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SSTI Flashcards

1
Q

treatment of mild impetigo

A

topical antibiotics eg:

- mupirocin BD x 5/7

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2
Q

empiric treatment of severe impetigo/ all ecthyma

A
  1. cephalexin 250-500mg PO QDS* x1/52
  2. cloxacillin 250-500mg PO QDS x1/52
  3. (penicillin allergy): clindamycin x1/52
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3
Q

culture directed treatment of severe impetigo/ all ecthyma

A

S pyogenes: penicilin VK 250-500mg PO QDS x1/52

MSSA:

  1. cephalexin 250-500mg PO QDS* x1/52
  2. cloxacillin 250-500mg PO QDS x1/52
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4
Q

mainstay of treatment for purulent SSTI

A

incision and drainage (I&D)

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5
Q

identify and treat mild, non purulent cellulitis/erysipelas

A

no signs of systemic infections (SIRS)
cover: strepto spp

treatment (PO)

  1. Penicillin VK
  2. Cloxacillin
  3. Cephalexin
  4. Clindamycin
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6
Q

identify and treat moderate, non purulent cellulitis/erysipelas

A 
org to cover: strept +staph
if 1 SIRS: PO antibiotic
1. Penicillin VK
2. Cloxacillin
3. Cephalexin
4. Clindamycin

if >2 SIRS or PO Tx fail: IV

  1. Cefazolin
  2. Penicillin G
  3. Clindamycin
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7
Q

identify and treat severe, non-purulent cellulitis/erysipelas

A

org to cover: strept + staph+ gram neg (p. aeruginosa)

if >2 SIRS + BP<100-60/ rapid progression/immuno/comorbidities : IV

  1. Pipe-Tazo
  2. Cefepime
  3. Meropenem

MRSA risk factor: (immuno, critically ill, previous failure to non MRSA AB)- IV Tx:

  1. vanco (preferred- narrower)
  2. dapto
  3. Linezolid
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8
Q

identify and treat mild, purulent cellulitis/erysipelas

A 
organism: Strep& staph
no SIRS: PO
1. Cephalexin
2. Cloxacillin
3. Clindamycin

MRSA risk factor- (immuno, critically ill, previous failure to non MRSA AB) PO antibiotics Tx:

  1. Trimetho-Sulfametho
  2. Clindamycin
  3. Doxycycline
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9
Q

identify and treat moderate, purulent cellulitis/erysipelas

A

org: strep+staph

if 1 SIRS: treat like mild, PO

  1. Cefalexin
  2. Cloxacillin
  3. Clindamycin

if >2 SIRS: IV antibiotics

  1. Cefazolin
  2. Cloxacillin (milder +MRSA)
  3. Clindamycin (milder +MRSA)

MRSA risk- (immuno, critically ill, previous failure to non MRSA AB) IV antibiotics:

  1. vanco
  2. dapto
  3. linezolid
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10
Q

identify and treat severe, purulent cellulitis/erysipelas

A

indications: >2SIRS, <100/60bpm, rapid progression, immuno, comorbidities

Organism: strepo + straph + gram neg (p aeruginosa)

Tx: IV antibiotics:

  1. Pipe-tazo
  2. Cefepime
  3. Meropenem

MRSA risk factors (immuno, critically ill, previous failure to non MRSA AB): IV

  1. Vanco
  2. Dapto
  3. Linezolid
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11
Q

identify and treat mild DFI

A

infection of skin and SC tissue + erythema <=2cm around ulcer + no signs of systemic infection (no SIRS)

organism: strep/staph

treatment: PO antibiotics
1. Cephalexin
2. Cloxacillin
3. Clindamycin

MRSA risk factors (immuno, critically ill, previous failed AB without MRSA coverage): PO antibiotics

  1. Trimetho/Sulfametho
  2. Clindamycin
  3. Doxycycline

duration: 1-2w

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12
Q

identify and treat Moderate DFI

A

infection of skin and SC tissue + erythema >2cm around ulcer + no signs of systemic infection (no SIRS)

organism: strep/staph + gram neg (p.aeruginosa) + anaerobes

treatment: IV antibiotics
1. Amoxi/clav (dont need anaerobic coverage)
2. ceftriaxone
3. ertapenem (not really preferred; keep for esbl)

MRSA risk: IV

  1. vanco
  2. dapto
  3. linezolid

Anaerobes

  1. metronidazole
  2. clindamycin

duration: 1-3w

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13
Q

identify and treat severe DFI

A

signs of systemic infection (with SIRS)

organism: strep/staph + gram neg (p.aeruginosa) + anaerobes

Tx: initial IV

  1. pipe/tazo
  2. cefepime
  3. meropenem

MRSA risk: IV

  1. vanco
  2. Daptop
  3. Linezolid

anaerobic: IV
1. metronidazole
2. clindamycin

duration: 2-4w

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14
Q

duration of DFI tx

A

mild: 1-2w
moderate: 1-3w
severe: 2-4w
surgery remove all infected bone: 2-5d
surgery with residual infected soft tissues: 1-3w
surgery with residual viable bone: 4-6w
no surgery/ dead bone: >=3mth

dont continue AB until wound heals completely

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15
Q

protective factors of skin

A
  1. drug surface (no moisture, prevent growth)
  2. fatty acids
  3. Acidic pH (~5.6)
  4. renewal of epidermis (skin shed)
  5. low temperature (inhibit bacteria growth)
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16
Q

predisposing factors

A
  1. high bacteria innocula
  2. excessive moisture
  3. reduced blood supply
  4. presence of bacteria nutrients
  5. poor hygiene
  6. sharing of personal items
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17
Q

least to most deep SSTI

A 
impetigo (epidermis)
ecthyma (dermis)
erysipelas (dermis)
furuncles (hair follicles)
carbuncles (hair follicles)
cellulitis (subcutaneous fat)
necrotising fascilitis (fascia)
myotitis (muscle)
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18
Q

how is impetigo and ecthyma usually managed and classified

A 
outpatient;
severity: mild
depth of infection: uncomplicated
discharge: purulent/ non purulent
microbiology: primary
anatomical site: epidermis/ up to the dermal-epidermal junction
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19
Q

scarring is common in ecthyma or impetigo

A

ecythma, it is deeper than impetigo

20
Q

causative agent of impetigo/ecthyma

A

staphlococcus aureus
B-hemolytic streptococci (pyrogenes)
bullous form caused by toxin-producing strains of S. aureus

21
Q

is culture a need for ecthyma or impetigo

A

it is optional; may culture if pus, but usually reasonable to treat without culture

22
Q

empirical coverage for ecthyma/impetigo

A

S. aureus and B-hemolytic streptococci (cover both since unsure which is the actual causative organism)

23
Q

furuncles

A

infection of the hair follicles, extended through the dermis, inflammatory nodule

24
Q

carbuncles

A

involved a few adjacent follicles; form a small abscess, , larger and deeper, multiple hair follicles may be involved

25
Q

cutaneous abscesses

A

pus collection usually within dermis, nodule with rim of erythematous swelling, abscess may not be where hair follicles are

26
Q

specific risk factors of purulent SSTI

A

close physical contact, crowded living quarters (dorms, camps, prison), sharing personal items, poor personal hygiene

27
Q

causative organism of purulent SSTI

A
  • staphylococcus aureus (single most common organism)

- large skin abscesses may be polymicrobial

28
Q

need for culture for purulent SSTI?

A

usually treated without cultures since purulent causing organism are very predictable, but reasonable to culture

29
Q

when to use adjunctive systemic antibiotic after I&D

A
  1. unable to drain completely
  2. lack of response of !&D
  3. extensive disease involving several site
  4. extreme age
  5. immunosuppressed (chemo, transplant)
  6. signs of systemic illness (SIRS)
30
Q

SIRS criteria

A
  1. temperature >38 degree or 36 degree
  2. HR>90 beats/min
  3. RR >24 bpm
  4. WBC >12 or <4 x10^9/L
31
Q

cellulitis

A

acute inflammation of epidermis, dermis and sometimes superficial fascia; bacteria can invade lymphatic tissue and blood; purulent or non-purulent, poorly demarcated area or erythema, purulent or non purulent

32
Q

erysipelas

A

affects up to superficial dermis and lymphatic tissues; non-purulent; sharply demarcated area of erythema with raised border

33
Q

complications of cellulitis or erysipelas

A
  1. bacteremia
  2. endocarditis
  3. toxic shock
  4. glomerulonephritis
  5. lymphedema
  6. osteomyelitis
  7. necrotising soft-tissue infections (necrotising fasciitis)
34
Q

causative organism for cellulitis & erysipelas

A
  • staphlyococcus aureus (mainly purulent)
  • B-hemolytic streptococci (pyogenes)- 99% cause of erypelas
  • chronic liver/renal disease: vibrio, E.coli, pseudo.
  • immunosuppressed: strep pnuemoniae, E.coli, serratia marcescens, pseudo.
35
Q

should cultures be done for cellulitis/erysipelas

A

usually not routinely recommended, possible if purulent infections occur after I&D, immunosuppressed (chemo, transplant), SIRS criteria

36
Q

organism causing cellulitis from bite wounds

A

caused by

  1. staphylo, strepto,
  2. anaerobes (prevotella spp, peptostreptococcus spp.)
  3. others (pasteurella multocida - animal; eikenella corrodens - human)
37
Q

cellulitis from bite wounds Tx

A
  1. Amoxi-Clav
  2. Ceftriaxone/ cefuroxime + clinda/metronidazole
  3. Cipro/levo + clinda/metronidazole (pen allergy)

PO/IV based of severity

38
Q

duration of cellulitis & erysipelas Tx

A

at least 5d, may extend if not significantly improved,

immunosuppressed may need 7-14d

39
Q

DFI site of infection and its complications

A

soft tissue or bone infections below malleolus; areas of DFIs includes skin ulceration (peripheral neuropathy) or wound (trauma); complications would include hospitalisation, osteomyelitis which would lead to amputation

40
Q

DFI Pathophysiology

A
  1. neuropathy
  2. vasculopathy
  3. immunopathy
41
Q

neuropathy of DFI

A

peripheral- reduced pain sensation and altered pain response
motor- muscle imbalance
autonomic- increase dryness, cracks and fissures

42
Q

vasculopathy of DFI

A

early atherosclerosis; peripheral vascular disease; worsen by hyperglycemia and hyperlipidaemia

43
Q

immunopathy of DFI

A

impaired immune response; increase susceptibility to infections; worsened by hyperglycemia

44
Q

presentation of DFI

A

superficial ulcer, mild erythema; deep tissue infection, extensive erythema; infection of bone and fascia, purulent discharge

45
Q

causative organism for DFI

A

typical polymicrobial (Staph/strep), gram neg (E. coli, Kleb, Proteus), anaerobes (ischemic or necrotic wounds- peptostrepto, veillonella, bacteriodes)

is cultures needed for DFI
- optional for mild D

46
Q

is cultures needed for DFI

A
  • optional for mild DFI;
  • moderate-severe DFI: deep tissue culture after cleansing and before starting antibiotics (if possible); avoid skin swabs
  • do not culture uninfected wounds

mi (4 decks)

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