Skin And Soft Tissue Infection

Question 1

Categories of SSTIs

Answer 1

Purulent
Non Purulent

Question 2

Define cellulitis

Answer 2

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

Question 3

Sx of cellulitis

Answer 3

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

Question 4

Microorganisms that cause cellulitis

Answer 4

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

Question 5

Microorganisms of non Purulent

Answer 5

Think predominantly strep

Question 6

Microorganisms for Purulent

Answer 6

Predominantly staph

Question 7

Risk factors for CA-MRSA

Answer 7

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

Question 8

What is the CDC 5 C’s

Answer 8

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

Question 9

More risk factors

Answer 9

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

Question 10

When should you cover for MRSA

Answer 10

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

Question 11

First choice for Non Purulent cellulitis antibiotic

Answer 11

Cephalexin

Question 12

What is the dose for cephalexin
Adults
Peds

Answer 12

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

Question 13

What to keep in mind for cephalexin

Answer 13

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

Question 14

Non Purulent for pen allergies

Answer 14

Clindamycin
Or
Erythromycin

Question 15

What is the dose for clindamycin?
Adult
Peds

Answer 15

300 mg Po QID
450 mg po TID

20-40 mg/kg/d TID or QID

Question 16

What is non Purulent dose for erythromycin?
Adult
Peds

Answer 16

250 mg QID
500 mg BID

30-40 mg/kg/d BID

Question 17

What to keep in mind about erythromycin to non Purulent?

Answer 17

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

Question 18

First choice for Purulent cellulitis MSSA

Answer 18

Cephalexin
Cloxacillin

Question 19

Dose for Purulent cellulitis for MSSA for cloxacillin

Answer 19

500 mg QID
50 mg/kg/d QID

Question 20

What to keep in mind for cloxacillin for MSSA?

Answer 20

100% of MSSA isolates in SHR and RQHR

Question 21

Purulent Cellulitis MRSA for Pen Allergy

Answer 21

TMP/SMX
Doxycycline

Question 22

Dose for TMP/SMX for Purulent cellulitis MRSA

Answer 22

1-2 DS tab po BID

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

Question 23

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

Answer 23

~96% MRSA sensitive

Question 24

Dose for doxycycline for MRSA for Purulent cellulitis

Answer 24

100 mg BID
4 mg/kg/day BID

Question 25

What is the resistance to doxycycline for MRSA Purulent cellulitis

Answer 25

97-99%

Question 26

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

Answer 26

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

Question 27

Empiric Therapy for GAS and MRSA

Answer 27

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

Question 28

What is the duration of therapy for uncomplicated cellulitis?

Answer 28

5 days of therapy is as effective as 10 days

Question 29

How long for uncomplicated cellulitis will the skin fully heal?

Answer 29

1-2 weeks after antibiotics are stopped

Question 30

What to keep in mind for uncomplicated cellulitis?

Answer 30

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

Question 31

What are some non pharmacological therapy?

Answer 31

Incision and Drainage Elevation of affected limb

Question 32

Explain incision and drainage

Answer 32

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

Question 33

Explain elevation of affected limb

Answer 33

Often essential for successful cellulitis therapy

Question 34

What are parameters you would use to monitor the pt?

Answer 34

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

Question 35

What information would you provide to the pt?

Answer 35

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