Systemic Inflammatory Response Syndrome (at least 2) -Temp >38 C or 24 breaths/min -Tachycardia >90 beats/min -WBC >12,000 or <4,000

Soft skin tissue infection Flashcards by key chibs

Purulent infections

Furnucles
Carbuncles
Cutaneous

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Purulent Mild Treatment

Incision & Drainage

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Purulent Moderate Treatment

Incision & Drainage
Culture & Sensitivity
Antibiotics

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True or False. Antibiotics are required for Mild Purulent Infections

False

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Empiric ABx for Moderate Purulent SSTIs

TMP/SMX
Doxycyclines

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Defined ABx for Moderate Purulent SSTIs

MRSA: TMP/SMX
MSSA: Dicloxacillin or Cephalexin

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True or False. Antibiotics for Moderate Purulent SSTIs are Oral

True

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What qualifies as Mild Purulent SSTIs?

Purulent infection WITHOUT systemic signs of infection

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What qualifies as Moderate Purulent SSTIs?

Purulent infection with systemic signs of Infection

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What qualifies as Severe Purulent SSTIs?

Patients who have failed I&D + Oral ABx
Septic patients
Immunocompromised patients

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SIRS criteria

Systemic Inflammatory Response Syndrome
(at least 2)

-Temp >38 C or <36 C
-Tachypnea >24 breaths/min
-Tachycardia >90 beats/min
-WBC >12,000 or <4,000

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True or False. Antibiotics for Severe Purulent SSTIs are oral.

False.
They are IV

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Empric ABx for Severe Purulent SSTIs

Vancomycin
Daptomycin
Linezolid
Televancin
Ceftaroline

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Defined ABx for Severe Purulent SSTIs

MRSA: Vanco/Dapto/Linezo/Televancin/Ceftaroline

MSSA: Nafcillin, Cefazolin, Clindamycin

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IV MRSA ABx for SSTIs

Vancomycin
Daptomycin
Ceftaroline
Dalbavancin/Oritavancin

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Oral MRSA ABx for SSTIs

TMP/SMX
Doxycycline
Linezolid

IV MSSA ABx for SSTIs

Ampicillin/Sulbactam
Nafcillin/Oxacillin
Cefazolin

Goal for Vancomycin IV (SSTIs)

Trough 10 - 15 mcg/ml

True or False. Mild Non-Purulent Treatment requires Antibiotics.

True. Oral ABx

Mild Non-Purulent Antibiotics

Penicillin
Cephalosporin
Dicloxacillin
Clindamycin

Moderate Non-Purulent Antibiotics

Penicllin
Ceftriaxone
Cefazolin
Clindamycin

***IV

Severe Non-Purulent Treatment

Antibiotics
Rule out necrotizing process
Culture and Sensitivity

Severe Non-Purulent Empiric Antibiotics

Vancomycin + Piperacillin/Tazobactam

Severe Non-Purulent Defined Antibiotics fpr Monomicrobial

Strep. Pyogenes: Penicillin + Clindamycin
Clostridial sp: Penicillin + Clindamycin
Vibrio Vulnificus: Doxycycline + Ceftazdime
Aeromonas hydrophilia: Doxycycline + Ciprofloxacin

Severe Non-Purulent Defined Antibiotics for Polymicrobial

Vancomycin + Piperacillin/Tazobactam

True or False. Both purulent and non-purulent SSTIs are exudatous

True

Bacterial species in Purulent SSTIs

Staphylococcus Aureus

Bacterial species in Non-Purulent SSTIs

Streptococcus

True or False. Drainage and culture is recommended for cellulitis

False. Blood cultures recommended though

Treatment for Necrotizing Fascitis

***SURGERY*** blood cultures and deep tissue cultures Start broad spectrum ABx empirically

What Antibiotics to start empirically for Necrotizing Fascitis?

Vancomycin + Piperacillin/Tazobactam

Treatment duration for Necrotizing Fascitis

No definite answer Continue ABx until: - debridement no longer needed - Patient clinically improves - Afebrile for 48 - 72 hours

Diabetic Foot Infection- why do they happen?

Neuropathy Vascular disease Immune modulation

How does diabetic foot infection clinically present?

From ulcer/wound from trauma Red, warm, tender, purulent charcot foot may probe to bone, foreign body, abscess >2 - wounded infection

DFI Mild classification

Erythema >0.5 cm but < 2cm

DFI Moderate Classification

Erythema >2 cm or with structures deeper than the skin

DFI Severe Classification

Erythema >2 SIRS criteria

True or False. For Diabetic Foot Infection, you must culture a clinically uninfected wound.

False. Do NOT culture a clinically uninfected wound.

Are cultures for moderate and severe DFIs essential?

Yes