IC14

Question 1

type of SSTI at epidermis

Answer 1

Impetigo

Question 2

type of SSTI at dermis

Answer 2

Ecthyma & erysipelas

Question 3

type of SSTI at hair follicles

Answer 3

Furuncles & carbuncles

Question 4

type of SSTI at subcutaneous fat

Answer 4

Cellulitis

Question 5

type of SSTI at fascia

Answer 5

Necrotising fasciitis

Question 6

type of SSTI at muscle

Answer 6

myositis

Question 7

pathophysiology of SSTIs

Answer 7

Disruption of normal host
defenses -> overgrowth and invasion of the skin and soft tissues by pathogenic microorganisms

Question 8

non‐pharmacologic interventions for prevention and treatment of diabetic foot infections and pressure ulcers

Answer 8

• Good care to maintain skin integrity, e.g. good wound care;
  treatment of tinea pedis;
  preventing dry, cracked skin;
  Good foot care for DM patients to prevent wound and ulcers;
• Predisposing factors should be identified and treated

Question 9

prevention of SSTIs in acute traumatic wound

Answer 9

Acute traumatic wounds should be copiously irrigated, foreign objects removed, and devitalized tissues debrided

Question 10

When is a cultured needed for SSTIs?

Answer 10

Wound with pus, exudates or tissues

Question 11

How should culture sample be obtained from wound?

Answer 11

culture should be collected
- from deep in the wound after surface cleansed
- from base of a closed abscess, where bacteria grow
- by curettage, rather than wound swab or irrigation

Question 12

When is a blood culture warranted?

Answer 12

Severe cases with marked systemic symptoms of infection or immunocompromised patients

Question 13

Is Erysipelas well-demarcated?

Answer 13

Yes

Question 14

Where is Erysipelas commonly found?

Answer 14

Face, lower extremities

Question 15

Where is cellulitis commonly found?

Answer 15

lower extremities, although it can appear on any area of the skin

Question 16

Likely pathogens for Impetigo

Answer 16

Staphylococci or streptococci

Question 17

Bullous form of impetigo is caused by _____

Answer 17

toxin‐producing strains of S. aureus

Question 18

Likely pathogens for Ecthyma

Answer 18

Most frequently caused by group A streptococci

Question 19

Likely pathogens for Nonpurulent (cellulitis, erysipelas)

Answer 19

Mainly beta‐hemolytic streptococcus;
Usually group A strep (Strep. Pyogenes)

Question 20

Likely pathogens for purulent (furuncles, carbuncles, skin abscesses, cellulitis)

Answer 20

Caused mainly by S. aureus;
Some beta‐hemolytic streptococcus;
Isolation of multiple organisms (including gram‐negatives and anaerobes) is more common in patients with skin abscess

Question 21

Which SCCmec strain causes CA-MRSA? (more common in US)

Answer 21

SCCmec IV

Question 22

Treatment for CA-MRSA

Answer 22

Oral non‐beta‐lactams (eg clindamycin, co‐trimoxazole, doxycycline)

Question 23

Treatment for impetigo, mild limited lesions

Answer 23

Topical Mupirocin BID x 5 days

Question 24

Pathophysiology for DFIs

Answer 24

Neuropathy + Vasculopathy + Immunopathy -> Ulcer formation or wounds -> Bacterial colonization, penetration, proliferation -> DFIs

Question 25

Likely pathogens for DFIs/ pressure ulcer

Answer 25

Typically polymicrobial:
Staphylococcus aureus and Streptococcus spp. most common;
Gram‐negative bacilli (E. coli, Klebsiella spp., Proteus spp) / Pseudomonas less common unless there is water exposure;
Anaerobes (Particularly in ischemic or necrotic wounds)

Question 26

SIRS criteria

Answer 26

temperature > 38 or < 36, heart rate > 90 bpm, respiratory rate > 24 bpm, WBC > 12 x 109/L or < 4 x 109/L

Question 27

Criteria for infection in DFI and pressure ulcers

Answer 27

Purulent discharge or at least 2 signs of inflammation (erythema, pain, induration, warmth, tenderness)