Soft Skin Infection - Block 1 Flashcards
List bacteria that is normal found on skin?
- S. aueus
- S. epidermis
- S. pyogenes
Superficial skin infection with fluid filled vesicles?
Impetigo
Superficial skin infection with extensive lymphatic involvement?
Erysipelas
Infection of dermis, epidermis, and superficial fascia with poorly defined margins?
Cellulitis
Inflammation of the hair follicules of the dermis and subcutaneous laye?
Furuncles
Infllamation of the hair follicles of the subcutaneous or deeper tissue
Carbuncles
Progessive destruction of superficial fascia and SQ fat?
Necrotizing fascitis
Consisitng or containing pus
Purulent
Describe the causes of purulent infections?
- b-hemolytic Strep
- Cellulitis
- Abscesses caused by MRSA
Cause of impetigo?
staph. aureus, GAS
Cause of erysipleas?
Group A strep
Cause of cellulitis?
Group A strep, S. aureus
Cause of necrotizing fascitis II?
Monomicribial: group A strep, clostidium perfrigens
Cause of necrotizing fascitis?
Polymicrobia: aerobes, anaerobes, facultative bacteria
Cause of diabetic foot infection?
Polymicrobial: s. aureus, strep, enterobac, bacteriodes, P. aeriginosa
Cause of bite wound infection?
Aerobes and anaerobes
What is the difference between primary and secondary infection?
Primary: healthy skin
Secondary: progressive infection from already damaged skin
What is a complicated infection?
- Deeper layer and/or DM, HIV, immune deficiency
- CA-SSTI (S. aureus)
- HA-SSTI (MRSA)
Infectious agents of purulent infections?
Both S. aureus and Group A strep
Infectious agents of erysipelas?
B-hemolytic strep
Infectious agent of impetigo and cellulitis?
MSSA +/- b-hemolytic strep
Immunocompromised patients are more likely to aquire infections from ___?
Fungi
Cellulitis from bites are more likely to be a mix of ___?
Aerobes and anaerobes
What are polymicrobial infections?
Both G- and + that have synergistic effects
Bacterial strains most common in surgical site infections?
G- and anaerobes
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
Presentations of erysipelas?
Painful, redness, swollen with high WBC and temp
How are the presentations of erysipelas and cellulitis caused by its underlying microbia?
GAS: hemolysis
Lymphatic system: pain
Presentation of cellulitis?
Systemic presentation -> severe
What is an abscess?
Collection of pus within the dermis or subcutaneous space
Presentations of furuncles?
Painful, firm pustules along hair follicles
Presentations of carbuncles?
A deep-seated purulent infection that forms sinus tracts between hair follicles
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
Biomarkers of SSRIs?
- > 38 C
- Tachycardia (>90bpm)
- Tachypnea (>24bpm)
- WBC (>12000)
List nonspecific markers of infection?
CRP, ESR
Diagnostic tools for SSTI?
- Tissue culture (Not for non-severe infections)
- Blood culture (Systemic infection)
- Ultrasonography (Abscesses)
- CT/MRI (Deep seated infection)
Nonpharm for SSTI?
- Incision and drainage
- Warm compress
- Debridement
- Raise leg
- Irrigation of bite wounds with NS
RF for MRSA?
- Hx of MRSA
- Recent hospitalizaation
- IVDU
- Immunocompromised
- Prevalence of MRSA ≥30%
- Penetrating trauma
- Treatment failure or severe infection
How do we prevent MRSA transmission?
- Careful hand hygiene
- Keep wounds lightly covered
- DOn’t pick sores
- Bleach linens
- Avoid sharing personal items
- MRSA decolonization
Methods of MRSA decolonization?
- Nasal with mupirocin in each nostrils BID for 5 days
- Whole body with chlorhexidine for 5 days
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
How do you treat mild impetigo?
Topical mupirocin or retapamilin ointment for 5 days
Tx for severe the impetigo with MSSA?
Tx for 7 days:
1. Dicloxacillin
2. 1st gen cephalosporin
3. Penicillin G or VK
Tx for severe the impetigo with MRSA?
Tx for 7 days:
1. Clindamycin
2. Doxycycline
3. Bactrim
4. Vancomycin (very severe)
Tx for mild-moderate erysipelas?
Outpatient for 7-10 days:
* Penicillin VK (PO)
* Pen allergy: Clindamycin
Tx for severe erysipelas?
7-10 day course: Penicillin G IV -> if sx improve transition to PO
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)
Types of nonpurulent SSTIs?
- Nonpulent cellulitis
- Necrotizing fasciitis
Types of purulent SSTIs?
- Nonpurulent cellulitis
- Furuncle, carbuncle
- Abscess
Tx for Mild, non-MRSA Nonpurulent cellulitis?
PO coverage for strep for 5 days:
1. Penicillin VK
1. Cephalexin
1. Dicloxacillin
1. Clindamycin
Tx for Mild, MRSA Nonpurulent cellulitis?
PO coverage for Strep and MRSA for 5 days:
1. Bactrim
2. Doxycycline
PLUS
Penicillin, Amoxicillin, or Cephalexin
Tx for Moderate, non-MRSA Nonpurulent cellulitis?
IV for strep for 5 days:
* Penicillin
* Cefazolin
* Cefatriaxone
* Clindamycin
Tx for Moderate, MRSA Nonpurulent cellulitis?
IV for MRSA and strep for 5 days:
* Vancomycin
* Daptomycin
* Linezolid
* Telavancin
* Ceftaroline
Tx for Severe, non-necrotic Nonpurulent cellulitis?
Treatment for 5 days:
Vancomycin
PLUS
Zosyn, Imipenum/cilastatin, or meropenum
Tx for Severe, necrotic Nonpurulent cellulitis?
Tx for th 1-2 weeks:
Vancomycin or linezolid
PLUS
Zosyn, imipenem/cilastatin, meropenum, ertapenem, or ceftriazone+metronidazole
Tx for mild purulent cellulitis?
Treatment for 5 days:
* Incision and drainage of abscesses w/o ABX
Tx for moderate purulent cellulitis?
Treatment for 5 days:
* Incision and drainage
AND PO MRSA coverage
* Bactrim or Doxycycline
Tx for severe purulent cellulitis?
Treatment for 5 days:
* Incision and drainage
AND IV MRSA coverage
* Vancomycin, Daptomycin, Linezolid, Telavancin, or Ceftaroline
Tx for folliculitis and mid furuncle?
None: warm saline compress
Tx for furuncle and carbuncles?
Incision and drainage plus ABX for 5-7 days:
* Bactrim OR
* Doxycycline or Minocycline
Nonpharm for necrotizing fasciitis?
Immediate debridement (>14 hrs after diagnosis can increase mortality)
Type 1 NF treatment?
Empirical treatment (polymicrobial): Zosyn and Vancomycin
Type 2 NF treatment?
Monomicrobial: Clindamycin + penicillin until clinically stable for 48-72 hrs -> then penicillin only
S/s of infected DMF?
Local infection of:
* Swelling
* Erythema
* Local tenderness
* Pain
* Warmth purulent discharge
S/s of mild DMF?
- Local infection without deepre tissues or SIRS
- ≥0.5 and ≤2 cm around ulcer
S/s of moderate DMF?
- Local lesion with erythema >2 cm around ulcer or deep tissue
- NO SIRS
Bacterial isolates in DMF?
- Aerobes
- Anaerobes
- G+ > G-
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
P. aeruginosa RF?
- Soaking feet
- Discolored bumps with foul smelling drainage
- Failed nonpseudomonal ABX regimen
- Severe infection
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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
Tx for mild, MRSA RF DFI?
MRSA coverage:
* Bactrim
* Doxycycline
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
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
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
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
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
Duration of mild-moderate DFI therapy?
PO: 1-2 weeks
Duration of moderate-severe DFI therapy?
IV: 1-3 weeks
Non pharm for bite wounds?
- Irrigate with SW/NS and soap/povidone-iodine
- Surgical debridement
- Elevate area to reduce edema
When do you initiate bite wound prophylaxis?
All patients with human bite injuries early within 8 hours: prophylactic antibiotic therapy for 3-5 days
Animal bite prophylaxis?
- Wound care is sufficient <12H
- Prophylaxis ABX (3-5 days)
- Tdap and rabies vaccine
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Pharm tx for bites?
- Augmentin
- Doxycycline
- Moxifloxacin
When do you monitor bites?
Follow-up in 48-72 hours after initiating antibiotic therapy -> normal improvement in 3 days
