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Infectious Diseases > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What are the presentations of impetigo?

A
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2
Q

What are the presentations of ecthyma?

A
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3
Q

What are the presentations of erysipelas?

A
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4
Q

What are the presentations of cellulitis?

A
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5
Q

What are the presentations of furuncles?

A

Infection of the hair follicles resulting in purulent lesions.

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6
Q

What are the presentations of carbuncles?

A

A group of furuncles

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7
Q

What are the presentations of cutaneous abscess?

A
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8
Q

What are the presentations of purulent cellulitis?

A
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9
Q

What are the treatment categories for SSTI?

A
  1. Impetigo (mild lesions)
  2. Impetigo and Ecthyma (multiple lesions)
  3. Non-purulent
  4. Purulent
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10
Q

What bugs do we need to cover for Impetigo (mild lesions)?

A

Beta-hemolytic strep, S. pneumoniae, S. aureus (bullous)

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11
Q

What bugs do we need to cover for Impetigo and Ecthyma (multiple lesions)?

A

Beta-hemolytic strep (most commonly), S. pneumoniae&raquo_space; S. aureus (bullous impetigo)

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12
Q

What bugs do we need to cover for non-purulent?

A

Beta-hemolytic strep»> S. aureus

For water exposure: Aeromonas, Vibrio vulnificus, P. aeruginosa
If hv risk factors: MRSA

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13
Q

What bugs do we need to cover for purulent SSTI?

A

S. aureus»>Beta-hemolytic strep

If skin abscess, involving perioral, perirectal or vulvovaginal: gram -ve, anaerobes
If hv risk factors: MRSA

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14
Q

What is the pathophysiology of general SSTI?

A

Disruption of natural skin protective barrier by physical, chemical, immunological injury –> colonisation, overgrowth

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15
Q

What is the pathophysiology for DFI?

A
  1. Neuropathy
    Peripheral neuropathy leads to decreased sensation of pain. Motor neuropathy leads to muscle imbalance. Autonomic neuropathy increases dryness, cracks and fissures in the skin.
  2. Vasculopathy
    Poor circulation of rescue agents for clearance of microorganisms
  3. Immunopathy
    Impaired immune response, increased susceptibility to infections. Worsened by hyperglycemia

Ulcer formation/wounds –> bacteria colonisation, penetration, proliferation

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16
Q

What are the adjunctive therapy for DFI?

A

Glycemic control.
Daily inspection of foot for wounds or ulcers.
Proper wound care, keep wounds dry. (dressing that promotes healing, controls xs exudate)
Debridement.
Offloading.

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17
Q

What is the pathophysiology for pressure ulcers?

A

Decreased blood circulation to the area receiving pressure

18
Q

What are the risk factors for pressure ulcers?

A

Reduced mobility, debilitated by severe chronic conditions (MS, stroke, cancer), Reduced consciousness, Sensory and autonomic impairment, extremes of age, malnutrition

19
Q

What are the adjunctive therapy for pressure ulcers?

A

Debridement of infected or necrotic tissue.
Local wound care (normal saline, avoid harsh chemicals).
Relief pressure (turn or reposition every 2h).

20
Q

What is the criteria for mild DFI or pressure ulcers?

A

No systemic S/S of infection.
Erythema <= 2cm in diameter ard ulcer
No bone or joint involvement.

21
Q

What is the criteria for moderate DFI or pressure ulcers?

A

No systemic S/S of infection.
Erythema > 2 cm in diameter ard ulcer.
Some bone or joint involvement.

22
Q

What is the criteria for severe DFI or pressure ulcers?

A

Systemic S/S of infection.
Erythema > 2 cm in diameter ard ulcer
Bone and join involvement.

23
Q

What bugs do we need to cover for mild DFI or pressure ulcers?

A

Streptococcus spp, S. aureus

24
Q

What bugs do we need to cover for moderate DFI or pressure ulcers?

A

Streptococcus spp, S. aureus, Gram-ve, anaerobes

If hv P. aeruginosa risk factors: P. aeruginosa

25
Q

What bugs do we need to cover for severe DFI or pressure ulcers?

A

Streptococcus spp, S. aureus, Gram -ve, anaerobes, P. aeruginosa

26
Q

What is the recommended regimen for Impetigo (mild lesions)?

A

Topical mupirocin BD x5d

27
Q

What is the recommended regimen for Impetigo and Ecthyma (multiple lesions)?

A

PO Cloxacillin or cephalexin
Penicillin allergy: PO clindamycin

Culture directed S. pyogenes: PO Pen V or amoxicillin
Culture directed S. aureus: PO cloxacillin, cephalexin

Treatment duration: 5-7d

28
Q

What is the recommended regimen for mild non-purulent SSTI?

A

PO cloxacillin or cephalexin or pen V
Penicillin allergy: PO clindamycin

Treatment duration: 5-10d, 14d if immunocompromised

29
Q

What is the recommended regimen for moderate purulent SSTI?

A

PO cloxacillin or cephalexin
Penicillin allergy: PO clindamycin

If gram -ve coverage req: PO amoxicillin clavulanate

Treatment duration: 5-10d, 14d if immunocompromised

30
Q

What is the recommended regimen for mild DFI or pressure ulcers?

A

PO cloxacillin or cephalexin
Penicillin allergy: PO clindamycin

If MRSA risk factors: clindamycin, cotrimoxazole, doxycycline

Treatment duration: 1-2 weeks

31
Q

What is the recommended regimen for moderate DFI or pressure ulcers?

A

IV Amoxicillin-clavulanate
IV cefazolin/ceftriaxone + metronidazole

If MRSA risk factors: add vancomycin, daptomycin or linezolid

32
Q

What is the recommended regimen for severe DFI or pressure ulcers?

A

IV piperacillin-tazobactam
IV cefepime + metronidazole
IV meropenem
IV ciprofloxacin + clindamycin

If MRSA risk factors: add IV vancomycin, daptomycin or linezolid

33
Q

What is the criteria for mild non-purulent SSTI?

A

No systemic S/S of infection

Mainly cover S. pyogenes

34
Q

What is the criteria for moderate non-purulent SSTI?

A

Systemic S/S of infection, mild purulence

Hv to incl MSSA

35
Q

What is the criteria for severe non-purulent SSTI?

A

Systemic S/S of infection, non-response to oral therapy, immunocompromised

36
Q

What is the criteria for mild purulent SSTI?

A

No systemic S/S of infection

37
Q

What is the criteria for moderate-severe purulent SSTI?

A

Systemic S/S of infections

38
Q

What is the recommended regimen for moderate non-purulent SSTI?

A

IV cloxacillin, cefazolin
Penicillin allergy: IV clindamycin

If water exposure: add ciprofloxacin

Treatment duration: 5-10d, 14d if immunocompromised

39
Q

What is the recommended regimen for severe non-purulent SSTI?

A

IV piperacillin tazobactam
IV cefepime
IV meropenem

If MRSA risk factor: add vancomycin, daptomycin or linezolid

Treatment duration: 5-10d, 14d if immunocompromised

40
Q

What is the recommended regimen for severe purulent SSTI?

A

IV cloxacillin or cefazolin
Penicillin allergy or MRSA coverage: clindamycin or vancomycin

If req gram -ve coverage: IV amoxicillin clavulanate

Treatment duration: 5-10d, 14d if immunocompromised

Infectious Diseases (9 decks)

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