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competency 10/11 > id: ssti > Flashcards

id: ssti Flashcards

1
Q

normal skin functions as protective barrier

A
  • dry surface
  • fatty acids
  • acidic pH: 5.6
  • renewal of epidermic
  • low temp
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2
Q

predisposing factors for SSTIs

A
  • high bacterial innocula
  • excessive moisture
  • reduced blood supply
  • presence of bacterial nutrients
  • poor hygiene
  • sharing or personal items
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3
Q

MRSA-covering abx

A

ceftaroline (IV),
doxycycline (PO),
tmp/smx (PO),
vancomycin (IV/PO),
clindamycin (IV/PO), linezolid (IV/PO), daptomycin (IV)

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4
Q

P.aeruginosa-covering abx

A

piper-tazo (PO/IV), ceftazidime (IV), cefepime (IV), meropenem/imipenem (IV), FQ (IV/PO), gentamicin/amikacin (IV)

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5
Q

abx that does not req renal dose adj

A

cloxacillin, clindamycin, metronidazole, pen VK

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6
Q

impetigo

A

most cases: mupirocin BD x5d

severe:
Pen VK (S.pyogenes)
Cephalexin
Cloxacillin
Clindamycin

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7
Q

ecthyma

A

Pen VK (S.pyogenes)
Cephalexin
Cloxacillin
Clindamycin

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8
Q

purulent SSTIs: furuncles, carbuncles, cutaneous abscesses

A

mainstay: I&D

MSSA: cloxacillin, cephalexin, clindamycin

MRSA: tmp/smx, clindamycin, doxycycline

x5-7d (outpatient)
x7-14d (inpatient)

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9
Q

when is adjunctive abx required for purulent SSTIs?

A
  • SIRS
  • unable to drain completely
  • lack of response to I&D
  • extensive disease involving several sites
  • immunocompromised (chemo/transplant)
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10
Q

additional causative org for cellultis/erysipelas: immunosuppressed (chemo, transplant)

A

streptococcus pneumoniae, escherichia coli, serratia marcescens, pseudomonas aeruginosa

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11
Q

additional causative org for cellultis/erysipelas: chronic liver/renal disease

A

vibrio spp, escherichia coli, pseudomonas aeruginosa

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12
Q

mild, non-purulent cellulitis

A

Streptococcus spp
- pen VK
- cloxacillin
- cephalexin
- clindamycin

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13
Q

moderate, non-purulent cellulitis

A

Streptococcus spp +/- S.aureus
- pen VK
- cloxacillin
- cephalexin
- clindamycin

IV:
- pen G
- cefazolin
- clindamycin

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14
Q

severe, non-purulent cellulitis

A

Streptococcus spp + S.aureus + gram-neg (including pseudomonas aeruginosa)
- IV piper-tazo
- IV cefepime
- IV meropenem

MRSA risk factor, add IV:
- vanco
- dapto
- linezolid

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15
Q

MRSA risk factor

A
  • immunocompromised (chemo/transplant)
  • critically ill (hypotensive, ICU)
  • failed prev abx without mrsa coverage
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16
Q

mild, purulent cellulitis

A

Streptococcus spp + S.aureus

PO
cloxacillin
cephalexin
clindamycin

MRSA:
tmp/smx, doxy, clinda

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17
Q

moderate, purulent cellulitis

A

Streptococcus spp + S.aureus

PO/IV:
cloxacillin
cephalexin
clindamycin

MRSA: IV
vanco, dapto, line

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18
Q

sever, purulent cellulitis

A

Streptococcus spp + S.aureus + gram-neg (including pseudomonas aeruginosa)
- IV piper-tazo
- IV cefepime
- IV meropenem

MRSA risk factor, add IV:
- vanco
- dapto
- linezolid

19
Q

cellulitis from bite wounds

A

Streptococcus spp + S.aureus + specific gram neg org (Pasteurella multocida, Eikenella corrodens), oral anaerobes

IV/PO:
amoxi-clav
ceftriaxone/cefuroxime/FQ + clinda or metro for anaerobes coverage

20
Q

duration of abx for cellulitis or erysipelas treatment

A

5d, immunosuppressed may need 7-14d

21
Q

criterias for pressure ulcer infection or DFI

A
  • purulent discharge or
  • > = 2 signs of inflammation: erythemia, warmth, tenderness, pain, induration
22
Q

mild DFI/pressure ulcers

A

infection of skin and SC tissue + erythema <2cm around ulcer + no SIRS

Streptococcus spp + S.aureus

PO cloxacillin, cephalexin, clindamycin

MRSA: tmp/smx, doxy, clinda

23
Q

moderate DFI/pressure ulcers

A

infection of skin and SC tissue + erythema >2cm around ulcer + no SIRS

Streptococcus spp + S.aureus + gran neg (+/- P.aeruginosa) + anaerobes

IV
amoxi-clav
ertapenem
ceftriaxone + metro/clinda

MRSA: vanco, dapto, linezolid

24
Q

severe DFI/pressure ulcers

A

SIRS

Streptococcus spp + S.aureus + gran neg (+ P.aeruginosa) + anaerobes

IV
piper-tazo
meropenem
cefepime + metro/clinda

MRSA: vanco, dapto, linezolid

25
Q

recommended duration of treatment, DFI: mild, no bone involved

26
Q

recommended duration of treatment, DFI: moderate, no bone involved

27
Q

recommended duration of treatment, DFI: severe, no bone involved

28
Q

recommended duration of treatment, DFI: surgery, all infected bone and tissue removed eg. amputation

29
Q

recommended duration of treatment, DFI: surgery, residual infected soft tissue

30
Q

recommended duration of treatment, DFI: surgery, residual viable bone

31
Q

recommended duration of treatment, DFI: no surgery or residual dead bone

A

> = 3 months

32
Q

ammoxi/clav dosing

A

625mg BD-TDS
1.2g Q8H

33
Q

cefazolin dosing

34
Q

cefepime dosing

35
Q

cephalexin dosing

A

250-500mg QDS

36
Q

cloxacillin dosing

A

250-500mg QDS
1-2g Q4-6H

37
Q

clindamycin dosing

A

300mg QDS
600mg Q8H

38
Q

metronidazole dosing

A

500mg TDS (IV/PO)

39
Q

pen G dosing

A

2-4mill units q4-6h

40
Q

pen vk dosing

A

250-500mg QDS

41
Q

piper-tazo dosing

A

4.5g q6-8h

42
Q

tmx/smp dosing

43
Q

vanco dosing

A

15mg/kg q8-12h

competency 10/11 (31 decks)

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