Skin and Soft Tissue Infections

Question 1

What is tenosynovitis?

Answer 1

An infection of the tendon sheaths

Question 2

What are some of the laboratory investigations?

Answer 2

Blood tests to look for; C reactive protein, WCC and platelets (all usually increased), U+E (urea and electolytes, glucose and blood cultures. Also a wound swab.

Question 3

What is a collar stud?

Answer 3

A large collection of pus in the digits

Question 4

What type of gram bacteria is the most common cause of SSTIs?

Answer 4

Gram positive cocci

Question 5

What are the two most commone causative organisms for SSTIs?

Answer 5

Staphylococcus aureus and streptococcus pyogens

Question 6

What is the most common causative organism in animal bite infections?

Answer 6

Gram negative coccobacillus eg, Pasturella multocida

Question 7

What are some species and host risk factors you must asses?

Answer 7

Species (what animal is was because they have different rates of infection) and host (immune status, site of injury (sites with greater blood supply are less likely to become infected) and wound management)

Question 8

What is the difference between cat, dog and human bites

Answer 8

Cat - Deep puncture wound with little superficial damage (more infectious).
Dog - extensive superficial and crush injury (people more likely to get seen).
Human - deep infection common and BBV’s

Question 9

What are some important management points for bites?

Answer 9

Full history, Radiology (for clenched fist and scalp bites), wound exploration (irrigate or debride and delay closure), and antibiotic prophylaxis or treatment

Question 10

When would you give prohylaxis?

Answer 10

After primary closure, puncture wounds, cat bites to hand/wrist, crush wounds, clenched fist and if the host has risk factors (prosthetic joint, asplenic ect) and it is given for 7 days.

Question 11

What drugs should NEVER be given for treatment or prophylaxis for animal bites

Answer 11

Clindamycin or flucloxacillin

Question 12

What are some high risks for infections from bites

Answer 12

The species (human and cats are very infectious), the site (hands and feet have poor blood supply so more likely to become infected) and if the host has risk factors (immunosupression or prosthetic joints etc)

Question 13

How long do you treat cellulitis, tenosynovitis, septic arthritis and osteomylitis for? (with antibiotics)

Answer 13

Cellulitis (7-10 days), Tenosynovitis (21 days), Septic arthritis (28 days) and osteomylitis (42days)

Question 14

What are some key points to remember when you see a patient with a bite

Answer 14

• Thorough examination and history.
• Risk assess travel and co-morbidities fully.
• Early surgical review.
• Avoid primary closure
• NEVER use erythromycin, clindamycin or flucloxacillin monotherapies.