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PR3124 > SSTI > Flashcards

SSTI Flashcards

1
Q

Normal protecting factors of skin

A

1) Dry surface - Inhibits bacterial growth
2) Fatty acids
3) Acidic pH (~5.6)
4) Renewal of epidermis - Dead skin cells & bacteria removed from skin surface
5) Low temperature

–> Inhibits excessive bacterial growth & entry into deeper layers

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2
Q

Pathophysiology of SSTIs

A

1) Penetration of normal skin bacteria into deeper layers
2) Introduction of other bacteria
3) Excess bacteria growth

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3
Q

Predisposing factors

A
  • High bacteria innocula
  • Excessive moisture
  • Reduced blood supply
  • Presence of bacterial nutrients
  • Poor hygiene
  • Sharing of personal items
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4
Q

How are SSTIs classified?

A
  • Severity/extent
  • Depth of infection
  • Presence/absence of pus discharge
  • Microbiology
  • Anatomical site
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5
Q

Impetigo & Ecthyma classification

A
  • Usually managed as outpatient

Severity: Mild
Depth: Uncomplicated
Discharge/ Purulent/Non-purulent
Micriobiology: Primary

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6
Q

Clinical presentation of Impetigo & Ecthyma

A

Impetigo: Most common in children/face/extremities as fluid-filled vesicles
Ecthyma: Deeper than impetigo, scarring common

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7
Q

Microbiology of Impetigo & Ecthyma

Causative microbes & cultures

A

Causative microbes:

i) Staph aureus - bullous form caused by S.Aureus
ii) B-hemolytic Streptococci (eg. Strep pyrogens)

Culture:
- Usually treated w/o but can culture if have pus

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8
Q

Impetigo treatment

A

Topical Mupirocin BD x 5days

Oral antibiotic only if severe cases

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9
Q

Ecthyma treatment

A

Empiric:

i) Cephalexin/Cloxacillin
ii) Clindamycin (penicillin allergy)

Culture-directed:

i) Pen VK (S. pyrogens)
ii) Cephalexin/Cloxacillin (MSSA)

Duration: x 7days

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10
Q

Risk factors for purulent SSTIs

A

Close physical contact
Crowded living conditions
Poor personal hygiene
Sharing personal items

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11
Q

Microbiology of Purulent SSTIs

Causative microbes & cultures

A

Causative microbe: Staph aureus
(Cutaneous abscess may be polymicrobial)

Usually treated w/o culture

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12
Q

Treatment of Purulent SSTIs

A

I&D

Adjunctive systemic antibiotics if:

  • Unable to drain completely/ lack of response
  • Extensive disease involving several sites
  • Extremes of age
  • Immmunosupressed
  • Signs of SIRS
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13
Q

Criteria for SIRS

A

Temp > 38C or < 36C
HR > 90 beats/min
RR > 24 beats/min
WBC > 12 X 10^9 or < 4 x 10^9

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14
Q

Antibiotics Treatment for Purulent SSTIs

Furuncles, carbuncles

A

MSSA only:

  • PO Cloxacillin
  • PO Cephelaxin
  • IV Cefazolin

MSSA, MRSA:

  • PO Clindamycin
  • PO Cotrimoxazole
  • PO Doxycycline

Duration: 5-7 days (outpatient)
7-14 days (inpatient)

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15
Q

Clinical presentation of Cellulitis vs Erysipelas

A

Cellulitis: Poorly demarcated area, purulent/non-purulent

  • Acute inflmm of epidermis, dermis & sometimes superficial fascia
  • Bacteria can invade lymphatic tissue & blood

Erysipelas: Sharply demarcated area with raised border
- Affects up to superficial dermis & lymphatic tissue

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16
Q

Complications of Cellulitis vs Erysipelas

A
  • Bacteremia
  • Endocarditis
  • Toxic shock
  • Glomerulonephritis
  • Lymphedema (Buildup of fluid due to blockage of lymphatic system)
  • Osteomyelitis (Inflmm/swelling in bone)
  • Necrotizing soft-tissue infections
17
Q

Microbiology of Cellulitis vs Erysipelas

Causative microbes & cultures

A

Causative microbe:

i) Staph aureus (purulent)
ii) B-hemolytic strep (for Erysipelas)

Cultures:

  • Not routinely recommended
  • Reasonable if purulent infections after I&D/ immunosuppressed/ SIRS
  • -> tissue sample valuable
18
Q

Treatment of non-purulent Cellulitis/ Erysipelas

A

Mild: Treat for Streptococcus spp

i) PO Penicillin VK
ii) PO Cloxacillin
iii) PO Cephalexin
iv) PO Clindamycin

Moderate: Treat for Strep/ S.Aureus
1 SIRS criteria –> Treat like mild

2 SIRS criteria

i) IV Cefazolin
ii) IV Pen G
iii) IV Clindamycin

Severe: Treat for Strep/ S.Aureus/ Gram(-)
2 SIRS + hypotension/rapid progression/immunosupressed/comorbidity
i) IV Pip/Tazo
ii) IV Cefepime
iii) IV Meropenem

if MRSA risk factors, add:

  • IV Vancomycin
  • IV Daptomycin
  • IV Linezolid
19
Q

MRSA Risk factors

A

i) Immunosupression
ii) Critically ill
iii) Previously failed antibiotics w/o MRSA activity

20
Q

Treatment of purulent Cellulitis/ Erysipelas

A

Mild: Streptococcus spp/S. Aureus

i) PO Cephalexin
ii) PO Cloxacillin
iii) PO Clindamycin

if MRSA risk factors, add:

  • PO Cotrimoxazole
  • PO Clindamycin
  • PO Doxycycline

Moderate: Streptococcus spp/S. Aureus
1 SIRS criteria –> Treat like mild

2 SIRS criteria

i) IV Cloxacillin
ii) IV Cefazolin
iii) IV Clindamycin

if MRSA risk factors, add:

  • IV Vancomycin
  • IV Daptomycin
  • IV Linezolid

Severe: Treat for Strep/S.Aureus/Gram(-) including P. aeruginosa
2 SIRS + hypotension/rapid progression/immunosupressed/comorbidity

i) IV Pip/Tazo
ii) IV Cefepime
iii) IV Meropenem

if MRSA risk factors, add:

  • IV Vancomycin
  • IV Daptomycin
  • IV Linezolid
21
Q

Organism for animal bite wounds

A

Pasteurella multocida

22
Q

Organism for human bite wounds

A

Eikenella corrodens

23
Q

Organism for oral anaerobes

A

Prevotella spp, Peptostreptococcus spp

24
Q

Treatment of cellulitis from bite wounds?

A

i) Augmentin
ii) Ceftriaxone/Cefuroxime + clindamycin/metronidazole
iii) Ciprofloxacin/Levofloxacin + clindamycin/metronidazole

25
Q

Pathophysiology of DFI

A

1) Neuropathy
- Peripheral: Decreased pain sensation & response
- Motor: Motor imbalance
- Autonomic: Increased dryness, cracks & fissures

2) Vasculopathy
- Early artherosclerosis
- PVD
- Worsened by hyperglycemia & dyslipidemia

3) Immunopathy
- Impaired immune response
- Increased susceptibility to infections
- Worsened by hyperglycemia

  • -> Ulcer/wound formation
  • -> Bacterial colonization/ proliferation/ penetration
  • -> DFI
26
Q

Causative organism of DFI/PU

A
  • Typically polymicrobial
    i) Staph aureus & Strep Most common

ii) Gram (-) [Chronic wounds/ Previously treated]
- E.coli, Klebsiella, Proteus

iii) Anaerobes [Ischaemic/ Necrotic wounds]
- Peptostreptococcus spp, Veilonella spp, Bacteriodes spp

27
Q

Cultures for DFI

A

Mild: optional
Moderate: Deep tissue cultures after cleansing & before starting antibiotics. Avoid skin swabs

Do not culture uninfected wounds

28
Q

Treatment of DFI/PU

A 
Mild x 1-2 weeks: 
Streptococcus spp/S. Aureus (Erythema < 2cm)
i) PO Cephalexin
ii) PO Cloxacillin
iii) PO Clindamycin

if MRSA risk factors, add:

  • PO Cotrimoxazole
  • PO Clindamycin
  • PO Doxycycline

Mod x 1-3weeks
: Strep/S. Aureus/Gram -ve (+- P. aeruginosa)/Anaerobes
(Erythema > 2cm + No signs of systemic infection)
i) IV Augmentin
ii) IV Ceftriaxone ** ( + Clindamycin/Metronidazole)

if MRSA risk factors, add:

  • IV Vancomycin
  • IV Daptomycin
  • IV Linezolid

Severe x 2-4weeks:
Strep/S. Aureus/Gram -ve (P. aeruginosa)/Anaerobes
(Signs of SIRS)
i) IV Pip/Tazo
ii) IV Mereopenem
iii) IV Cefepime ** ( + Clindamycin/Metronidazole)

if MRSA risk factors, add:

  • IV Vancomycin
  • IV Daptomycin
  • IV Linezolid
29
Q

Adjunctive measures for DFI

A

Wound care

  • Debridement
  • “Off-loading” [Supportive shoes]
  • Apply dressings that promote a healing environment & control excess exudation

Foot care

  • Daily inspection
  • Prevent wounds & ulcers
30
Q

How does Pressure Ulcers come about?

A
  • Moisture
  • Pressure (Amount & duration)
  • Shearing force
  • Friction
31
Q

Risk factors for pressure ulcers

A
  • Reduced mobility
  • Debilitated by severe chronic disease
  • Reduced consciousness
  • Sensory & autonomic impairment
  • Extremes of age
  • Malnutrition
32
Q

Cultures for PU?

A
  • Recommend deep tissue cultures/biopsy specimens

- Avoid skin swabs

33
Q

Adjunctive measures for pressure ulcers

A
  • Debridement of infected or necrotic tissue
  • Local wound care (Normal saline preferred)
  • Relief of pressure
    (Turn or reposition every 2hrs, also impt for prevention)

PR3124 (16 decks)

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