Infectious Disease: SSTI Flashcards
Cellulitis Microbiology
Skin flora - Group A, B, C, G Streptococci
Strep pyogenenes
Staphylococcus aureaus
Treatment of Non-purulent Cellulitis
Mild Options are
Duration of therapy?
Penicillin VK 250-500mg PO q6h
Cephalexin 500mg PO q6h
Dicloxacillin 500mg PO q6h
Clindamycin 300-450mg PO q6h
x7 days (can be 5d IF NOT Staph or Strep)
Treatment of Non-purulent Cellulitis
Moderate Options are
Duration of therapy?
Penicillin G 2-4million units IV q4-6h
Ceftriaxone 1g IV daily
Cefazolin 1g IV q8h
Clindamycin 600mg IV q8h
x7 days (can be 5d IF NOT Staph or Strep)
Treatment of Non-purulent Cellulitis
Severe Options are
Duration of therapy?
RULE OUT NECROTIZING PROCESS
Empiric Therapy
Vancomycin 15-20mg/kg q12h
+
Cefepime 2gm q12h
+
Metronidazole 500mg IV TID
x7 days (can be 5d IF NOT Staph or Strep)
Treatment of Purulent SSTIs
Mild Options are
Duration of therapy?
Incision and drainage alone
*Drainable lesions usally < 5cm diameter
Treatment of Purulent Cellulitis
Moderate Options for Empiric Therapy are?
Duration of therapy?
Incision & Drainage w/ Culture and Sensitivity PLUS
TMP/SMZ 1 DS tabs PO q12h
OR
Doxycycline 100mg PO q12
Treatment of Purulent Cellulitis
Moderate Options for Definitive Therapy MRSA are?
Duration of therapy?
Incision & Drainage w/ Culture and Sensitivity PLUS
TMP/SMZ 1DS tabs PO q12h
Treatment of Purulent Cellulitis
Severe Options for Empiric Therapy are?
Duration of therapy?
Incision & Drainage w/ Culture and Sensitivity PLUS
Vancomycin 15-20mg/kg q12h
Linezolid 600mg IV q12h
Daptomycin 6mg/kg IV q12h
Ceftaroline 600mg IV q12
Treatment of Purulent Cellulitis
Moderate Options for Definitive Therapy MSSA are?
Duration of therapy?
Incision & Drainage w/ Culture and Sensitivity PLUS
Dicloxacillin 500mg PO q6h
Cephalexin 500mg PO q6h
Treatment of Purulent Cellulitis
Severe Options for Definitive Therapy MRSA are?
Duration of therapy?
Incision & Drainage w/ Culture and Sensitivity PLUS
Vancomycin 15-20mg/kg q12h
Linezolid 600mg IV q12h
Daptomycin 6mg/kg IV q12h
Ceftaroline 600mg IV q12
Treatment of Purulent Cellulitis
Severe Options for Definitive Therapy MSSA are?
Duration of therapy?
Incision & Drainage w/ Culture and Sensitivity PLUS
Nafcillin 2g IV q4h
Cefazolin 1g IV q8h
Clindamycin 600mg IV q8h
Bite Wounds from Animals
Microbiology
Pasturella multocida
S. Aureus
anaerobes
polymicrobial
Bite Wounds from Animals
Treatment Options are
Amox/Clav
Doxycycline
Pen VK + Dicloxacillin
Cefuroxime +/- Metronidazole OR Clinda
FQ +/- Metronidazole OR Clinda
Bactrim +/- Metronidazole OR Clinda
Bite Wounds from Animals
Treatment duration is?
Prophylaxis duration is?
5-10d
3-5d
Bite Wounds Humans
Microbiology
Streptococcus spss.
S. aureus
Haemophilus spss.
Eikenella corrodens
anaerobes
Bite Wounds Humans
Treatment Options
Amp/Sulbact
Amox/Clav
Ertapenem
Meropenem
Imipenem/Cliastatin
Cefoxitin
Bite Wounds Humans
Treatment duration?
Prophylaxis duration?
7-14d
3-5d
Necrotizing Fasciitis
Type I
Typically after what?
May involve what bugs?
More common in?
Skin may be spared and infection is spread
surgery or trauma
Bacteroides, Peptostreptococcus, Streptococci, and enterobacterales
IVDAs
slower
Necrotizing Fasciitis
Type II
Typically caused by?
Referred to as?
_____ extending necrosis of subQ tissues and skin,gangrene severe local pain, and systemic toxicity
Early onset waht?
S. Pyogenes
Streptococcal gangrene (“Flesh-eating Disease”)
Rapidly
shock and organ failure
Empiric Therapy For Type I Necrotizing Fasciitis
Vancomycin + [GN & anaerobic coverage]*
*Piperacillin/tazobactam
*Imipenem
*Meropenem
*Ertapenem
**D/t resistance, would avoid FQ here
Empiric Therapy For Type II Necrotizing Fasciitis
Vancomycin + B-Lactam* + Clindamycin
*Penicillin G
*1st or 3rd gen cephalosporin
Definitive Therapy for Streptococcal Necrotizing Fasciitis
Penicillin G 2-4million units IV q4-6hrs
+
Clindamycin 600-900mg IV q8h
Definitive Therapy For MSSA necrotizing fasciitis
Nafcillin 1-2g IV q4h OR
Oxacillin 1-2g IV q4h OR
Cefazolin 2g IV q8h
Definitive Therapy For MRSA necrotizing fasciitis
Vancomycin 15mg/kg IV q12h
+
Clindamycin 600-900mg IV q8h
Medications to consider if patient is not responsive to or cannot tolerate vancomycin for necrotizing fasciitis?
Duration?
Daptomycin
Ceftaroline
Linezolid
14d (could be shorter or longer depending on surgery, Clinda may only need to be on-board for 3-5d)
Septic Arthritis
Microbiology
S. aureus
Streptococcus spss.
N. gonorrheae
E. coli
P. aeruginosa
Septic Arthritis
Treatment
Duration?
Ceftriaxone + Vancomycin tailor as needed
2-3 weeks
Osteomyelitis
Microbiology
Streptococcus spss.
S. aureus
GN
anaerobes
SSTIs Infection Severity
Presence of >/=2 manifestations of inflammation (purulence or erythema, pain, tenderness, warmth, or induration), but area of cellulitis or erythema around an ulcer is </= 2cm and the patient has NO SIRS criteria
Mild
SSTIs Infection Severity
Meets criteria for mild infection, but erythema extends > 2cm, or involves structures deeper than the skin and subQ tissue (abscesses or fasciitis) and has NO more than 1 SIRS criteria is present
Moderate
SSTIs Infection Severity
Meets criteria of either Mild or Moderate Infection, but also meets SIRS criteria w/ >/= 2 of the following:
Temp > 38C or < 36C
HR > 90 bpm
RR > 20 or PaCO2 < 32 mmHg
WBC count > 12K or < 4K
Severe
Abx Therapy SSTIs Mild
No Complicating features
Usual Pathogens?
Potential Empiric Regimens?
GPCocci; GPChains
Cefazolin
Cephalexin
nafcillin
Abx Therapy SSTIs Mild
Recent abx exposure w/ 90d
Usual Pathogens?
Potential Empiric Regimens?
GPC + GNR
Amox/Clav
Amp/sulb
TMP/SMX
FQ
Abx Therapy SSTIs Mild
High Risk for MRSA
Usual Pathogens?
Potential Empiric Regimens?
MRSA
TMP/SMX
Linezolid
Doxycycline
Abx Therapy SSTIs Moderate or Severe
No Complicating features
Usual Pathogens?
Potential Empiric Regimens?
GPC +/- GNR
Amox/Clav
Amp/Sulb
Cefotetan
Cefoxitin
Ceftriaxone
Abx Therapy SSTIs Moderate or Severe
Recent Abx exposure w/n 90d
Usual Pathogens?
Potential Empiric Regimens?
GPC +/- GNR
Piperacillin/tazobactam
Ceftriaxone
ertapenem
Abx Therapy SSTIs Moderate or Severe
Macerated ulcer or warm climate or resulting from a puncture wound
Usual Pathogens?
Potential Empiric Regimens?
GNR, including Pseudomonas
Piperacillin/tazobactam
cefepime
nafcillin + ciprofloxacin
imipenem
meropenem
doripenem
Abx Therapy SSTIs Moderate or Severe
Ischemic Limb/necrosis/gas forming
Usual Pathogens?
Potential Empiric Regimens?
GPC +/- GNR +/- anaerobes
Piperacillin/tazobactam
ertapenem
imipenem
meropenem
doripenem
cetriaxone + metronidazole
Abx Therapy SSTIs Moderate or Severe
MRSA risk Factors
Usual Pathogens?
Potential Empiric Regimens?
MRSA + GNR
Add Vanc, Linezolid, Daptomycin to a regimen w/ GNR coverage
