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ID PHARM 152 > Skin And Soft Tissue Infection > Flashcards

Skin And Soft Tissue Infection Flashcards

1
Q

Categories of SSTIs

A

Purulent
Non Purulent

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2
Q

Define cellulitis

A

Initially affects epidermis and dermis
May spread within superficial fascia
May spread through lymphatic tissue and bloodstream

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3
Q

Sx of cellulitis

A

Affected area hot and painful
Erythema and edema of skin
Fevers chills, malaise
Often history of antecedent minor trauma, abrasion, ulcer or surgery

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4
Q

Microorganisms that cause cellulitis

A

GAS ]
Staphylococcus aureus
MSSA
MRSA
CA-MRSA
HCA-MRSA

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5
Q

Microorganisms of non Purulent

A

Think predominantly strep

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6
Q

Microorganisms for Purulent

A

Predominantly staph

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7
Q

Risk factors for CA-MRSA

A

CDC 5 C
Age <2 and >65 yrs
Atheletes
Men who have sex with men
Living in correctional facilities
History of colonization
Antibiotic use in last 6 months

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8
Q

What is the CDC 5 C’s

A

Crowding
Frequent skin contact
Compromised skin
Sharing contaminated personal items
Lack of cleanliness

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9
Q

More risk factors

A

Recent invasive procedures
IV drug use
Military personnel
Homeless persons
Prior hospitalization for SSTI
Trauma associated

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10
Q

When should you cover for MRSA

A

Pt has been around CA-MRSA
CA-MRSA risk factors
Lack of improvement on beta-lactation
Clinical judgement

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11
Q

First choice for Non Purulent cellulitis antibiotic

A

Cephalexin

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12
Q

What is the dose for cephalexin
Adults
Peds

A

500 mg po QID
50-100 mg/kg/d QID

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13
Q

What to keep in mind for cephalexin

A

100% GAS isolated in Saskatoon and Regina
Will not cover MRSA
QID may be difficult for compliance

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14
Q

Non Purulent for pen allergies

A

Clindamycin
Or
Erythromycin

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15
Q

What is the dose for clindamycin?
Adult
Peds

A

300 mg Po QID
450 mg po TID

20-40 mg/kg/d TID or QID

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16
Q

What is non Purulent dose for erythromycin?
Adult
Peds

A

250 mg QID
500 mg BID

30-40 mg/kg/d BID

17
Q

What to keep in mind about erythromycin to non Purulent?

A

Resistance in SHR 12% GAS
Resistance in RQHR 7% GAS

18
Q

First choice for Purulent cellulitis MSSA

A

Cephalexin
Cloxacillin

19
Q

Dose for Purulent cellulitis for MSSA for cloxacillin

A

500 mg QID
50 mg/kg/d QID

20
Q

What to keep in mind for cloxacillin for MSSA?

A

100% of MSSA isolates in SHR and RQHR

21
Q

Purulent Cellulitis MRSA for Pen Allergy

A

TMP/SMX
Doxycycline

22
Q

Dose for TMP/SMX for Purulent cellulitis MRSA

A

1-2 DS tab po BID

8-12mg/kg/day BID (TMP)

23
Q

What to keep in mind for TMP/SMX for MRSA?

A

~96% MRSA sensitive

24
Q

Dose for doxycycline for MRSA for Purulent cellulitis

A

100 mg BID
4 mg/kg/day BID

25
Q

What is the resistance to doxycycline for MRSA Purulent cellulitis

A

97-99%

26
Q

What is the problem with clindamycin and MRSA (Purulent cellulitis)

A

Resistance with MRSA is a problem
73% (Saskatoon)
84% Regina

27
Q

Empiric Therapy for GAS and MRSA

A

Cephalexin plus TMP/SMX
OR cephalexin plus doxycycline
Requires two antibiotics because cephalexin covers GAS but not MRSA
TMP/SMX and doxycycline have poor coverage for GAS but cover MRSA
Clindamycin potentially covers both however MRSA resistance rates are high

28
Q

What is the duration of therapy for uncomplicated cellulitis?

A

5 days of therapy is as effective as 10 days

29
Q

How long for uncomplicated cellulitis will the skin fully heal?

A

1-2 weeks after antibiotics are stopped

30
Q

What to keep in mind for uncomplicated cellulitis?

A

May worsen in first few days
This is part of the healing process and not tx failure

31
Q

What are some non pharmacological therapy?

A

Incision and Drainage
Elevation of affected limb

32
Q

Explain incision and drainage

A

Key to successful treatment of Purulent skin infections
For abscess < 5 cm this alone is adequate
Antibiotics will not help it heal faster

33
Q

Explain elevation of affected limb

A

Often essential for successful cellulitis therapy

34
Q

What are parameters you would use to monitor the pt?

A

Better at the 5 day point
Decrease in size or shape
Less pain and no fever
Follow up with pt

35
Q

What information would you provide to the pt?

A

Let them know that it will not be cured when you are done antibiotics (1-2 was after)
It will get worst before it gets better

ID PHARM 152 (11 decks)

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