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PR3151_Final Exam > Skin and Soft Tissue Infections > Flashcards

Skin and Soft Tissue Infections Flashcards

1
Q

What are the normal protective mechanisms against skin infections?

A
  • normal, intact skin
  • shedding of keratocytes and skin microbiota
  • sebaceous secretions inhibit growth
  • commensal skin microbiome prevents colonisation and overgrowth of more pathogenic strains
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2
Q

What are the 3 risk factors for SSTI?

A
  1. disruption of skin barrier
  2. conditions that predispose to infection
  3. history of cellulitis
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3
Q

Where should wound culture be taken?

A

Deep inside wound / base of closed abscess / curettage

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4
Q

What bacteria usually cause impetigo?

A

Group A strep (s. pyogenes) and s. aureus

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5
Q

What bacteria usually cause ecthyma?

A

Group A strep (s. pyogenes)

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6
Q

What is the first line treatment for mild impetigo with limited lesions?

A

Topical mupirocin BD x 5d

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7
Q

What is the first-line empiric regimen for ecthyma / impetigo with multiple lesions?

A

PO Cloxacillin / cephalexin
pen allergy: PO clindamycin
duration x 7d

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8
Q

What is the culture directed regimen for ecthyma / impetigo with multiple lesions caused by s. pyogenes?

A

PO penicillin V / PO amoxicillin x 7d

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9
Q

What is the culture directed regimen for ecthyma / impetigo with multiple lesions caused by s. aureus?

A

PO cloxacillin / PO cephalexin x 7d

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10
Q

Define Healthcare-associated MRSA infection

A

MRSA infection that occurs >48H after hospitalisation or outside hospital within 12 months of exposure to healthcare

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11
Q

What are the risk factors of HA-MRSA?

A

Prior antibiotic use, recent hospitalisation, prolonged hospitalisation, intensive care, hemodialysis, MRSA colonisation, contact with MRSA colonised individuals

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12
Q

Which SSTIs are purulent?

A

Furuncle, Carbuncles, skin abscess

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13
Q

What are the common pathogens implicated in purulent SSTI?

A

s. aureus, some beta hemolytic strep

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14
Q

What other pathogens must be considered if the purulent SSTI is a skin abscess near GI?

A

Gram negative and anaerobic bacteria

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15
Q

What is the treatment option for mild purulent SSTI?

A

Incision and drainage, warm compress to promote drainage

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16
Q

What is the recommended regimen for moderate purulent SSTI?

A

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

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17
Q

What is the recommended regimen for severe purulent SSTI?

A

IV cloxacillin / IV cefazolin / IV clindamycin / IV vancomycin

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18
Q

What antibiotics should be included in a patient with purulent SSTI with MRSA risk factors?

A

PO: Bactrim / Clindamycin / Doxycycline
IV: Vancomycin / Daptomycin / Linezolid / Ceftaroline (too broad)

19
Q

What antibiotics should be included in a patient with purulent SSTI near GI?

A

Amox-clav (gram-neg and anaerobe coverage)

20
Q

What is the recommended treatment duration for purulent SSTU?

A

x 5-10d

21
Q

What are the pathogens implicated in cellulitis and erysipelas?

A

s. pyogenes, s. aureus less common

22
Q

What are the pathogens implicated in cellulitis with water exposure?

A

Aeromonas (fresh water), vibrio (sea water), pseudomonas

23
Q

How is mild, moderate, and severe cellulitis classified?

A

mild: no systemic symptoms
moderate: systemic symptoms, some purulence
severe: systemic symptoms, failed oral therapy, immunocompromised

24
Q

What are the recommended antibiotics for mild cellulitis?

A

PO penicillin V, cloxacillin, cephalexin
penicillin allergy: clindamycin

25
Q

What are the recommended antibiotics for moderate cellulitis?

A

IV cloxacillin, cefazolin
penicillin allergy: clindamycin

26
Q

What are the recommended antibiotics for severe cellulitis?

A

Broad-spectrum IV
pip-tazo, cefepime, meropenem

27
Q

What antibiotic to add to cover water exposure?

A

ciprofloxacin

28
Q

What is the recommended treatment duration for cellulitis?

A

x 5-10d

29
Q

What is the definition of diabetic foot infection?

A

Purulent discharge OR >= 2 signs of inflammation
Warmth
Induration
Pain
Erythema
Tenderness

30
Q

What are the expected pathogens of DFI?

A
  • s. aureus, streptococci
  • gram neg: e. coli, klebsiella, proteus, pseudomonas (less common)
  • anaerobe: peptostreptococcus, veillonella, bacteroides
31
Q

How to differentiate between mild, moderate and severe DFI?

A

mild: erythema <= 2cm around wound, no systemic symptoms
moderate: erythema > 2cm around wound, no systemic symptoms
severe: erythema > 2cm around wound, systemic symptoms

32
Q

What pathogens to cover for mild DFI?

A

s. aureus, streptococci

33
Q

What antibiotics to use for mild DFI?

A

PO cloxacillin, cephalexin, clindamycin (pen allergy)

34
Q

What pathogens to cover for moderate DFI?

A

s. aureus, streptococci, gram neg (klebsiella, e. coli, proteus)
anaerobe: peptostreptococcus, veillonella, bacteroides
x pseudomonas

35
Q

What antibiotics to use for moderate DFI?

A

IV amox-clav
IV cefazolin / ceftriazone + metronidazole

36
Q

What pathogens to cover for severe DFI?

A

s. aureus, streptococci, gram neg (klebsiella, e. coli, proteus, pseudomonas)
anaerobe: peptostreptococcus, veillonella, bacteroides

37
Q

What antibiotics to use for severe DFI?

A

pip-tazo, meropenem, ciprofloxacin + clindamycin, cefepime + metronidazole

38
Q

What antibiotics to add in mild, moderate, and severe DFI with MSRA risk?

A

mild: PO bactrim, doxycycline, clindamycin
moderate / severe: IV vancomycin, daptomycin, linezolid

39
Q

What is the recommended duration of treatment of mild, moderate, and severe DFI with no bone involvement?

A

mild: 1-2w
moderate: 1-3w
severe: 2-4w

40
Q

What is the recommended duration of treatment of mild, moderate, and severe DFI with bone involvement (surgery - all infection removed / residual infected tissue / residual infected bone; no surgery - residual dead bone)?

A

surgery
- all infection removed: 2-5d
- residual infected tissue: 1-3w
- residual infected bone: 4-6w
no surgery, residual dead bone: >= 3m

41
Q

What are the monitoring points for SSTI?

A

Improvement in 48-72H, no progression of lesion / complications

42
Q

What are the 3 adjunctive measures in the management of pressure ulcers?

A
  1. Wound care with normal saline
  2. Debridement
  3. Pressure relief by repositioning every 2 hours
43
Q

What is the criteria for infection of pressure ulcers?

A

Purulent discharge OR >= 2 signs of inflammation
Warmth
Induration
Pain
Erythema
Tenderness

44
Q

What are the pathogens implicated in pressure ulcer infections?

A

s. aureus, streptococci
gram neg: e. coli, klebsiella, proteus, pseudomonas (less common)
anaerobe: peptostreptococcus, viellonella, bacteroides

PR3151_Final Exam (8 decks)

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