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Infectious Disease > Skin & Soft Tissue Infections > Flashcards

Skin & Soft Tissue Infections Flashcards

1
Q

What is the empiric antimicrobial therapy for moderate purulent (furuncle, carbuncle, abscess) infection?

A

Cephalexin (unless high MRSA prevalence) OR
TMP/SMX OR
Doxycycline

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2
Q

What is the empiric treatment for severe purulent (furuncle, carbuncle or abscess) infection?

A

Vancomycin

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3
Q

What is the empiric therapy for mild cellulitis, without signs of systemic infection or purulence?

A

Oral cephalexin x 5 days - can extend if no improvement at completion.

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4
Q

What did the PATCH I trial show?

A

Patients with at least 2 episodes of cellulitis over the past 3 years were treated prophylactically with oral amoxicillin or cephalexin daily for at least 1 year. This was found to be effective in preventing subsequent attacks while on prophylaxis.

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5
Q

What do the guidelines suggest for cellulitis prophylaxis?

A

Consider if > or = 3 episodes of cellulitis per year DESPITE controlling other risk factors, such as re-vascularization, wound care, footwear, compression, treated tinea.

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6
Q

What is the role of compression stockings in recurrent cellulitis?

A

Compression therapy results in lower incidence of recurrent cellulitis.

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7
Q

What is the empiric therapy for suspected necrotizing fasciitis?

A

Piptazo 3.375 g IV Q6H +

Vancomycin 15-20 mg/kg IV Q12H + Clindamycin 600 mg IV Q8H

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8
Q

How do you treat necrotizing fasciitis secondary to Group A Strep?

A

Penicillin/Beta-Lactam +

Clindamycin

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9
Q

What are the criteria for streptococcal toxic shock syndrome?

A
  1. Hypotension (sBP < 90 mmHg) AND
  2. Isolation of GAS from a normally sterile site AND
    2 of the following:
    - Renal Impairment (Cr> 177)
    - Coagulopathy (Plt < 100 or DIC)
    - Liver Fxn Abnormality (AST/ALT/Tbili 2 x ULN)
    - ARDS
    - Generalized erythematous macular rash that may desquamate
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10
Q

What precautions due toxic shock syndrome require?

A

Contact & Droplet

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11
Q

Which microorganism is responsible for green nail syndrome?

A

Pseudomonas aeruginosa

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12
Q

Which organism should you cover for with malignant otitis externa?

A

Pseudomonas aeruginosa

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13
Q

Which microorganism is responsible for oral hairy leukoplakia?

A

EBV

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14
Q

What are the characterisitics of a neuropathic foot ulcer?

A
  • Pressure point ulcers
  • Punched out appearance
  • Deep ulcer
  • Minimal pain
  • Warm and dry foot
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15
Q

What are the characterisitics of an arterial foot ulcer?

A
  • Lateral malleolus
  • Dry & punctate
  • Decreased pulses
  • Cold & dry foot
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16
Q

What are the characterisitics of venous foot ulcers?

A
  • Medial malleolus
  • Irregular margins
  • Shallow depth
  • Mildly painful
  • Venous stasis dermatitis/lipodermatosclerosis
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17
Q

What has the highest likelihood ratio for an infected foot ulcer?

A

Pain in a chronic wound (+ LR 11-20)

18
Q

What is the gold standard for diagnosis of osteomyelitis?

A

Bone biopsy and culture

19
Q

What clinical findings has the highest likelihood ratio for osteomyelitis?

A

ESR > 70 has a + LR of 11

Bone exposure has a + LR of 9.2

20
Q

Which clinical finding has the best negative likelihood ratio for osteomyelitis?

A

Negative MRI has a negative LR of 0.14

21
Q

What is the most common causative organism in native vertebral osteomyelitis?

A

S. Aureus

22
Q

If you suspect vertebral OM, what workup is guideline recommended?

A
  1. Blood cultures (2 sets)
  2. Baseline ESR/CRP
  3. MRI Spine
23
Q

What is the recommended management of vertebral osteomyelitis?

A
  • Hold abx until biopsy if no sepsis/neurological compromise
  • Then start empiric ceftriaxone and vancomycin
  • Continue abx for 6 weeks
  • Repeat inflammatory markers at 4 week
  • Repeat MRI ONLY if poor clinical response
24
Q

What is the empiric antibiotics for prosthetic joint infection?

A

Vancomycin and CTX

Antibiotics for 4-6 weeks IV or high dose oral with consideration for chronic suppression w/daily oral abx thereafter

25
Q

Which trial compared oral to IV antibiotics for bone and joint infections?

A

OVIVA

26
Q

What did the OVIVA trial demonstrate?

A

Patient we’re randomized to IV versus oral therapy. Trial demonstrated non-inferiority, with the caveat that the majority of patients managed had identifiable organisms and were able to use highly bioavailable oral antibiotics.

27
Q

What is the most common cause of impetigo?

A

Staphylococcus aureus

28
Q

What is the empiric treatment for a moderate cellulitis (or other non-purulent SSTI such as impetigo and erysipelas), with systemic signs of infection?

A

IV cephalosporin (cefazolin)

29
Q

What are two pathogens that cause necrotizing fasciitis and can be acquired through injury exposure to water?

A

(1) Aeromonas hydrophilia - freshwater

2) Vibrio vulnificus - Saltwater exposure (consider if underlying liver disease, seafood ingestion as well

30
Q

How would you treat a Vibrio vulnificus infection?

A

Doxycycline and ceftazidime

31
Q

How would you treat an Aeromonas hydrophila infection?

A

Doxycycline + ciprofloxacin

32
Q

What are the classic features of Salmonella typhi infection?

A

Fever & diarrhea in a returning traveller
Rose spots
Faint pink macules on lower chest and upper abdomen

33
Q

What causes oral hairy leukoplakia?

A

EBV - often in the context of HIV

White plaque that does no scrape off!

34
Q

What is the empiric treatment for native vertebral osteomyelitis?

A

Ceftriaxone + Vancomycin

35
Q

How would you treat arthritis caused by Lyme disease?

A

Doxycycline x 28 days

36
Q

Which patients with a tick bite would you treat empirically for Lyme disease?

A

If all 3 criteria are met:

(1) Confirmed Ixodes species
(2) Highly endemic area
(3) Tick attached for > 36 hours

37
Q

What is the treatment for a high risk tick bite if you are concerned about Lyme disease?

A

Doxycycline 200 mg PO x 1 dose within 72 hours of tick removal

38
Q

What is the treatment for erythema migrans with a target lesion at the site of a tick bite?

A

Doxycycline x 10 days

39
Q

What are three options for treatment of an animal bite infection?

A

(1) Amoxicillin-clavulanic acid
(2) Cephalosporin (2nd or 3rd) + Metronidazole
(3) Moxifloxacin

40
Q

What would you treat an infection related to a human bite with?

A

(1) Amoxicillin-Clavulanic Acid
(2) 2nd or 3rd Gen Cephalosporin + Flagyl
(3) Moxifloxacin

Infectious Disease (13 decks)

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