Lecture 9 - Skin/Soft tissue Infections & Surgical Prophylaxis Flashcards
ABSSSI
Acute bacterial skin and skin structure infection
bacterial infection of the skin with a lesion size area of atleast 75cm
Cellulitis/Erysipelas
Diffuse skin infection characterized by spreading areas of redness, edema and/or induration
Wound infection
infection characterized by purulent drainage from a wound with surrounding redness, edema, and or induration
Major cutaneous absces
infection characterized by a collection of pus within the dermis or deeper that is accompanied by redness, edema and/or induration
What is impetigo
initialy papule that may progress to vesicles and pustules that rupture, later forming yellow-crust discharge that causes superficial skin infeciton
Impetigo etiology and info
most cases occur in kids, annual incidence 1-2%
Staph aureus + Group A strep
Bullous vs Nonbullous impetigo
Bullous worse, fluid filled vesicles that leak shit
Impetigo Treatment
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
Cellulitis info & Etiology
Etiology: Grp A strep, other “Grouped” strep, Staph aureus
systemic disease
Acute spreading infection of skin that extends to involve subcutaneous tissues
When should coverage against MRSA be considered for Cellulitis?
penetrating trauma, IV Drug use, purulent drainage, or previous/concurrent MRSA infection
What are systemic symptoms?
Temp < 36 or > 38
HR > 90
RR > 20 or PaCO < 32
Altered or deteriorated mental stauts
Class I Cellulitis treatment
Oral ABX
5-7 day duration
PCN VK, Cephalosporin, Diclox, Clinda
Class II Cellulitis treatment
IV ABX initially, transitioned to oral to complete course maybe
7-14 day duration
PCN, Ceftriaxone, Cefazolin, Clinda
Class III & IV Cellulitis Treatment
IV ABX w/ broader coverage due to severity of illness for class IV
14 day min duration
Vancomycin + Pip/Tazo = severe
Non-purulent SSTI Cellulitis Txm
PCN
Clinda
Nafcillin
Cefazolin
PCN VK
Cephalexin
MSSA SSTI cellulitis txm
Nafcillin or oxacillin
Cefazolin
Clindamycin
Dicloxacillin
Cephalexin
Doxy, mino
Tmp/Smx
MRSA SSTI cellulitis Txm
Vanco
Linezolid
Clinda
Dapto
Ceftaroline
Doxy, Mino
Tmp/Smx
Diabetic foot infection possible pathogens
Gram + = S aureus, Enterococci, Streptococci
Gram - = Enterobacter, Acinetobacter, Pseudomonas
Anaerobes = Bacteroids, peptococcus
Diabetic foot infection, Mild to moderate…
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
Diabetic foot infection, Severe or those with risk factors
Expanded coverage, including resistant organisms
IV therapy to start, can transition to Oral or continue IV
Typical duration for Diabetic foot infection
7-14 days
2-6 weeks for bone infection
wound healing can take months
Mild/PEDIS grade 1/2 Txm
non-limb threading
oral Clinda, cephalosporins, or dicloxacillin
duration: 7-14 days
Moderate/PEDIS Grade 3 txm
similar to mild but stronger considerations for IV
Cefazolin, Clinda or vancomycin IV for those with pcn allergy
duration: 10-14 days
Severe/PEDIS Grade 4 Txm
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
Type 1 Necrotizing fasciitis
polymicrobial
atleast 1 anaerobic organism (most common Bacteroids or peptostrep)
Facultative anaerobes (B hemolytic strep)
Enterobacteriaceae
Type 2 Necrotizing fasciitis
Monomicrobial or polymicrobial
Grp A strep alone or combo w/ other species (most common S.aureus)
can be severe due to toxin producing strains
empiric Treatment for Necrotizing Fasciitis
Surgery to remove necrosis
Pip/tazo, carbapenem, 3/4 Gen Ceph + metronidazole
+ Vancomycin/linezolid/dapto + clinda
narrow therapy after cultures back
Animal bite prophylactic treatment
3-5 days
Amox/clav 875/125 q12h or 500/125 q8h
2nd line = Doxy, Levo, Bactrim, Cefuroxime + metronidazole/clinda
rabies & tetanus vaccine consider
Animal bite treatment
Duration typically 5-14 days
consider MRSA if risk factors or failure
same as prophylaxis treatment
Human bite treatment
amoxicilli/clav 875/125 q12h
amp/sulbactam 1.5-3 q6h
Risk factors for Surgical site infection
Age/Hx of radiation or skin infection
Immune status*
Nutritional status*
Neutropenia**
Immunosuppresives**
Surgery sites
Management of Pre-op MRSA
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
Antimicrobial admin for Initiation
Cefazolin or betalactams = within 60min incision
Fluoroquinolone or van = 120 min of incision
Antimicrobial reducing during surgery
usually done if procedure exceeds 2-6hrs ( >4 reconsider)
additional consideration for excessive blood loss (>1.5L) or extensive burns
Antimicrobial D/c after surgery
should occur within 24hrs of surgery, 48hrs for cardio thoracic**
Cefazolin pediatric dosing
30mg/kg
Cefazolin adults
2g or 3g if pt > 120kg
redone after 4hrs
Vanco pediatric and adult dosing
15mg/kg
