Skin and Soft Tissue Infections Flashcards
What are the presentations of impetigo?
What are the presentations of ecthyma?
What are the presentations of erysipelas?
What are the presentations of cellulitis?
What are the presentations of furuncles?
Infection of the hair follicles resulting in purulent lesions.
What are the presentations of carbuncles?
A group of furuncles
What are the presentations of cutaneous abscess?
What are the presentations of purulent cellulitis?
What are the treatment categories for SSTI?
- Impetigo (mild lesions)
- Impetigo and Ecthyma (multiple lesions)
- Non-purulent
- Purulent
What bugs do we need to cover for Impetigo (mild lesions)?
Beta-hemolytic strep, S. pneumoniae, S. aureus (bullous)
What bugs do we need to cover for Impetigo and Ecthyma (multiple lesions)?
Beta-hemolytic strep (most commonly), S. pneumoniae»_space; S. aureus (bullous impetigo)
What bugs do we need to cover for non-purulent?
Beta-hemolytic strep»> S. aureus
For water exposure: Aeromonas, Vibrio vulnificus, P. aeruginosa
If hv risk factors: MRSA
What bugs do we need to cover for purulent SSTI?
S. aureus»>Beta-hemolytic strep
If skin abscess, involving perioral, perirectal or vulvovaginal: gram -ve, anaerobes
If hv risk factors: MRSA
What is the pathophysiology of general SSTI?
Disruption of natural skin protective barrier by physical, chemical, immunological injury –> colonisation, overgrowth
What is the pathophysiology for DFI?
- 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. - Vasculopathy
Poor circulation of rescue agents for clearance of microorganisms - Immunopathy
Impaired immune response, increased susceptibility to infections. Worsened by hyperglycemia
Ulcer formation/wounds –> bacteria colonisation, penetration, proliferation
What are the adjunctive therapy for DFI?
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.
What is the pathophysiology for pressure ulcers?
Decreased blood circulation to the area receiving pressure
What are the risk factors for pressure ulcers?
Reduced mobility, debilitated by severe chronic conditions (MS, stroke, cancer), Reduced consciousness, Sensory and autonomic impairment, extremes of age, malnutrition
What are the adjunctive therapy for pressure ulcers?
Debridement of infected or necrotic tissue.
Local wound care (normal saline, avoid harsh chemicals).
Relief pressure (turn or reposition every 2h).
What is the criteria for mild DFI or pressure ulcers?
No systemic S/S of infection.
Erythema <= 2cm in diameter ard ulcer
No bone or joint involvement.
What is the criteria for moderate DFI or pressure ulcers?
No systemic S/S of infection.
Erythema > 2 cm in diameter ard ulcer.
Some bone or joint involvement.
What is the criteria for severe DFI or pressure ulcers?
Systemic S/S of infection.
Erythema > 2 cm in diameter ard ulcer
Bone and join involvement.
What bugs do we need to cover for mild DFI or pressure ulcers?
Streptococcus spp, S. aureus
What bugs do we need to cover for moderate DFI or pressure ulcers?
Streptococcus spp, S. aureus, Gram-ve, anaerobes
If hv P. aeruginosa risk factors: P. aeruginosa
What bugs do we need to cover for severe DFI or pressure ulcers?
Streptococcus spp, S. aureus, Gram -ve, anaerobes, P. aeruginosa
What is the recommended regimen for Impetigo (mild lesions)?
Topical mupirocin BD x5d
What is the recommended regimen for Impetigo and Ecthyma (multiple lesions)?
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
What is the recommended regimen for mild non-purulent SSTI?
PO cloxacillin or cephalexin or pen V
Penicillin allergy: PO clindamycin
Treatment duration: 5-10d, 14d if immunocompromised
What is the recommended regimen for moderate purulent SSTI?
PO cloxacillin or cephalexin
Penicillin allergy: PO clindamycin
If gram -ve coverage req: PO amoxicillin clavulanate
Treatment duration: 5-10d, 14d if immunocompromised
What is the recommended regimen for mild DFI or pressure ulcers?
PO cloxacillin or cephalexin
Penicillin allergy: PO clindamycin
If MRSA risk factors: clindamycin, cotrimoxazole, doxycycline
Treatment duration: 1-2 weeks
What is the recommended regimen for moderate DFI or pressure ulcers?
IV Amoxicillin-clavulanate
IV cefazolin/ceftriaxone + metronidazole
If MRSA risk factors: add vancomycin, daptomycin or linezolid
What is the recommended regimen for severe DFI or pressure ulcers?
IV piperacillin-tazobactam
IV cefepime + metronidazole
IV meropenem
IV ciprofloxacin + clindamycin
If MRSA risk factors: add IV vancomycin, daptomycin or linezolid
What is the criteria for mild non-purulent SSTI?
No systemic S/S of infection
Mainly cover S. pyogenes
What is the criteria for moderate non-purulent SSTI?
Systemic S/S of infection, mild purulence
Hv to incl MSSA
What is the criteria for severe non-purulent SSTI?
Systemic S/S of infection, non-response to oral therapy, immunocompromised
What is the criteria for mild purulent SSTI?
No systemic S/S of infection
What is the criteria for moderate-severe purulent SSTI?
Systemic S/S of infections
What is the recommended regimen for moderate non-purulent SSTI?
IV cloxacillin, cefazolin
Penicillin allergy: IV clindamycin
If water exposure: add ciprofloxacin
Treatment duration: 5-10d, 14d if immunocompromised
What is the recommended regimen for severe non-purulent SSTI?
IV piperacillin tazobactam
IV cefepime
IV meropenem
If MRSA risk factor: add vancomycin, daptomycin or linezolid
Treatment duration: 5-10d, 14d if immunocompromised
What is the recommended regimen for severe purulent SSTI?
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
