id: ssti Flashcards
normal skin functions as protective barrier
- dry surface
- fatty acids
- acidic pH: 5.6
- renewal of epidermic
- low temp
predisposing factors for SSTIs
- high bacterial innocula
- excessive moisture
- reduced blood supply
- presence of bacterial nutrients
- poor hygiene
- sharing or personal items
MRSA-covering abx
ceftaroline (IV),
doxycycline (PO),
tmp/smx (PO),
vancomycin (IV/PO),
clindamycin (IV/PO), linezolid (IV/PO), daptomycin (IV)
P.aeruginosa-covering abx
piper-tazo (PO/IV), ceftazidime (IV), cefepime (IV), meropenem/imipenem (IV), FQ (IV/PO), gentamicin/amikacin (IV)
abx that does not req renal dose adj
cloxacillin, clindamycin, metronidazole, pen VK
impetigo
most cases: mupirocin BD x5d
severe:
Pen VK (S.pyogenes)
Cephalexin
Cloxacillin
Clindamycin
ecthyma
Pen VK (S.pyogenes)
Cephalexin
Cloxacillin
Clindamycin
purulent SSTIs: furuncles, carbuncles, cutaneous abscesses
mainstay: I&D
MSSA: cloxacillin, cephalexin, clindamycin
MRSA: tmp/smx, clindamycin, doxycycline
x5-7d (outpatient)
x7-14d (inpatient)
when is adjunctive abx required for purulent SSTIs?
- SIRS
- unable to drain completely
- lack of response to I&D
- extensive disease involving several sites
- immunocompromised (chemo/transplant)
additional causative org for cellultis/erysipelas: immunosuppressed (chemo, transplant)
streptococcus pneumoniae, escherichia coli, serratia marcescens, pseudomonas aeruginosa
additional causative org for cellultis/erysipelas: chronic liver/renal disease
vibrio spp, escherichia coli, pseudomonas aeruginosa
mild, non-purulent cellulitis
Streptococcus spp
- pen VK
- cloxacillin
- cephalexin
- clindamycin
moderate, non-purulent cellulitis
Streptococcus spp +/- S.aureus
- pen VK
- cloxacillin
- cephalexin
- clindamycin
IV:
- pen G
- cefazolin
- clindamycin
severe, non-purulent cellulitis
Streptococcus spp + S.aureus + gram-neg (including pseudomonas aeruginosa)
- IV piper-tazo
- IV cefepime
- IV meropenem
MRSA risk factor, add IV:
- vanco
- dapto
- linezolid
MRSA risk factor
- immunocompromised (chemo/transplant)
- critically ill (hypotensive, ICU)
- failed prev abx without mrsa coverage
mild, purulent cellulitis
Streptococcus spp + S.aureus
PO
cloxacillin
cephalexin
clindamycin
MRSA:
tmp/smx, doxy, clinda
moderate, purulent cellulitis
Streptococcus spp + S.aureus
PO/IV:
cloxacillin
cephalexin
clindamycin
MRSA: IV
vanco, dapto, line
sever, purulent cellulitis
Streptococcus spp + S.aureus + gram-neg (including pseudomonas aeruginosa)
- IV piper-tazo
- IV cefepime
- IV meropenem
MRSA risk factor, add IV:
- vanco
- dapto
- linezolid
cellulitis from bite wounds
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
duration of abx for cellulitis or erysipelas treatment
5d, immunosuppressed may need 7-14d
criterias for pressure ulcer infection or DFI
- purulent discharge or
- > = 2 signs of inflammation: erythemia, warmth, tenderness, pain, induration
mild DFI/pressure ulcers
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
moderate DFI/pressure ulcers
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
severe DFI/pressure ulcers
SIRS
Streptococcus spp + S.aureus + gran neg (+ P.aeruginosa) + anaerobes
IV
piper-tazo
meropenem
cefepime + metro/clinda
MRSA: vanco, dapto, linezolid
