Skin And Soft Tissue Flashcards
signs and symptoms of systemic toxicity
- Fever or hypothermia
- tachycardia
- hypotension
treatment for outpatients with mild-moderate SSTI’s
empiric treatment: check pt 24-48 hours
- PCN
- cephalosporins
- and/or clindamycin
what is the outer most protective layer of the skin?
stratum corneum
Define PRIMARY skin infection
involves normal healthy skin
- typically one pathogen
Define SECONDARY skin infection
Involves damaged skin
- polymicrobial
ex: Bed ridden patients typically get bed sores/ulcers–> these get infected
5 factors for infections
- breakdown of skin integrity
- vascular insufficiency
- indwelling devices
- immunocompromised
- poor hygiene
Describe an uncomplicated SSTI and list the 5 types.
- Typically mild, superficial
1. folliculitis
2. fruncles
3. carbuncles
4. impetigo
5. uncomplicated cellulitis
what is folliculitis
superficial infection surrounding the hair follices
- inflammaed
what are the pathogens associated with folliculitis
staph aureus
pseudomonas aeruginosa
Where are people prone to getting psuedomonas folliculitis and why?
in the hot tub bc pseudomonas are water loving bugs
Clinical presentations of folliculitis
- papules: 48 hrs after exposure
- –> maybe pus
- multiple clustered lesions
- pruritis possibly —> swimmer’s itch
what are the two local managemnt topical therapy options for folliculitis
- Warm saline compresses
- Topical antimicrobials
what are topical antimicrobial options for folliculitis
- clindamycin
- erythromycin
- mupirocin ( bactroban)
- Gentamicin (pseudomonas)
- antifungals (candida sp.)
what topical antimicrobial is used for pseud. (brand/generic) biotches
mupirocin (BACTROBAN)
is folliculiitis a progressive infection?
NO derpp
Define Furuncle. aka….
Boils. inflammatory nodule involving a hair follicle
—> extension of folliculitis from hair shaft to dermis
where are furuncles present? more common?
anywhere on hairy skin. more common in areas of friction and perspiration.
who’s is the loosest?
Kori’s bahahaha
Define carbuncles?
furuncle extended to the subcutaneous tissue. a cluster of subcutaneous abscesses.
systemic symptoms of carbuncles
fever, chills, malaise, bacteremia
what bacteria is most likely the cause of carbuncles and furuncles. from where does it enter the body?
staph.
nasal carriage
Where are carbuncles typically present
back of the neck
treatment options for carbuncles and furuncles
- moist heat —> drainage
- surgical incision to drain (large/multiple)
- Oral ABX therapy 5-10 days
When will you use ABX for furuncles and carbuncles
if fever or extensive cellulitis documented
what ABX for carbuncles or furuncles?
dicloxicillin
clindamycin (DOC for PCN allergy)
cephalexin
what Antibacterial soaps help to prevent a recurrence of furuncles or carbuncles
- clorhexidine
- hexachloraphene
what intranasal ABX help to prevent a recurrence of furuncles or carbuncles
- Mupirocin ointment for nasal carriage
- Bacitracin
What oral antibiotic is given to prevent a recurrence? is it given prophylactically?
No. CLINDAMYCIN is given when theres an outbreak
Nickname of Erysipelas
Saint Anthony’s Fire
What is erysipelas?
acute spreading skin infection.
- –>involves the superficial dermis and lymphatics
- –> spreads rapidly causing impaired lymphatic drainage.
What are the common pathogens that cause erysipelas?
Group A & B streptococcus
erysipelas caused by group b strep is commonly present in what type of people?
Newborns
who is more prone to erysipelas?
- infants
- young children
- old people
- pts with nephrotic syndrome
where on the body is erysipelas present?
lower extremities and sometimes face (around the eyes)
describe the rash of erysipelas?
bright red, edematous (edema), indurated (hard) and demarcated (boundary), painful, elevated border (different from cellulitis)
Common signs of erysipelas
fever and leukocytosis
Mild to moderate uncomplicated erysipelas treatment
- Procaine PCN G
- PCN VK
- PCN allergy
- Clindamycin (7-10 days)
Serious complicated erysipelas treatment
-Aqueous PCN
define impetigo?
superficial vesticulopustular skin infection
where does impetigo occur?
on exposed area of the face and extremities
what pathogens causes impetigo?
staph aureus and or group A strept
what are common causes of impetigo?
- warm climates
- poor hygiene
- minor skin trauma
name the three types of impetigo
- non bullous
- bullous
- Ecthyma
Describe Non-bullous impetigo.
most common form that begin as papules and progress to vesicles surrounded by erythema
describe bullous impetigo. (compare to nonbullous, what pathogen?)
fewer lesions when compared to nonbullous, commonly on the trunk, forms bullae that rupture into light brown crusts, caused by S. AUREUS but not MRSA
Describe ecythema impetigo and what pathogen causes it
ulcerative impetigo caused by group A STREPTOCOCCI
takes place in the epidermis and dermis
explain how impetigo manifests
start of small fluid filled vesicles, they rupture leading to crusty golden yellow lesions.
treatment of impetigo for small # of lesions w/o bullae
DOC: topical mupirocin 2% ointment
- retapamulin 1% ointment ( for MRSA resistance)
treatment for impetigo for numerous lesions or not responding to topical therapy
- dicloxacillin
- cephalexin or cefadroxil (1st generations)
- clindamycin
what medications are resistant and should be avoided for impetigo
FQ and macrolides
What is cellulitis
acute infection that spreads from epidermis to deep to deep into the dermis
the most important clinical presentations of cellulitis
area RED HOT & SWOLLEN
what are the two common pathogens that cause cellulitis
staph aureus and strep pyogenes
describe cellulitis caused by staph aureus
pus producing slow moving ---> VERY VIRULENT PORTAL OF ENTRY positive cultures moderate pain no lymphatic streaking
describe cellulitis caused by strep pyogenes
limited pus advances rapidly dark red pigmentation no portal entry rarely positive cultures EXTREMELY PAINFUL lymphatic streaking---> bacteria spreads through the bloodstream and you see it travelling through the lymphs to your heart
non-pharm therapy for cellulitis
proper local wound care is essential
pus must be removed if present
Cellulitis empiric treatment (mild-mod gram + w/o systemic symptoms) oral, IV, PCN allergy
Oral: - dicloxacillin (anti-staph) OR cephalexin (1st)
IV : (if systemic symptoms present)
- Nafcillin (anti-staph) OR cefazolin (1st)
PCN allergy: cephalexin
cefazolin
clindamycin
Cellulitis empiric treatment (polymicrobial and anaerobes)oral, IV, PCN allergy
Oral: Augmentin OR Bactrim
IV: Nafcillin OR Unasyn
PCN: FQ +/- clindamycin
AG +clindamycin
Cellulitis empiric treatment (mod - severe)
IV ONLY
zosyn OR timentin (cover pseudomonas)
Carbapenems +/- vancomycin (to cover MRSA)
gram negative cellulitis treatment
give 3rd generation cephalosporin OR FQ
PCN allergy: FQ plus clindamycin or vancomycin
Risk factors for CA-MRSA
HX of MRSA high prevalence in community crowded living contact sports shaving
list medications for severe MRSA
IV ONLY daptomycin (use when breakpoint <1) tigecycline (not for bacteremia) linezolid quinupristin/dalfopristin vancomycin (preferred for severe cases) (DOC for HA MRSA) telavancin
list medications for mild MRSA
PO only
Bactrim (if clinda resistant) (give Beta lactam also if
----> used for community acquired
cellulitis present)
clindamycin
doxycycline
rifampin (ADD on ONLY)types of complicated SSTIs (CSSTIs)
Deep tissue infection
- abscesses
- necrotizing wounds(cellulitis and fascilitis)
- bites
- burns
- surgical wounds
- ulcers
abscess treatment and pathogens that cause them
drainage
IVDU ( staph, strep, pseudomonas,oral anaerobes)
consider CA MRSA
describe Necrotizing fascitis (type 1 and 2)
progressive fatal flesh eating bacteria
type 1: polymicrobial (mixed anaerobic/aerobic)
type 2: Group A strep
—-> associated with toxic shock syndrome
Treatment of necrotizing fascitis type 1 and 2
aggressive surgical intervention
empiric IV ABX
Type 1: carbapenems or BLBLI
3rd gen. ceph + clinda or metronidazole
FQ (cipro) + clinda or metronidazole
ADD vanco maybe for MRSA
Type2: high dose PCN plus Clinda
Empiric treatment for diabetic foot inf (Mild)
1st generation ceph
amox/clav acid
TMP/SMX
FQs
Empiric treatment for diabetic foot inf (Severe)
ischemia present - wound debridement/amputation carbapenems or BLBLI \+/- vanco, linezolid, dapto ----> metronidazole or clindamycin + 3rd/4th ceph OR FQs
