Soft skin tissue infection Flashcards
Purulent infections
Furnucles
Carbuncles
Cutaneous
Purulent Mild Treatment
Incision & Drainage
Purulent Moderate Treatment
Incision & Drainage
Culture & Sensitivity
Antibiotics
True or False. Antibiotics are required for Mild Purulent Infections
False
Empiric ABx for Moderate Purulent SSTIs
TMP/SMX
Doxycyclines
Defined ABx for Moderate Purulent SSTIs
MRSA: TMP/SMX
MSSA: Dicloxacillin or Cephalexin
True or False. Antibiotics for Moderate Purulent SSTIs are Oral
True
What qualifies as Mild Purulent SSTIs?
Purulent infection WITHOUT systemic signs of infection
What qualifies as Moderate Purulent SSTIs?
Purulent infection with systemic signs of Infection
What qualifies as Severe Purulent SSTIs?
Patients who have failed I&D + Oral ABx
Septic patients
Immunocompromised patients
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
True or False. Antibiotics for Severe Purulent SSTIs are oral.
False.
They are IV
Empric ABx for Severe Purulent SSTIs
Vancomycin
Daptomycin
Linezolid
Televancin
Ceftaroline
Defined ABx for Severe Purulent SSTIs
MRSA: Vanco/Dapto/Linezo/Televancin/Ceftaroline
MSSA: Nafcillin, Cefazolin, Clindamycin
IV MRSA ABx for SSTIs
Vancomycin
Daptomycin
Ceftaroline
Dalbavancin/Oritavancin
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
