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PHRM 865 > EXAM 3 SSTI/DFI > Flashcards

EXAM 3 SSTI/DFI Flashcards

1
Q

SSTI risk factors

A

Hx of SSTI, PAD, IV drug use, CKD, DM

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2
Q

SSTI complications

A

ulcers, bacteremia, endocarditis, osteomyelitis, sepsis
staph is the most common bug on the skin

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3
Q

types of SSTIs

A

non-purulent
purulent
necrotizing fasciitis

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4
Q

non-purulent SSTI presentation

A

No PUS
tender, erythema, swelling, warm to touch
Orange peel like skin

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5
Q

non-purulent SSTI diagnosis

A

cultures: skin/blood not routinely done bc skin likely contaminated
blood cultures recommended if: immunocompromised, severe infection, animal bite

imaging:
CT/MR imaging to rule out necrotizing fasciitis

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6
Q

non-purulent + purulent SSTI classifcation

A

mild: no systemic symptoms
moderate: systemic symptoms of infection
severe: meet SIRS criteria

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7
Q

SIRS criteria

A

temp > 38C
HR >90 bpm
RR > 24 bpm
WBC > 12K or <4K

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8
Q

non-purulent SSTI causative pathogens

A

streptococcus spp
MRSA: if penetrating trauma, MRSA elsewhere, nasal colonization, SIRS, failed non-MRSA ABX regimen

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9
Q

Non-purulent SSTI treatment - Mild

A

Oral ABX:
Penicillin VK
Cephalosporin
Dicloxacillin
Clindamycin

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10
Q

Non-purulent SSTI treatment - moderate

A

IV ABX:
Penicillin
Ceftriaxone
Cefazolin
Clindamycin

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11
Q

Non-purulent SSTI treatment - Severe

A

emergent surgical inspection or debridement:

Empiric ABXs:
Vancomycin + piperacillin/tazobactam

Then culture susceptibility:
Narrow based on culture and susceptibility

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12
Q

Purulent SSTI characteristics

A

Abscesses: pus within dermis and deeper skin tissue
Furuncles (boils): small abscess that formation of the hair follicle
Carbuncles: infection involving several follicles

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13
Q

Purulent SSTI presentation

A

PUS
tender, red nodules, erythema, warm to touch

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14
Q

Purulent SSTI
diagnosis

A

Cultures: wound cultures are recommended for all abscesses, carbuncles and patients with systemic sign of infection regardless of severity

Imaging: CT/MR imaging to confirm presence of abscess

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15
Q

purulent SSTI pathogens

A

MRSA
MSSA
Streptococcus spp.

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16
Q

how long is treatment for non-purulent + purulent SSTIs?

A

minimum: 5 days

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17
Q

Purulent SSTI treatment - mild

A

Incision + drainage

only treatment

18
Q

Purulent SSTI treatment - moderate

A

incision + drainage

culture + susceptibility

empiric ABX:
sulfamethoxazole/trimethoprim
doxycycline

targeted ABX:
MRSA: sulfamethoxazole/trimethoprim or doxycycline
MSSA: dicloxacillin or cephalexin

19
Q

Purulent SSTI treatment - severe

A

incision + drainage

culture + susceptibility

empiric ABX:
vancomycin
daptomycin
linezolid

targeted:
MRSA: vancomycin, daptomycin, linezolid
MSSA: nafcillin, cefazolin, clindamycin

20
Q

Necrotizing Fasciitis characteristics

A

Medical emergency associated with morbidity and mortality

21
Q

Necrotizing Fasciitis presentation

A

systemic toxicity
change in color of skin to maroon/purple/black
crepitus
edema
severe pain

22
Q

Necrotizing Fasciitis diagnosis

A

cultures:
blood cultures recommended given severity of infection
wound cultures likely obtained from surgery

imaging:
Ct/MR imaging to confirm necrotizing fasciitis or presence of abscess –> looking for gas

23
Q

necrotizing fasciitis treatment

A

surgery until spreading stops + broad spectrum antibiotics

Empiric therapy:
Vancomycin + piperacillin/tazobactam

Targeted ABX:
S. pyogenes: PCN + clindamycin
Polymicrobial: Vancomycin + piperacillin/tazobactam

24
Q

necrotizing fasciitis treatment duration

A

until patient has clinical improvement

Fever absent for 48-72 hours

25
why clindamycin?
inhibits streptococcal toxin production inoculum effect --> maintains efficacy of ABX no matter amount of bacteria
26
Impetigo Characteristics/diagnosis
Highly contagious superficial skin infection Cultures are recommended but not required
27
impetigo treatment few lesions
topical 5 days: Mupirocin
28
impetigo treatment many lesions/outbreak
oral 7 days: Dicloxacillin or cephalexin Streptococcus only: DOC --> penicillin Allergies/MRSA: doxycycline, clindamycin, TMP/SMX
29
animal bites
Cat bites : deep/ sharp puncture wounds Dog/human bites: cellulitis signs and symptoms Cultures: blood cultures are recommended in animal bites
30
animal bites pathogens
anaerobes since they are more common in the mouth
31
animal bites treatment
DOC: amoxicillin/clavulanate Alterative: 2nd/3rd gen cephalosporin + anerobic coverage B-lactam allergy: ciprofloxacin/levofloxacin + anerobic coverage or moxifloxacin Vaccines: Tdap if due +/- rabies
32
animal bites treatment duration
Established infection: 7-14 days Preemptive: 3-5 days
33
diabetic foot infection risk factors
neuropathy, angiopathy/ischemia, immunologic defects, poor wound healing
34
diabetic foot infection diagnosis
Presentation: local signs of infection +/- purulent discharge More specific to DFI: discolored tissue/foul odor Cultures: Wound cultures: not recommended for mild infection Bone cultures: typically following I&D Blood cultures: may be considered
35
diabetic foot infection
Staph aureus, streptococci Pseudomonas due to soaking
36
DFI - MRSA risk factors
in Indianapolis: add on MRSA coverage Previous MRSA infection
37
DFI - Pseudomonas risk factors
Soaking feet in water Hx pseudomonas
38
DFI - overall management
Surgery Glycemic control Antibiotics
39
DFI treatment mild
goal: cover MSSA + streptococci 1st line: for 1-2 weeks dicloxacillin cephalexin clindamycin Recent ABX: SWITCH TO amoxicillin/clavulanate levofloxacin/moxifloxacin MRSA risk factors: SWITCH TO sulfamethoxazole/trimethoprim doxycycline
40
DFI treatment moderate
goal: cover MSSA, streptococci, enterobacterales, anaerobes 1st line: 2-3 weeks moxifloxacin amoxicillin/clavulanate ciprofloxacin/levofloxacin clindamycin or metronidazole Pseudomonas risk factors: SWITCH TO ciprofloxacin/levofloxacin + clindamycin or metronidazole MRSA risk factors: ADD doxycycline linezolid vancomycin sulfamethoxazole/trimethoprim
41
DFI treatment severe
goal: cover MSSA, strep, enterobacterales, anaerobes, pseudomonas 1st line: 2-3 weeks piperacillin/tazobactam carbapenem cefepime + clindamycin or metronidazole MRSA: ADD vancomycin linezolid daptomycin

PHRM 865 (31 decks)

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