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Antibiotics > Skin and Soft Tissue Infection > Flashcards

Skin and Soft Tissue Infection Flashcards

1
Q

What are the types of SSTI at the corresponding sites: epidermis, dermis, hair follicles, s/c fat, fascia, muscle

A

Epidermis: impetigo
Dermis: ecthyma, erysipelas
Hair follicles: folliculitis, furuncles, carbuncles
s/c fat: cellulitis
Fascia: necrotising fasciitis
Muscle: myositis

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2
Q

Normal pH of skin (and why) and how does it act as a chemical barrier?

A

pH 4-5 (acidic) -> due to production of free fatty acids from phospholipids
Chemical barrier: keeps bacteria and Candida low by regulating desquamation and resident bacteria

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3
Q

Is blood flow to the skin important?

A

Yes -> for immunity

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4
Q

What are 5 non-traumatic disruptions that increase risk of SSTI?

A

Ulcer, tinea pedis, dermatitis, toe web intertrigo, chemical irritants

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5
Q

What conditions predispose a person to SSTI?

A

Diabetes, cirrhosis, neutropenia, HIV, transplantation and immunosuppressive medications

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6
Q

Where should wound culture samples be collected from? Should a wound swab be done?

A
  • deep in the wound after surface cleansed
  • from the base of a closed abscess where bacteria grow
  • by curettage

no wound swabs -> difficult to obtain representative sample

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7
Q

Progression of impetigo?

A

Begin as erythematous papules -> vesicles and pustules -> rupture -> dried discharge forms honey-coloured crusts

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8
Q

What is a furuncle and carbuncle?

A

Furuncle: boil
Carbuncle: cluster of furuncles

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9
Q

When is blood culture done for SSTI?

A

Immunocompromised patients or when patients show systemic symptoms (e.g. fever)

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10
Q

Difference between erysipelas and cellulitis?

A

Erysipelas affects upper dermis and has well-demarcated edges, raised, more common on face & lower extremities

Cellulitis affects s/c fat, poorly demarcated, non-elevated, more common on lower extremities

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11
Q

What does increased lactate levels suggest?

A

Tissue/organ underperfusion, possible tissue necrosis

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12
Q

In which condition does creatinine phosphokinase increase?

A

Myonecrosis, necrotising fasciitis
(CPK high means muscle, heart or brain injury)

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13
Q

What is the likely pathogen causing impetigo?

A

Staphylococci or streptococci
(bullous form caused by toxic-producing strains of S. aureus)

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14
Q

What is the likely pathogen causing ecthyma?

A

Group A Streptococci

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15
Q

What is the likely pathogen causing non-purulent skin conditions?

A

Beta-haemolytic streptococcus (Group A, B); usually Group A (Strep pyogenes)

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16
Q

What is the most likely pathogen causing purulent skin conditions?

A

S aureus, some beta-hemolytic streptococcus

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17
Q

What colour will S aureus look like on a culture plate?

A

Golden yellow

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18
Q

What type of bacteria are more common in skin abscesses involving the peri oral, perirectal or vulvovaginal area?

A

gram -ve, anaerobes

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19
Q

Treatment for impetigo with mild limited lesions? and duration

A

Topical mupirocin BD x 5 days

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20
Q

Treatment for impetigo and ecthyma (empiric)? and duration

A

PO cephalexin or cloxacillin
If penicillin allergy: PO clindamycin
Duration: 7 days

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21
Q

Treatment for impetigo and ecthyma (culture-directed) for S pyogenes and MSSA? and duration

A

S pyogenes: PO penicillin V, amoxicillin
MSSA: PO cephalexin, cloxacillin
Duration: 7 days

22
Q

Treatment (empiric) for mild purulent infection?

A

Incision and drainage or warm compress

23
Q

What is considered purulent skin infections?

A

Furuncles, carbuncles, skin accesses, purulent cellulitis

24
Q

What is considered non-purulent skin infections?

A

Cellulitis, erysipelas

25
Q

Treatment (empiric) for moderate (with systemic symptoms) purulent infection?

A

Incision and drainage + PO cloxacillin / cephalexin / clindamycin (if penicillin allergy)

26
Q

Treatment (empiric) for severe purulent infection?

A

Incision and drainage + IV cloxacillin / cefazolin / clindamycin (if penicillin allergy) / vancomycin (last line)

27
Q

Treatment (empiric) for MRSA purulent infection?

A

PO/IV co-trimoxazole, PO doxycycline, PO/IV clindamycin, IV vancomycin, IV daptomycin, IV linezolid

28
Q

Duration of treatment for purulent infections?

A

5-10 days

29
Q

Treatment (empiric) for gram -ve and anaerobe purulent infection?

A

PO/IV augmentin

30
Q

Treatment (empiric) for mild non-purulent infection? What are you mainly covering for?

A

PO penicillin V, cephalexin, cloxacillin, clindamycin (if penicillin allergy)
[cover strep pyogenes]

31
Q

Treatment (empiric) for moderate non-purulent infection (systemic signs of infection)? What are you mainly covering for?

A

IV cefazolin, clindamycin (if penicillin allergy)
[cover MSSA, strep pyogenes]

32
Q

Treatment (empiric) for severe non-purulent infection (failed PO therapy, immunocompromised, systemic signs of infection)? What are you mainly covering for?

A

IV pip-tazo, cefepime, meropenem
if have MRSA risk factor: add IV vancomycin, daptomycin, linezolid
[broader coverage]

33
Q

Duration of treatment for non-purulent infections?

A

5-10 days
14 days if immunocompromised

34
Q

What does mupirocin cover?

A

Aerobic gram +ve esp S aureus

35
Q

Non-pharm for non-purulent skin infections?

A

Rest, limb elevation (drain edema, inflammatory substances), treat underlying conditions (tinea pedis, dermatitis etc)

36
Q

What 3 components make up the pathophysiology of diabetic foot infections?

A

Neuropathy, vasculopathy, immunopathy

37
Q

What bacteria are involved in diabetic foot infections / pressure ulcers?

A

Polymicrobial
- Most common: S aureus, strep
- Gram -ve (esp in chronic wounds or prev treated with abx): E coli, Klebsiella, Proteus
- Anaerobes (esp in ischaemic/necrotic wounds)

38
Q

Do you culture uninfected wounds?

A

No

39
Q

What to cover for mild, moderate and severe diabetic foot infections / pressure ulcers?

A

Mild: Strep, S aureus
Moderate: strep, S aureus, gram -ve (+- pseudomonas), anaerobes
Severe: strep, S aureus, gram -ve (+ pseudomonas), anaerobes

40
Q

What is considered mild, moderate and severe diabetic foot infections / pressure ulcers?

A

Mild: skin & SC tissue infection, erythema ≤2cm around ulcer, no signs of systemic infection
Moderate: deeper tissue infection (bone, joint), erythema >2cm around ulcer, no signs of systemic infection
Severe: same as moderate but have signs of systemic infection

41
Q

What is used to treat mild diabetic foot infections / pressure ulcers?

A

PO cephalexin, cloxacillin, clindamycin (if penicillin allergy)

if have MRSA risk factor: PO co-trimoxazole, clindamycin, doxycycline, levofloxacin, moxifloxacin

42
Q

What is used to treat moderate diabetic foot infections / pressure ulcers?

A

IV augmentin, cefuroxime/ceftriaxone + metronidazole

if have MRSA risk factor: IV vancomycin, daptomycin, linezolid

43
Q

What is used to treat severe diabetic foot infections / pressure ulcers?

A

IV pip-tazo, cefepime + metronidazole, meropenem

if have MRSA risk factor: IV vancomycin, daptomycin, linezolid

44
Q

Duration of treatment for diabetic foot infections / pressure ulcers?

No bone involved
- mild:
- moderate:
- severe:

Bone involved
- surgery (all infected bones & tissues removed):
- surgery (residual infected soft tissue):
- surgery (residual viable bone):
- No surgery or surgery (residual dead bone):

A

No bone involved
- mild: 1-2 weeks
- moderate & severe: 2-4 weeks

Bone involved
- surgery (all infected bones & tissues removed): 2-5 days
- surgery (residual infected soft tissue): 1-2 weeks
- surgery (residual viable bone): 3 weeks
- No surgery or surgery (residual dead bone): 6 weeks

45
Q

Non-pharm for diabetic foot infections?

A
  • wound care (debridement, relieve pressure on ulcer, dressings to promote healing)
  • foot care (daily inspection)
  • optimal glycemic control
46
Q

Non-pharm for pressure ulcers?

A
  • wound care (debridement, normal saline)
  • relieve pressure (reposition Q2h)
47
Q

MRSA risk factors for SSTI (5)

A
  • recent hospitalisation
  • MRSA coloniser
  • long term care facility resident
  • hemodialysis
  • immunocompromised
48
Q

When to use prophylactic abx for SSTI and what kind (dose, duration) to use?

A

For pts with 3-4 episodes/year of cellulitis

  • PO penicillin 250-500mg BD for 4-52 weeks
  • IM 2.4 MU benzathine penicillin Q2w
49
Q

Which abx interacts with omeprazole and why?

A

Cefuroxime -> needs acidic env to be absorbed

50
Q

Max clindamycin dose?

A

600mg TDS

Antibiotics (11 decks)

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