Soft Tissue Infections Flashcards
An infection of the epidermis usually caused by S aureus and Beta-hemolytic strep
Impetigo
Impetigo skin findings
Vesicles, honey-colored crust
Impetigo treatment
Limited infections: topical mupirocin or retapamulin
Extensive infx: dicloxacillin (penicillin) or cephalexin (1st gen cephalosposin)
MRSA: Bactrim or doxycycline
Infection of the upper dermis, usually caused by Beta-hemolytic strep or rarely by S aureus
Erysepelas
Erysipelas skin findings
well-demarcated, edematous area of erythema, often on the face. Painful
Can have fever
Erysipelas treatment
First line: penicillin
If S aureus suspected: 1st gen cephalosporin
MRSA: Bactrim or doxycycline
Infection of the dermis and subcutaneous fat with possible portal of entry
Cellulitis
Cellulitis most common bugs
S aureus
Strep pyogenes
Cellulitis - if diabetes present Abx must cover?
Pseudomonas and gram (-) rods
Human bite pathogens
anaerobes (Eikenella)
Animal bite pathogens
Anaerobes (Pasteurella - cats) (Capnocytophaga - dogs)
Cellulitis skin findings
warmth, erythema, tenderness
Possible abscess
Cellulitis differential diagnosis
Stasis dermatitis (chronic, bilateral, no systemic symptoms)
Necrotizing fasciitis (pain out of proportion to PE, gas on imaging)
hypersensitivity reactions (hives, pruritic, suspected distribution)
DVT
Cellulitis workup
Blood cultures
CBC
ESR, CRP
XR
Cellulitis management
First line: 1st gen cephalosporin (cephalexin), penicillin if abscess
MRSA: clindamycin, doxycycline, Bactrim, vancomycin (if inpatient)
Gram (-) coverage if diabetic
Human/animal bites: Amoxicillin/clavulanate (Augmentin) for anaerobes
Tetanus vaccination
If abscess: incision and drainage
Rapidly spreading infection of the subcutaneous fat and fascia
Necrotizing fasciitis
Necrotizing fasciitis presentation
erythematous, warm, tenderness
Rapidly progresses to dark, indurated skin with bullae
Toxic appearing
Necrotizing fasciitis complication
Compartment syndrome due to edema - out of proportion pain, weakness, paresthesia/numbess
Necrotizing fasciitis differential
Requires high degree of suspicion
Cellulitis
Can have elevated CK levels
Necrotizing fasciitis diagnosis
CT or MRI to look for gas and soft tissue involvement
Necrotizing fasciitis treatment
Surgery consult
Fasciotomy needed if compartment syndrome present
Clyndamycin for anti-toxin, vancomycin for MRSA
If mixed infection: Zosyn
Necrotizing fasciitis complications
Compartment syndrome
Shock
multiorgan failure
Dearth
