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CDM 3 Exam 1 > Lecture 9 - Skin/Soft tissue Infections & Surgical Prophylaxis > Flashcards

Lecture 9 - Skin/Soft tissue Infections & Surgical Prophylaxis Flashcards

1
Q

ABSSSI

A

Acute bacterial skin and skin structure infection

bacterial infection of the skin with a lesion size area of atleast 75cm

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2
Q

Cellulitis/Erysipelas

A

Diffuse skin infection characterized by spreading areas of redness, edema and/or induration

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3
Q

Wound infection

A

infection characterized by purulent drainage from a wound with surrounding redness, edema, and or induration

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4
Q

Major cutaneous absces

A

infection characterized by a collection of pus within the dermis or deeper that is accompanied by redness, edema and/or induration

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5
Q

What is impetigo

A

initialy papule that may progress to vesicles and pustules that rupture, later forming yellow-crust discharge that causes superficial skin infeciton

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6
Q

Impetigo etiology and info

A

most cases occur in kids, annual incidence 1-2%

Staph aureus + Group A strep

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7
Q

Bullous vs Nonbullous impetigo

A

Bullous worse, fluid filled vesicles that leak shit

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8
Q

Impetigo Treatment

A

Beta-Lactam (amor, diclix, cephalosporin) X 7 days

if no/poor response then try….

Tmp/Smx (not use in peds), Doxy, Clinda, Linezolid X 7 days

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9
Q

Cellulitis info & Etiology

A

Etiology: Grp A strep, other “Grouped” strep, Staph aureus

systemic disease

Acute spreading infection of skin that extends to involve subcutaneous tissues

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10
Q

When should coverage against MRSA be considered for Cellulitis?

A

penetrating trauma, IV Drug use, purulent drainage, or previous/concurrent MRSA infection

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11
Q

What are systemic symptoms?

A

Temp < 36 or > 38
HR > 90
RR > 20 or PaCO < 32
Altered or deteriorated mental stauts

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12
Q

Class I Cellulitis treatment

A

Oral ABX

5-7 day duration

PCN VK, Cephalosporin, Diclox, Clinda

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13
Q

Class II Cellulitis treatment

A

IV ABX initially, transitioned to oral to complete course maybe

7-14 day duration

PCN, Ceftriaxone, Cefazolin, Clinda

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14
Q

Class III & IV Cellulitis Treatment

A

IV ABX w/ broader coverage due to severity of illness for class IV

14 day min duration

Vancomycin + Pip/Tazo = severe

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15
Q

Non-purulent SSTI Cellulitis Txm

A

PCN
Clinda
Nafcillin
Cefazolin
PCN VK
Cephalexin

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16
Q

MSSA SSTI cellulitis txm

A

Nafcillin or oxacillin
Cefazolin
Clindamycin
Dicloxacillin
Cephalexin
Doxy, mino
Tmp/Smx

17
Q

MRSA SSTI cellulitis Txm

A

Vanco
Linezolid
Clinda
Dapto
Ceftaroline
Doxy, Mino
Tmp/Smx

18
Q

Diabetic foot infection possible pathogens

A

Gram + = S aureus, Enterococci, Streptococci
Gram - = Enterobacter, Acinetobacter, Pseudomonas
Anaerobes = Bacteroids, peptococcus

19
Q

Diabetic foot infection, Mild to moderate…

A

if no risk factors for gram - or anaerobes, narrow spec targeting S.aureus/strep fine
Gram - = ABx therapy or hospitalization >2 days in last 90, Anaerobes = gangrene, ischemia

topical therapy often ineffective, oral or IV (hospital) favored

20
Q

Diabetic foot infection, Severe or those with risk factors

A

Expanded coverage, including resistant organisms

IV therapy to start, can transition to Oral or continue IV

21
Q

Typical duration for Diabetic foot infection

A

7-14 days
2-6 weeks for bone infection

wound healing can take months

22
Q

Mild/PEDIS grade 1/2 Txm

A

non-limb threading

oral Clinda, cephalosporins, or dicloxacillin
duration: 7-14 days

23
Q

Moderate/PEDIS Grade 3 txm

A

similar to mild but stronger considerations for IV

Cefazolin, Clinda or vancomycin IV for those with pcn allergy

duration: 10-14 days

24
Q

Severe/PEDIS Grade 4 Txm

A

Vancomycin + other agent targets against gram -/ anaerobes

Additional agents: Carbapem, ext-spectrum pcn alone, or 3/4 Gen Cep + metronidazole

Duration: atleast 14 days, if bone or join = 2-6 months

25
Q

Type 1 Necrotizing fasciitis

A

polymicrobial

atleast 1 anaerobic organism (most common Bacteroids or peptostrep)
Facultative anaerobes (B hemolytic strep)
Enterobacteriaceae

26
Q

Type 2 Necrotizing fasciitis

A

Monomicrobial or polymicrobial

Grp A strep alone or combo w/ other species (most common S.aureus)

can be severe due to toxin producing strains

27
Q

empiric Treatment for Necrotizing Fasciitis

A

Surgery to remove necrosis

Pip/tazo, carbapenem, 3/4 Gen Ceph + metronidazole
+ Vancomycin/linezolid/dapto + clinda

narrow therapy after cultures back

28
Q

Animal bite prophylactic treatment

A

3-5 days

Amox/clav 875/125 q12h or 500/125 q8h

2nd line = Doxy, Levo, Bactrim, Cefuroxime + metronidazole/clinda

rabies & tetanus vaccine consider

29
Q

Animal bite treatment

A

Duration typically 5-14 days

consider MRSA if risk factors or failure
same as prophylaxis treatment

30
Q

Human bite treatment

A

amoxicilli/clav 875/125 q12h
amp/sulbactam 1.5-3 q6h

31
Q

Risk factors for Surgical site infection

A

Age/Hx of radiation or skin infection

Immune status*
Nutritional status*
Neutropenia**
Immunosuppresives**

Surgery sites

32
Q

Management of Pre-op MRSA

A

Planned: will swab and look to see if you have, decolonization w/ mupiricin if have it (intranasally BID for 5 days)

if emergency: dont give decolonization, dont screen

33
Q

Antimicrobial admin for Initiation

A

Cefazolin or betalactams = within 60min incision
Fluoroquinolone or van = 120 min of incision

34
Q

Antimicrobial reducing during surgery

A

usually done if procedure exceeds 2-6hrs ( >4 reconsider)

additional consideration for excessive blood loss (>1.5L) or extensive burns

35
Q

Antimicrobial D/c after surgery

A

should occur within 24hrs of surgery, 48hrs for cardio thoracic**

36
Q

Cefazolin pediatric dosing

A

30mg/kg

37
Q

Cefazolin adults

A

2g or 3g if pt > 120kg

redone after 4hrs

38
Q

Vanco pediatric and adult dosing

A

15mg/kg

CDM 3 Exam 1 (10 decks)

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