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Infectious Disease > Skin/Soft tissue/Bone Infections > Flashcards

Skin/Soft tissue/Bone Infections Flashcards

1
Q

Skin and soft tissue infections are most commonly seen where?

A

Outpatient and inpatient

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2
Q

Skin and soft tissue infections can affect a single or all layers of what?

A

Fascia, skin, or muscle

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3
Q

(T/F) - Skin surface is conducive to bacterial growth - not resistant to infection

A

FALSE - it is NOT conducive to bacterial growth - resistant to infection

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4
Q

What are reasons that skin is resistant to infection?

A
  1. Extremely dry surface
  2. Continual renewal of skin cells
  3. Sebaceous secretions inhibit the growth of many bacteria and fungi
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5
Q

What are risk factors for skin infection?

A
  • High concentrations of bacteria (> 10^5)
  • Inadequate blood supply
  • Damage to the stratum corneum allowing for bacterial entry
  • Availability of nutrients
  • Excessive moisture of the skin
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6
Q

What is normal flora that is common in exposed skins (face, neck)?

A

Staph. epidermidis

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7
Q

What is the normal flora that is common in moisture areas (axilla, groins)?

A

Acinetobacter spp.

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8
Q

What are other predominant bacterial organisms of normal skin other than staph. epidermidis and acinetobacter spp.?

A
  • Corynebacterium spp.
  • Propionibacterium spp.
  • Micrococcus spp.
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9
Q

What are predominant fungal organisms involved in normal skin?

A
  • Malassezia spp.

- Candida spp.

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10
Q

What are the classic signs and symptoms of a patient experiencing skin or soft tissue infection?

A
  • Heat/localized fever
  • Erythema/redness
  • Inflammation/swelling
  • Pain
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11
Q

Define primary infections of skin/soft tissue infections

A

Usually involve areas of previously healthy skin and typically caused by one pathogen

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12
Q

Define secondary infections of skin/soft tissue infections

A

Usually occur in areas of previously damaged skin and often polymicrobic

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13
Q

What are some primary skin/soft tissue infections (SSTIs)?

A
  • Impetigo
  • Erysipelas
  • Purulent SSTIs
  • Cellulitis
  • Necrotizing fasciitis
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14
Q

Define impetigo

A

Superficial infection of stratum corneum

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15
Q

Impetigo is usually involved in which population(s)?

A
  • Children

- Poor hygiene

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16
Q

What organisms cause impetigo?

A
  • Staph. aureus (including MRSA)

- Group A streptococci

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17
Q

How is impetigo usually clinically presented?

A
  • Purulent, localized vesicles/lesions
  • Mild pain, pruritus
  • Common in exposed areas
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18
Q

What nonpharmacological therapy can be done with impetigo?

A

Wash affected area with soap and water

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19
Q

What topical treatment can be used for impetigo, localized lesions? For how long?

A
  • Mupirocin
  • Retapamulin
    Both for 5 days
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20
Q

What oral treatment can be used for impetigo, extensive/nonresponsive? For how long?

A
  • Dicloxacillin
  • Cephalexin
  • Amoxicillin/clavulanate
    Both for 7 days
21
Q

Define erysipelas

A

Cellulitis involving the more superficial layers of the skin and cutaneous lymphatics

22
Q

Erysipelas is usually involved in which population(s)?

A
  • Very young

- Very old

23
Q

What organisms cause erysipelas?

A

Group A streptococci

24
Q

How is erysipelas usually clinically presented?

A
  • Raised, erythematous with clear line demarcation
  • Orange peel appearance
  • Often with systemic symptoms (fever, malaise)
  • Intense burning
  • Common in lower extremeties
25
Q

What are the treatment options for erysipelas? For how long?

A
  • PCN G (IV, PO, IM)
  • Amoxicillin
    Both for 7-10 days
26
Q

There are 3 types of purulent SSTIs, what are they?

A
  • Furuncles
  • Carbuncles
  • Cutaneous abscess
27
Q

Define furuncle’s

A

Infection of hair follicles that usually extend through the dermis into the SQ tissue resulting in small abscess

28
Q

Define carbuncles

A

Inflammatory nodules that extends through multiple adjacent follicles

29
Q

Which population has a chance of gaining purulent SSTIs?

A

Those who have irritated/injured hair follicles/skin

30
Q

What organisms cause purulent SSTIs?

A

Staph. aureus (including MRSA)

31
Q

(T/F) - Carbuncles usually start as a firm, tender, red nodule, that become painful and fluctuant

A

FALSE - This is describing farbuncles

32
Q

(T/F) - Carbuncles are inflamed, drain nodule involving a hair follicle

A

FALSE - This is describing farbuncles

33
Q

(T/F) - Furuncle’s lesion often drain spontaneously

A

TRUE

34
Q

(T/F) - Carbuncles lesions caused by CA-MRSA often have a characteristic of a ‘spider bite’

A

FALSE - This is describing furuncle’s

35
Q

(T/F) - Carbuncle’s form a broad, swollen, erythematous, deep, and painful follicular masses

A

TRUE

36
Q

(T/F) - Furuncle’s commonly develop at the back of the neck and are likely to occur in diabetic patients

A

FALSE - This is describing carbuncles

37
Q

What is highly recommended for all carbuncles, large furuncles, and abscesses?

A
  • Incision and drainage

- Culture and sensitive testing

38
Q

How is a mild (localized but no signs of systemic infections) purulent SSTIs treated?

A

No need for antibiotics

39
Q

How is a moderate (signs of systemic infection) purulent SSTI treated empirically? For how long?

A
  • Doxycycline
  • TMP/SMX
    For both 5-10 days PO
40
Q

How is a moderate (signs of systemic infection) MRSA purulent SSTI treated? For how long?

A
  • TMP/SMX

For 5-10 days PO

41
Q

How is a moderate (signs of systemic infection) MSSA purulent SSTI treated? For how long?

A
  • Doxycycline
  • Cephalexin
    For 5-10 days PO
42
Q

When should PO meds be switched to IV meds for purulent SSTIs?

A
  • Failed incision and drainage plus PO antibiotics OR

- Systemic inflammatory response syndrome (SIRS) is present

43
Q

What are the SIRS symptoms?

A
  • Fever
  • Hypotension
  • Tachypnea
  • Tachycardia
  • High WBC count
44
Q

How is a severe purulent SSTI treated empirically? For how long?

A 
Treat as if it were MRSA infection
- Vancomycin
- Daptomycin
- Linezolid
- Ceftaroline
- Dalbavancin
- Ortiavancin
- Telavancin
For all of them 5-10 days IV
45
Q

How is severe MRSA purulent SSTI treated? For how long?

A

Same as severe purulent SSTI treated empirically

46
Q

How is severe MSSA purulent SSTI treated? For how long?

A
  • Nafcillin
  • Oxacillin
  • Clindamycin
47
Q

Define cellulitis

A

Involves the deeper dermis and SQ fat

48
Q

Who is at risk of gaining CA-MRSA of cellulitis?

A
  • Smoker
  • Diabetics
  • Recurrent infections
  • IVDU
  • Skin contact
  • Sharing personal contaminated items
  • Lack of cleanliness
  • Crowding
  • IVDU
49
Q

What are the most common organisms that cause cellulitis?

A
  • Group A streptococci

- Staph. aureus

Infectious Disease (41 decks)

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