenes

A

PCN + Clindamycin (suppress toxin production)

42
Q

Necrotizing Fasciitis:

Directed therapy for clostridium

A

PCN + Clindamycin (suppress toxin production)

43
Q

Necrotizing Fasciitis:

Directed therapy for Staph Aureus?

A

MSSA: Nafcillin/Cefazolin
MRSA: Vanc

44
Q

what does DFI stand for

A

diabetic foot infection

45
Q

why are diabetics at increased risk for DFIs??

A

bc neuropathy, angiopathy with ischemia, immune system defects, decreased wound healing

46
Q

Not all diabetic ulcers/wounds are infected:
to be considered infected they have to have at least __#__ signs and symptoms of inflammtion

What are the signs/sypmtoms

A

at least 2

redness, warmth, swelling/induration tenderness or pain

47
Q

what system is used to classify diabetic foot infections

A

PEDIS Grade

48
Q

A PEDIS grade of _____ is considered mild infection seveirty

A

2

49
Q

A PEDIS grade of _____ is considered moderate infection severity

A

3

50
Q

A PEDIS grade of _____ is considered severe infection severity

A

4

51
Q

what does SIRS stand for

A

Systemic inflammatory response signs

52
Q

T or F: Abx alone are great for treating DFIs

A

false!!
need appropriate wound care (debridement)
Tight glycemic control
Optimizing blood flow too

53
Q

Difference between PEDIS Grade 2 (mild) vs PEDIS Grade 3 (moderate)?

A

2: local infection – only skin/SQ tissue – erythema is b/w 0.5 - 1.9 cm around ulcer
3: local infection – deeper than skin and SQ tissue – erythema is > 2 cm around ulcer

BOTH DO NOT HAVE SIRS

54
Q

what are examples of SIRS

A

Temperature > 38 C or < 36 C
HR > 90 bpm
RR > 20 breaths/min
WBC > 12,000 or < 4,000

55
Q

What criteria makes a DFI and PEDIS Grade 4/Severe?

A

Local infection described above + at least 2 or more SIRS!!

56
Q

If MILD DFI:

Covering what bacteria?

A

beta hemolytic streptococic
and
Staph aureus

57
Q

If MODERATE DFI:

Covering what bacteria?

A

Same as mild (beta hemolytic streptococic
and Staph aureus)
+ consider ENTEROBACTERIACEAE

58
Q

If SEVERE DFI:

Covering what bacteria?

A

Same as moderate (beta hemolytic streptococic
and Staph aureus and ENTEROBACTERIACEAE)
+ MRSA, Pseudomonas and Anaerobes

59
Q

want Pseduomonas coverage for DFIs when?

A

if pt has soaked their foot in water!

also if pt is failing therapy w/out pseudomonal coverage or if pt has SEVERE DFI

60
Q

Duration of Therapy for DFIs:

Mild infections?

A

1- 2 weeks

61
Q

Duration of Therapy for DFIs:

Moderate infections?

A

1 - 3 weeks

62
Q

Duration of Therapy for DFIs:

Severe infections?

A

2- 4 weeks

63
Q

Duration of Therapy for DFIs:

if bone involvement?

A

4 - 6 weeks

64
Q

Empiric Therapy for DFIs:

Mild Infection?

A

PO Cephalexin OR
PO dixcloaxillin OR
PO Augmentin

or PO Clindamycin or PO SMX/TMP

65
Q

Empiric Therapy for DFIs:

Moderate infection?

A

IV cefazolin
(IV ceftriaxone alone if enterbacteriaceae suspected)

add PO metronidazole if anaerobes suspected

66
Q

Empiric Therapy for DFIs:

Severe infection?

A

BROAD SPEC AS HELL:

VANC + Pip/Tazo
or VANC + meropenem
or VANC + Ceftazidime + metronidazole
or VANC + Cefepime + metronidazole
or VANC + FQ + metronidazole
67
Q

what organisms are we trying to cover for empiric therapy of severe DFIs?

A

strep, staph (MSSA and MRSA), enterbacteriaceae, pseudomonas, and anaerobes….

68
Q

Non-antibiotic options for treatment of DFIs?

A

appropriate wound care!! debridement/stay off it/bed rest
tight glycemic control
optimizing blood flow (smoking cessation/stents..)

Therapeutics V Spring 2019 (P3 Spring) (27 decks)

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