Soft Skin Infection - Block 1 Flashcards
1
Q
List bacteria that is normal found on skin?
A
- S. aueus
- S. epidermis
- S. pyogenes
2
Q
Superficial skin infection with fluid filled vesicles?
A
Impetigo
3
Q
Superficial skin infection with extensive lymphatic involvement?
A
Erysipelas
4
Q
Infection of dermis, epidermis, and superficial fascia with poorly defined margins?
A
Cellulitis
5
Q
Inflammation of the hair follicules of the dermis and subcutaneous laye?
A
Furuncles
6
Q
Infllamation of the hair follicles of the subcutaneous or deeper tissue
A
Carbuncles
7
Q
Progessive destruction of superficial fascia and SQ fat?
A
Necrotizing fascitis
8
Q
Consisitng or containing pus
A
Purulent
9
Q
Describe the causes of purulent infections?
A
- b-hemolytic Strep
- Cellulitis
- Abscesses caused by MRSA
10
Q
Cause of impetigo?
A
staph. aureus, GAS
11
Q
Cause of erysipleas?
A
Group A strep
12
Q
Cause of cellulitis?
A
Group A strep, S. aureus
13
Q
Cause of necrotizing fascitis II?
A
Monomicribial: group A strep, clostidium perfrigens
14
Q
Cause of necrotizing fascitis?
A
Polymicrobia: aerobes, anaerobes, facultative bacteria
15
Q
Cause of diabetic foot infection?
A
Polymicrobial: s. aureus, strep, enterobac, bacteriodes, P. aeriginosa
16
Q
Cause of bite wound infection?
A
Aerobes and anaerobes
17
Q
A
18
Q
What is the difference between primary and secondary infection?
A
Primary: healthy skin
Secondary: progressive infection from already damaged skin
19
Q
What is a complicated infection?
A
- Deeper layer and/or DM, HIV, immune deficiency
- CA-SSTI (S. aureus)
- HA-SSTI (MRSA)
20
Q
Infectious agents of purulent infections?
A
Both S. aureus and Group A strep
21
Q
Infectious agents of erysipelas?
A
B-hemolytic strep
22
Q
Infectious agent of impetigo and cellulitis?
A
MSSA +/- b-hemolytic strep
23
Q
Immunocompromised patients are more likely to aquire infections from ___?
A
Fungi
24
Q
Cellulitis from bites are more likely to be a mix of ___?
A
Aerobes and anaerobes
25
What are polymicrobial infections?
Both G- and + that have synergistic effects
26
Bacterial strains most common in surgical site infections?
G- and anaerobes
27
What are the presentations of impetigo?
**Bullous:** painless, fluid-filled blisters on face, arms, and legs
**Nonbullous:** clusters of vesciles or pustules, ooze fluid forming honey-colored scabs
28
Presentations of erysipelas?
Painful, redness, swollen with high WBC and temp
29
How are the presentations of erysipelas and cellulitis caused by its underlying microbia?
GAS: hemolysis
Lymphatic system: pain
30
Presentation of cellulitis?
Systemic presentation -> severe
31
What is an abscess?
Collection of pus within the dermis or subcutaneous space
32
Presentations of furuncles?
Painful, firm pustules along hair follicles
33
Presentations of carbuncles?
A deep-seated purulent infection that forms sinus tracts between hair follicles
34
What is the difference between necrotizing fasciitis type 1 and 2?
**Type 1:** secondary to diabetic patients or other comorbities
**Type 2:** Primary to strep
35
Biomarkers of SSRIs?
1. >38 C
2. Tachycardia (>90bpm)
3. Tachypnea (>24bpm)
4. WBC (>12000)
36
List nonspecific markers of infection?
CRP, ESR
37
Diagnostic tools for SSTI?
1. Tissue culture (Not for non-severe infections)
2. Blood culture (Systemic infection)
3. Ultrasonography (Abscesses)
4. CT/MRI (Deep seated infection)
38
Nonpharm for SSTI?
1. Incision and drainage
2. Warm compress
3. Debridement
4. Raise leg
5. Irrigation of bite wounds with NS
39
RF for MRSA?
1. Hx of MRSA
2. Recent hospitalizaation
3. IVDU
4. Immunocompromised
5. Prevalence of MRSA ≥30%
6. Penetrating trauma
7. Treatment failure or severe infection
40
How do we prevent MRSA transmission?
1. Careful hand hygiene
2. Keep wounds lightly covered
3. DOn't pick sores
4. Bleach linens
5. Avoid sharing personal items
6. MRSA decolonization
41
Methods of MRSA decolonization?
1. Nasal with mupirocin in each nostrils BID for 5 days
2. Whole body with chlorhexidine for 5 days
42
Describe severity of SSTI?
**Mild:** no systemic infection, well controlled, no comorbidities
**Moderate:** systemic signs, infection sx, poorly controlled comorbidites
**Severe:** SIRS with toxic appearance, altered mentation, hypotension, end organ dysfunction
43
How do you treat mild impetigo?
Topical mupirocin or retapamilin ointment for 5 days
44
Tx for severe the impetigo with MSSA?
Tx for 7 days:
1. Dicloxacillin
2. 1st gen cephalosporin
3. Penicillin G or VK
45
Tx for severe the impetigo with MRSA?
Tx for 7 days:
1. Clindamycin
2. Doxycycline
3. Bactrim
4. Vancomycin (very severe)
46
Tx for mild-moderate erysipelas?
Outpatient for 7-10 days:
* Penicillin VK (PO)
* Pen allergy: Clindamycin
47
Tx for severe erysipelas?
7-10 day course: Penicillin G IV -> if sx improve transition to PO
48
How should you evaluate erysipelas tx?
* Temp and WBC to normal within 48-72H
* Erythema, edema, and pain resolves gradually (may worsen 72H its is a sign of course of infection not tx failure)
49
Types of nonpurulent SSTIs?
1. Nonpulent cellulitis
2. Necrotizing fasciitis
50
Types of purulent SSTIs?
1. Nonpurulent cellulitis
2. Furuncle, carbuncle
3. Abscess
51
Tx for Mild, non-MRSA Nonpurulent cellulitis?
PO coverage for strep for 5 days:
1. Penicillin VK
1. Cephalexin
1. Dicloxacillin
1. Clindamycin
52
Tx for Mild, MRSA Nonpurulent cellulitis?
PO coverage for Strep and MRSA for 5 days:
1. Bactrim
2. Doxycycline
**PLUS**
Penicillin, Amoxicillin, or Cephalexin
53
Tx for Moderate, non-MRSA Nonpurulent cellulitis?
IV for strep for 5 days:
* Penicillin
* Cefazolin
* Cefatriaxone
* Clindamycin
54
Tx for Moderate, MRSA Nonpurulent cellulitis?
IV for MRSA and strep for 5 days:
* Vancomycin
* Daptomycin
* Linezolid
* Telavancin
* Ceftaroline
55
Tx for Severe, non-necrotic Nonpurulent cellulitis?
Treatment for 5 days:
Vancomycin
**PLUS**
Zosyn, Imipenum/cilastatin, or meropenum
56
Tx for Severe, necrotic Nonpurulent cellulitis?
Tx for th 1-2 weeks:
Vancomycin or linezolid
**PLUS**
Zosyn, imipenem/cilastatin, meropenum, ertapenem, or ceftriazone+metronidazole
57
Tx for mild purulent cellulitis?
Treatment for 5 days:
* Incision and drainage of abscesses w/o ABX
58
Tx for moderate purulent cellulitis?
Treatment for 5 days:
* Incision and drainage
**AND PO MRSA coverage**
* Bactrim or Doxycycline
59
Tx for severe purulent cellulitis?
Treatment for 5 days:
* Incision and drainage
**AND IV MRSA coverage**
* Vancomycin, Daptomycin, Linezolid, Telavancin, or Ceftaroline
60
Tx for folliculitis and mid furuncle?
None: warm saline compress
61
Tx for furuncle and carbuncles?
Incision and drainage plus ABX for 5-7 days:
* Bactrim **OR**
* Doxycycline or Minocycline
62
Nonpharm for necrotizing fasciitis?
Immediate debridement (>14 hrs after diagnosis can increase mortality)
63
Type 1 NF treatment?
Empirical treatment (polymicrobial): Zosyn and Vancomycin
64
Type 2 NF treatment?
Monomicrobial: Clindamycin + penicillin until clinically stable for 48-72 hrs -> then penicillin only
65
S/s of infected DMF?
Local infection of:
* Swelling
* Erythema
* Local tenderness
* Pain
* Warmth purulent discharge
66
S/s of mild DMF?
* Local infection without deepre tissues or SIRS
* ≥0.5 and ≤2 cm around ulcer
67
S/s of moderate DMF?
* Local lesion with erythema >2 cm around ulcer or deep tissue
* **NO** SIRS
68
Bacterial isolates in DMF?
1. Aerobes
2. Anaerobes
3. G+ > G-
69
S/s of severe DMF?
Local infection with 2 SIRs criteria:
* Temp >100.4F or <98.6F
* HR >90
* RR >20
* WBC >12000, <4000, or 10% bands
70
P. aeruginosa RF?
1. Soaking feet
2. Discolored bumps with foul smelling drainage
3. Failed nonpseudomonal ABX regimen
4. Severe infection
## Footnote
`
71
Tx for mild, non-MRSA RF DFI?
PO or topical (superficial) for 1-2 weeks, max 4 weeks:
**Previous ABX:** GPC and GNR (Levofloxacin, Moxifloxacin, Augmentin)
**No previous ABX:** GPC (Dicloxacillin, Clindamycin, Cephalexin
72
Tx for mild, MRSA RF DFI?
MRSA coverage:
* Bactrim
* Doxycycline
73
Tx for moderate DFI with no extensive wound or P. aeruginosa RF?
PO coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Levofloxacin +/- clindamycin
* Ciprofloxacin +/- clindamycin
* Moxifloxacin
* Augmentin
**with MRSA RF:**
* Add doxycycline or linezolid or consider switching to IV
74
Tx for moderate DFI with no extensive wound **BUT** with P. aeruginosa RF?
**PO** coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Levofloxacin +/- clindamycin
* Ciprofloxacin +/- clindamycin
**with MRSA RF:**
* Add doxycycline or linezolid or consider switching to IV
75
Tx for moderate DFI with extensive wounds and P. aeruginosa RF?
**PO** coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Zosyn
* Ceftazime, cefepime, aztreonam, levofloxacin, ciprofloxacin **with clindamycin**
**with MRSA RF:**
* Add vancomycin, linezolid, or daptomycin
76
Tx for moderate DFI with extensive wounds **BUT** no P. aeruginosa RF?
**PO** coverage for GPC, GNR, +/- obligate anaerobes for 1-3 weeks:
* Levofloxacin +/- clindamycin
* Ciprofloxacin + clindamycin
* Moxifloxacin
* Ceftriaxone
* Cefoxitin
* Ampicillin-sulbactam
* Ertapenum
* Tigacycline
**with MRSA RF:**
* Add vancomycin, linezolid, or daptomycin
77
Tx for severe DFI with MRSA?
**IV** coverage for MSSA, strep, GNR, P. auruginosa, obligate anareobes and MRSA for 2-4 weeks:
Vancomycin **with:**
* Zosyn
* Imipenem-cilastatin
* Ceftazidime + clindamycin or metronidazole
* Cefepime + clindamycin or metronidazole
* Aztreonam + clindamycin or metronidazole
78
Duration of mild-moderate DFI therapy?
PO: 1-2 weeks
79
Duration of moderate-severe DFI therapy?
IV: 1-3 weeks
80
Non pharm for bite wounds?
1. Irrigate with SW/NS and soap/povidone-iodine
2. Surgical debridement
3. Elevate area to reduce edema
81
When do you initiate bite wound prophylaxis?
All patients with human bite injuries early within 8 hours: prophylactic antibiotic therapy for **3-5 days**
82
Animal bite prophylaxis?
1. Wound care is sufficient <12H
2. Prophylaxis ABX (3-5 days)
3. Tdap and rabies vaccine
| `
83
Pharm tx for bites?
1. Augmentin
2. Doxycycline
3. Moxifloxacin
84
When do you monitor bites?
Follow-up in 48-72 hours after initiating antibiotic therapy -> normal improvement in 3 days
