Skin Infections Flashcards
define epidermis
outermost, nonvascular layer of skin
define dermis
consists of connective tissue, blood vessels, lymphatics, sensory nerve endings, sweat and secaceous glands, hair follicles, and smooth muscle fibers
define subcutaneous tissue
layer of loose connective tissue containing primarily fat cells
Define fascia
connective tissue surrounding muscle
Health care acquired MRSA risk factors
Hospital attendance in the past 3 months antimicrobial usage surgery dialysis diabetes indwelling devices residency in LTCF
Community acquired MRSA risk factors
Recurrent infections Prison inmates athletes military recruits native americans children IVDU
define folliculitis
superficial inflammatory reaction involving the hair follicle
treatment for folliculitis
moist heat
describe the appearance of folliculitis
small, pruritic, erythematous papules
define furnuncle
infections of the hair follicle extending through the dermis into subcutaneous tissue
most common areas for furnuncles
face, neck, axilla, buttock
describe the appearance of a furnuncle
small, red, tender nodule -> painful and pustular
common pathogen of furnuncles and carbuncles
S. aureus
Define carbuncle
multiple furnuncles - very broad multiple hair follicles
most common area for carbuncles
back of the neck
describe the appearance of a carbuncle
broad, swollen, erythematous, deep, and painful masses
Empiric therapy for furnuncles/carbuncles with no surrounding cellulitis
moist heat
empiric therapy for furnuncles/carbuncles with large, focal, fluctuant lesions
incision + drainage
when are antibiotics required in addition to incision and drainage for furuncles/carbuncles
extensive surrounding cellulitis
face
fever
antibiotics for furuncles/carbuncles if no MRSA risk factors
Nafcillin IV -> Dicloxacillin PO
Cefazolin -> cephalexin
Amp/sulbactam -> amox/clav
antibiotics for furuncles/carbuncles if MRSA risk factors
bactrim
doxy
clinda
duration of treatment for furuncles/carbuncles
5-10 days
when is bactrim not used
SCr > 1.5
Hyperkalemia > 5.5
Plts
when is bactrim not used
SCr > 1.5
Hyperkalemia > 5.5
Plts
when is doxy not used
photosensitivity
tetracycline allergy
When is clinda not used
C.diff - severe or recurrent
Prevention for furuncles/carbuncles
Improve personal hygiene (chlorhexidine soap/seperate use of towels, clothing, bed wear)
mupirocin ointment to anterior nares
clindamycin x 3 months
define cellulitis
deeper into dermis and subcutaneous tissue; due to skin break
describe cellulitis
rapidly spreading areas of edema, redness, and heat with inflammation of lymph nodes
lesions are non-elevated and have poorly defined margins
commonly affect the lower extremities
common pathogens in cellulitis
Beta hemolytic strep
S. aureus
cellulitis with bollae + vessicles causative organism
Staph
treatment for cellulitis with bullae
treat like furuncle/carbuncle
non-pharmacologic therapy for cellulitis
immobilization and elevation of a limb to reduce swelling
cool, sterile, saline dressing - remove purulent exudate and decrease pain
drainage of abscess
what makes cellulitis severe
abnormal skin or wounds
immunocompromised
requiring surgery
when should hospitalization and IV antibiotics be used for cellulitis
systemic signs of infection
significant comorbid conditions
cellulitis is spreading rapidly
treatment of cellulitis with no risk factors for MRSA
Dicloxacillin PO / nafcillin/oxacillin IV
Cephalexin / cefazolin
Levofloxacin
duration of treatment for uncomplicated cellulitis
5 days
duration of treatment for complicated/more severe cellultis
5-10 days
duration of treatment for complicated/more severe cellultis
5-10 days
treatment of cellulitis with risk factors for MRSA
clindamycin doxycycline Bactrim vanco linezolid daptomycin
