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D&D Infectious Disease Midterm > Skin and Soft Tissue Infections Part 1 > Flashcards

Skin and Soft Tissue Infections Part 1 Flashcards

1
Q

Skin and soft tissue infections are one of the most common infections where??

A

in BOTH the community and in hospital settings

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2
Q

which layers of the skin may be involved in skin and soft tissue infections

A

may involve any or all layers

including epidermis, dermis, hypodermis, fascia, and muscle

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3
Q

true or false

skin and soft tissue infections are not a big clinical concern because they stay localized

A

FALSE

they can spread and lead to more severe complications like endocarditis and gram negative sepsis

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4
Q

the MAJORITY of skin and soft tissue infections are caused by what organisms (in general)

A

gram positive organisms that are on the skin

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5
Q

differentiate between the normal flora ABOVE THE WAIST and the normal flora BELOW THE WAIST

A

above the waist - primarily gram positive - ie: coagulase negative staph, corynebacterum, MRSA, mssa, strep pyogenes

below the waist - all gram positive present above AND gram negative (enterobacterales, enterococcus)

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6
Q

name 2 NOSOCOMIAL pathogens

A

pseudomonas aeruginosa
MRSA

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7
Q

true or false

MRSA cannot be community-asssociated

A

FALSE

it can - there is community-associated MRSA (CA-MRSA)

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8
Q

in general, what are risk factors for skin and soft tissue infections

A

anything that affects the skin integrity

for example – trauma, inflammation, obesity, breaks in skin, venous insufficiency, etc

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9
Q

what are 2 broad categorizations of SSTIS

A

purulent (cause pus formation)
and nonpurulent (no pus formation)

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10
Q

name 4 purulent skin and soft tissue infections

A

folliculitis
furuncle
carbuncle
ascess

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11
Q

name 4 non-purulent SSTIS

A

impetigo
erysipelas
cellulitis
necrotizing fasciiitis

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12
Q

typically, purulent skin and soft tissue infections are caused by which bacteria?

A

staph aureus

SO, must cover for MRSA in empiric coverage

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13
Q

another name for a boil

is it purulent or non-purulent SSTI

A

furuncle

purulent

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14
Q

define folliculitis

where is the pus?

A

very superficial purulent infection of the hair follicles

the pus is only in the EPIDERMIS

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15
Q

differentiate between a furuncle and a carbuncle

A

a furuncle has a single sinus tract. is an inflammatory, draining nodule that involves a hair follicle (purulent)

a carbuncle is when adjacent furuncles (boils) come together to form a single painful area – forms DEEP masses tha open into MULTIPLE sinus tracts

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16
Q

what is an abscess

A

collection of PUS (purulent) within the dermis and the deeper skin tissue

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17
Q

treatment for folliculitis

A

resolves on its own
use warm, moist compress

if however it does NOT resolve on its own, use mupirocin twice a day for 5 days, or even bacitracin

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18
Q

furuncle, carbuncle, and abscess treatment (mild vs moderate vs severe)

A

mild - incision and drainage. ALWAYS done regardless of severity + adjunctive antibiotic if the abscess is greater than 5 cm

moderate - incision and drainage + culture and sensitivity + empiric PO AB’s against MRSA

severe - incision and drainage + culture and sensitivity + empiric IVVVV antibiotics against MRSA

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19
Q

as a reminder, name 12 AB’s that cover MRSA

A

bactrim
doxycycline
tigecycline
vancomycin
daptomycin
linezolid
clindamycin

televancin
oritavancin
dalbavancin

delafloxacin
ceftaroline (5th gen ceph)

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20
Q

differentiate between when a purulent infection (aside from folliculitis - so a furuncle, carbuncle, or an absess) can be considered mild vs moderate vs severe when determining treatment

A

mild - no systemic symptoms

moderate - 1 systemic symptom (ie- fever, white count, hypotension, rapid breathing)

severe - 2 or more systemic or severe signs of the infection. OR failed incision and drainage AND PO antibiotics

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21
Q

true or false

in a mild purulent SSTI, there is no antibiotic therapy used

A

TRUE bc not recommended by IDSA guideleine

HOWEVER, new literature suggests there may be a benefit of using antibiotics against MRSA
-shows lower risk of treatment failure, lower risk of ascess recurrence, and lower risk of hospitalization and surgical procuedure

THEREFORE – if the infection size of the mild SSTI is GREATER THAN 5 CM, we recommend oral antibiotics like doxy or bactrim

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22
Q

EMPIRIC antibiotic treatment for MODERATE SSTI

A

PO bactrim or doxycycline
(want to cover MRSA!!)

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23
Q

empiric treatment for SEVERE SSTI

A

IV antibiotics that cover MRSA -

vanco, dapto, linezolid, telavancin, or ceftaroline

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24
Q

DEFINED treatment for moderate SSTI for:

MRSA vs MSSA

A

MRSA - bactrim

MSSA - dicloxacillin or cephalexin

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25
Q

DEFINED treatment for SEVERE SSTI for:

MRSA vs MSSA

A

MRSA - same as empiric (vanco, dapto, linezolid, televancin, ceftaroline)

MSSA - nafcillin or cefazolin (1st gen) or clindamycin (if resistance less than 10-15%)

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26
Q

what to monitor when doing incision and drainage/adjunctive antibiotic for a mild SSTI

A

watch for signs that the infection is improving

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27
Q

as mentioned, either bactrim or doxy is recommended as empiric treatment for moderate SSTI

what are the dosings and monitoring parameters of each

A

bactrim - 1 ds tab q12

doxy - 100mg q12

monitoring:

bactrim - SJS (rash), hyperkalemia, renal function (crystalluria - drink water!!), photosensitivity, hematologic toxicity (monitor CBC if on long time)

doxy - photosensitivty, NVD, avoid less than 8 and in pregnant pts

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28
Q

important counseling point for patients on bactrim

A

photosensitive - stay out sun

STAY HYDRATED to prevent crystalluria bc affects renal function

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29
Q

Vanco dosing for severe SSTI

A

15mg/kg q12hours

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30
Q

what to monitor when administering vanco for a severe SSTI

A

therapeutic drug monitoring
infusion reactions (given IV)
renal function

31
Q

what to monitor when administering daptomycin for a severe SSTI

A

CPK (can cause increased creatinine phosphokinase)

myopathy/rhabdomyolysis

32
Q

what to monitor when giving linezolid for a severe SSTI

A

myelosuppression
thrombocytopenia
optic neuropathy
peripheral neuropathy
serotonin syndrome

33
Q

which of the drugs given only for SEVERE SSTI as empiric therapy can cause thrombocytopenia?

A

LINEZOLID

happens around day 7-10 of therapy - very common in older peopl

34
Q

which of the empiric antibiotics given for SEVERE SSTI is not usually combined with serotenergic meds bc of risk of serotonin syndrome

A

linezolid

35
Q

in purulent SSTIS, ______should be streamlined based on ______

A

empiric therapy should be streamlined based on CULTURE AND SENSITIVTY RESULTS

36
Q

daptomycin dosing for severe SSTI

A

4-6mg/kg q24

37
Q

linezolid dosing for severe SSTI

A

600mgIV (or PO) q12 hours

38
Q

ceftaroline dosing for severe SSTI

A

400mg IV Q12H

39
Q

typically, the treatment for purulent skin and soft tissue infections lasts….

A

7-14 days, but it depends on the clinical improvement

40
Q

true or false

for purulent skin and soft tissue infections, the antibiotics need to be completed for the full 7-14 days, even if clinical improvement has been noted

A

FALSE

once you see clinical improvement, you can stop them. the lesions do not need to FULLY RESOLVE to stop the antibiotics

41
Q

what should patients with skin and soft tissue infections (purulent) be educated on?

A

appropriate wound care to avoid recurrent infections

42
Q

25 year old female presents with 7cm abscess of right axilla.

no systemic signs of infection and NKA

what is the most appropriate treatment for her

LATER her I&D was sent for culture and came back as METHICILLIN RESISTANT
what is appropriate therapy now? counseling points?

A

incision and drainage plus bactrim

could also be doxy, but bactrim is best

CONTINUE BACTRIM!!! COVERS MRSA
apply spf, stay hydrated (renal), report any signs of rash, watch for muscle cramping bc sign of hyperkalemia

43
Q

pt in previous example (on bactrim for MRSA mild SSTI) now complains of a rash since starting bactrim

now what is the best therapy?

A

doxycycline - its the other first line for mild SSTI and also covers MRSA

44
Q

define impetigo

A

contagious SUPERFICIAL infection of the skin, most commonly seen in children

45
Q

2 broad categorizations of impetigo

A

bullous vs nonbullous

46
Q

difference in the cause (bacteria) of bullous vs nonbullous impetigo

A

bullous - caused by toxin-producing staph aureus

nonbullous - caused by beta hemolytic streptococci and/or staph aureus

47
Q

which is the most common form of impetigo - bullous or nonbullous?

A

nonbullous

48
Q

differentiate between the physical features of bullous impetigo vs nonbullous

A

nonbullous - small, fluid-filled vesicles that are like pustules that can rupture. has golden yellow crust

bullous - bullae have clear yellow fluid that reptures and is characterized by a thin, light brown crust – associated with ENLARGED LYMPH NODES

49
Q

treatment for MILD impetigo (just 1 or 2 spots)

A

topical mupirocin (or even bacitracin) BID for 5 days

50
Q

treatment for impetigo in which there are multiple lesions OR involving the face

A

PO antibiotics for 7 days

51
Q

as mentioned, when there are multiple impetigo lesions or involving the face, use PO antibiotics for 7 days

in general, the agents chose should be active against what??
be specific

A

STAPH AUREUS

for MRSA - give clindamycin, doxy, or bactrim

for MSSA - give dicloxacillin or cephalexin or augmentin

dependent on RISK FACTORS whether you will give 1 that covers MRSA or not

52
Q

symptomatic relief (not drugs) that the pt can do for impetigo

A

help the symptoms by removing the crusts by soaking with soap and warm water

53
Q

define erysipelas

it is most commonly associated with what bacteria?

A

cellulitis involving the more superficial layers of the skin and the lymphatics

GROUP A STREP (streptococcus pyogenes)

54
Q

drug of choice for erysipelas

A

penicillin (IV or PO - based on the severity)

55
Q

clinical presentation of erysipelas

A

continuously red and edematous and indurated (fibrous and hard)
spread peripherally, associated with HIGH FEVER, CHILLS, AND GENERAL MALAISE

56
Q

which presents with more systemic symptoms - impetigo or erysipelas?

A

erysipelas

have high fever, chills, and malaise

for impetigo its just the skin that’s really tight and itchy

57
Q

which PCN are administered IM/IV/PO

and how long for erysipelas

NOTE: skipped penicillin dosing - waiting for her to reply to email

A

IM - procaine penicillin G

IV - penicillin G

PO - Penicillin VK

7-10 days

58
Q

true or false

erysipelas does not respond quickly to penicillin treatment

A

FALSE - it does

marked improvement usually seen within 48 hours of treatment

59
Q

explain the areas that cellulitis affects

A

initially it’s just the epidermis and dermis, but may spread to the superficial fascia, lymphatic tissue, and ultimately to the BLOODSTREAM

60
Q

which 2 bacteria frequently cause cellulitis

A

group A strep (strep pyogenes)

staph aureus

BOTH ARE GRAM POSITIVE

61
Q

cellulitis may lead to ______ formation, particularly in what 2 scenarios

A

abscess

polymicrobial infection or an anaerobic infection

62
Q

in cellulitis, patients usually have a history of what

A

wound or trauma

63
Q

clinical presentation of cellulitis

A

erythema and edema of the skin, warm to touch and PAINFUL

lesions NOT ELEVATED with poor defined margins

may drain, exudate, or abscess

64
Q

true or false

in cellulitis, the lesions are elevated and have poorly defined margins

A

FALSE

not elevated and have poorly defined margins

65
Q

NONPHARMACOLOGIC management of cellulitis

A

elevate the area and dont move - to decrease swelling

use cold compresses for pain

use moist heat to help keep the cellulitis local

may need surgical debridement to remove the dead or infected tissue — in COMPLICATED cases

66
Q

in cellulitis, what can be used to try to keep the infection local?
what about for pain?
what about for swelling?

A

keep local - moist heat

pain - cold compress
swelling - elevate it and immobilize

67
Q

what is the term for surgical intervention in cellulitis

A

debridement

68
Q

antibiotics can be used in cellulitis - either empiric or directed therapy

when choosing what to give, what should we be looking at ??

A

the patient’s risk factors and severity

for ex - are they an IV drug user? immunocompromised? is an absess forming? etc

69
Q

what do we want to cover if cellulitis is purulent vs non-purulent

in mild-moderate cases !!! (outpatient)

A

non-purulent - just need to cover group A strop

if purulent - cover staph (MRSA)

70
Q

which 4 drugs can potentially be used to cover MRSA in mild-moderate outpatient purulent cellulitis

(empiric)

A

bactrim and doxy PO are first line

can consider linezolid or tedizolid but they’re more $$$ and less tolerated

71
Q

which antibiotics are first line in nonpurulent mild-moderate OUTPATIENT cellulitis

(empiric)

A

want to cover group A strep (strep pyogenes - gram (+))

use PO beta lactams like pen VK, cephalexin, dicloxacillin

CAN use later gen PO cephalosporins but they’re more money

72
Q

for mild-moderate outpatient cellulitis (whether purulent or non-purulent) how long does empiric treatment last?

A

around 5 days but it all depends on the clinical response

73
Q
A

D&D Infectious Disease Midterm (26 decks)

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