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Skin & Soft Tissue Infection > Skin And Soft Tissue > Flashcards

Skin And Soft Tissue Flashcards

1
Q

signs and symptoms of systemic toxicity

A
  • Fever or hypothermia
  • tachycardia
  • hypotension
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2
Q

treatment for outpatients with mild-moderate SSTI’s

A

empiric treatment: check pt 24-48 hours

  • PCN
  • cephalosporins
  • and/or clindamycin
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3
Q

what is the outer most protective layer of the skin?

A

stratum corneum

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4
Q

Define PRIMARY skin infection

A

involves normal healthy skin

- typically one pathogen

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5
Q

Define SECONDARY skin infection

A

Involves damaged skin

  • polymicrobial
    ex: Bed ridden patients typically get bed sores/ulcers–> these get infected
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6
Q

5 factors for infections

A
  1. breakdown of skin integrity
  2. vascular insufficiency
  3. indwelling devices
  4. immunocompromised
  5. poor hygiene
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7
Q

Describe an uncomplicated SSTI and list the 5 types.

A
  • Typically mild, superficial
    1. folliculitis
    2. fruncles
    3. carbuncles
    4. impetigo
    5. uncomplicated cellulitis
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8
Q

what is folliculitis

A

superficial infection surrounding the hair follices

- inflammaed

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9
Q

what are the pathogens associated with folliculitis

A

staph aureus

pseudomonas aeruginosa

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10
Q

Where are people prone to getting psuedomonas folliculitis and why?

A

in the hot tub bc pseudomonas are water loving bugs

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11
Q

Clinical presentations of folliculitis

A
  • papules: 48 hrs after exposure
  • –> maybe pus
  • multiple clustered lesions
  • pruritis possibly —> swimmer’s itch
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12
Q

what are the two local managemnt topical therapy options for folliculitis

A
  • Warm saline compresses

- Topical antimicrobials

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13
Q

what are topical antimicrobial options for folliculitis

A
  • clindamycin
  • erythromycin
  • mupirocin ( bactroban)
  • Gentamicin (pseudomonas)
  • antifungals (candida sp.)
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14
Q

what topical antimicrobial is used for pseud. (brand/generic) biotches

A

mupirocin (BACTROBAN)

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15
Q

is folliculiitis a progressive infection?

A

NO derpp

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16
Q

Define Furuncle. aka….

A

Boils. inflammatory nodule involving a hair follicle

—> extension of folliculitis from hair shaft to dermis

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17
Q

where are furuncles present? more common?

A

anywhere on hairy skin. more common in areas of friction and perspiration.

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18
Q

who’s is the loosest?

A

Kori’s bahahaha

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19
Q

Define carbuncles?

A

furuncle extended to the subcutaneous tissue. a cluster of subcutaneous abscesses.

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20
Q

systemic symptoms of carbuncles

A

fever, chills, malaise, bacteremia

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21
Q

what bacteria is most likely the cause of carbuncles and furuncles. from where does it enter the body?

A

staph.

nasal carriage

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22
Q

Where are carbuncles typically present

A

back of the neck

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23
Q

treatment options for carbuncles and furuncles

A
  • moist heat —> drainage
  • surgical incision to drain (large/multiple)
  • Oral ABX therapy 5-10 days
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24
Q

When will you use ABX for furuncles and carbuncles

A

if fever or extensive cellulitis documented

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25
Q

what ABX for carbuncles or furuncles?

A

dicloxicillin
clindamycin (DOC for PCN allergy)
cephalexin

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26
Q

what Antibacterial soaps help to prevent a recurrence of furuncles or carbuncles

A
  • clorhexidine

- hexachloraphene

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27
Q

what intranasal ABX help to prevent a recurrence of furuncles or carbuncles

A
  • Mupirocin ointment for nasal carriage

- Bacitracin

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28
Q

What oral antibiotic is given to prevent a recurrence? is it given prophylactically?

A

No. CLINDAMYCIN is given when theres an outbreak

29
Q

Nickname of Erysipelas

A

Saint Anthony’s Fire

30
Q

What is erysipelas?

A

acute spreading skin infection.

  • –>involves the superficial dermis and lymphatics
  • –> spreads rapidly causing impaired lymphatic drainage.
31
Q

What are the common pathogens that cause erysipelas?

A

Group A & B streptococcus

32
Q

erysipelas caused by group b strep is commonly present in what type of people?

A

Newborns

33
Q

who is more prone to erysipelas?

A
  • infants
  • young children
  • old people
  • pts with nephrotic syndrome
34
Q

where on the body is erysipelas present?

A

lower extremities and sometimes face (around the eyes)

35
Q

describe the rash of erysipelas?

A

bright red, edematous (edema), indurated (hard) and demarcated (boundary), painful, elevated border (different from cellulitis)

36
Q

Common signs of erysipelas

A

fever and leukocytosis

37
Q

Mild to moderate uncomplicated erysipelas treatment

A
  • Procaine PCN G
  • PCN VK
  • PCN allergy
  • Clindamycin (7-10 days)
38
Q

Serious complicated erysipelas treatment

A

-Aqueous PCN

39
Q

define impetigo?

A

superficial vesticulopustular skin infection

40
Q

where does impetigo occur?

A

on exposed area of the face and extremities

41
Q

what pathogens causes impetigo?

A

staph aureus and or group A strept

42
Q

what are common causes of impetigo?

A
  • warm climates
  • poor hygiene
  • minor skin trauma
43
Q

name the three types of impetigo

A
  • non bullous
  • bullous
  • Ecthyma
44
Q

Describe Non-bullous impetigo.

A

most common form that begin as papules and progress to vesicles surrounded by erythema

45
Q

describe bullous impetigo. (compare to nonbullous, what pathogen?)

A

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

46
Q

Describe ecythema impetigo and what pathogen causes it

A

ulcerative impetigo caused by group A STREPTOCOCCI

takes place in the epidermis and dermis

47
Q

explain how impetigo manifests

A

start of small fluid filled vesicles, they rupture leading to crusty golden yellow lesions.

48
Q

treatment of impetigo for small # of lesions w/o bullae

A

DOC: topical mupirocin 2% ointment

- retapamulin 1% ointment ( for MRSA resistance)

49
Q

treatment for impetigo for numerous lesions or not responding to topical therapy

A
  • dicloxacillin
  • cephalexin or cefadroxil (1st generations)
  • clindamycin
50
Q

what medications are resistant and should be avoided for impetigo

A

FQ and macrolides

51
Q

What is cellulitis

A

acute infection that spreads from epidermis to deep to deep into the dermis

52
Q

the most important clinical presentations of cellulitis

A

area RED HOT & SWOLLEN

53
Q

what are the two common pathogens that cause cellulitis

A

staph aureus and strep pyogenes

54
Q

describe cellulitis caused by staph aureus

A 
pus producing
slow moving ---> VERY VIRULENT
PORTAL OF ENTRY
positive cultures
moderate pain
no lymphatic streaking
55
Q

describe cellulitis caused by strep pyogenes

A 
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
56
Q

non-pharm therapy for cellulitis

A

proper local wound care is essential

pus must be removed if present

57
Q

Cellulitis empiric treatment (mild-mod gram + w/o systemic symptoms) oral, IV, PCN allergy

A

Oral: - dicloxacillin (anti-staph) OR cephalexin (1st)
IV : (if systemic symptoms present)
- Nafcillin (anti-staph) OR cefazolin (1st)
PCN allergy: cephalexin
cefazolin
clindamycin

58
Q

Cellulitis empiric treatment (polymicrobial and anaerobes)oral, IV, PCN allergy

A

Oral: Augmentin OR Bactrim
IV: Nafcillin OR Unasyn
PCN: FQ +/- clindamycin
AG +clindamycin

59
Q

Cellulitis empiric treatment (mod - severe)

A

IV ONLY
zosyn OR timentin (cover pseudomonas)
Carbapenems +/- vancomycin (to cover MRSA)

60
Q

gram negative cellulitis treatment

A

give 3rd generation cephalosporin OR FQ

PCN allergy: FQ plus clindamycin or vancomycin

61
Q

Risk factors for CA-MRSA

A 
HX of MRSA
high prevalence in community
crowded living 
contact sports
shaving
62
Q

list medications for severe MRSA

A 
IV ONLY
daptomycin (use when breakpoint <1)
tigecycline (not for bacteremia)
linezolid 
quinupristin/dalfopristin
vancomycin (preferred  for severe cases) (DOC for HA MRSA)
telavancin
63
Q

list medications for mild MRSA

A 
PO only 
Bactrim (if clinda resistant) (give Beta lactam also if 
    ----> used for community acquired 
cellulitis present)
clindamycin
doxycycline
rifampin (ADD on ONLY)
64
Q

types of complicated SSTIs (CSSTIs)

A

Deep tissue infection

  • abscesses
  • necrotizing wounds(cellulitis and fascilitis)
  • bites
  • burns
  • surgical wounds
  • ulcers
65
Q

abscess treatment and pathogens that cause them

A

drainage
IVDU ( staph, strep, pseudomonas,oral anaerobes)
consider CA MRSA

66
Q

describe Necrotizing fascitis (type 1 and 2)

A

progressive fatal flesh eating bacteria
type 1: polymicrobial (mixed anaerobic/aerobic)
type 2: Group A strep
—-> associated with toxic shock syndrome

67
Q

Treatment of necrotizing fascitis type 1 and 2

A

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

68
Q

Empiric treatment for diabetic foot inf (Mild)

A

1st generation ceph
amox/clav acid
TMP/SMX
FQs

69
Q

Empiric treatment for diabetic foot inf (Severe)

A 
ischemia present
- wound debridement/amputation
carbapenems or BLBLI
\+/- vanco, linezolid, dapto
----> metronidazole or clindamycin + 3rd/4th ceph OR FQs

Skin & Soft Tissue Infection (1 decks)

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