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PR3124 CA2 > SSTI > Flashcards

SSTI Flashcards

1
Q

___, ___ go up to the epidermis and dermal-epidermal junction.

A

Impetigo and ecthyma

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2
Q

What is the first line treatment for impetigo?

A

Mupirocin ointment BD 5d

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3
Q

What is the treatment for severe impetigo and ecthyma?

A

PO cephalexin/cloxacillin/clindamycin

IF culture: (S. pyogenes) penicillin VK, (MSSA) cephelaxin/cloxacillin

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4
Q

What are the 3 purulent infections?

A

Carbuncle, furuncle, cutaneous abscess

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5
Q

What is the standard treatment for purulent infections?

A

Incision & drainage

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6
Q

When should systemic antibiotics be used for purulent infections?

A
  1. Can’t drain properly
  2. Lack of response (erythema)
  3. Extensive infection w/ several sites
  4. very young/old
  5. Immunosuppressed or SIRS
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7
Q

What are the SIRS criteria?

A
  1. Temp <36C or >38C
  2. HR >90 bpm
  3. RR >24bpm
  4. WBC > 12x10^4 or <4x10^4
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8
Q

What is the duration of antibiotics for out/inpatient in purulent antibiotics?

A

Outpatient 5-7 days

Inpatient 7-14 days

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9
Q

What antibiotics are used for MSSA and MRSA in purulent infections?

A

MSSA: cloxacillin, cephalexin, cefazolin
MRSA: clindamycin, cotrimoxazole, doxycycline

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10
Q

Staphylococcus aureus commonly causes what kind of infections?

A

Purulent infections

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11
Q

What are the differences in presentation of erysipelas and cellulitis?

A

Erysipelas: sharply demarcated w/ raised border, non-purulent; up to superficial fascia and lymph
Cellulitis: poorly demarcated area; from epidermis to superficial fascia and lymph

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12
Q

What is the duration of antibiotics for cellulitis & erysipelas?

A

At least 5 days

Immunosuppressed 7-14days

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13
Q

What comorbidities make you more susceptible to what organisms?

A
  1. Immunosuppression: Strep. pneumoniae, E. coli, P. aeruginosa, Serratia marcescens
  2. Chronic liver/renal disease: Vibrio spp, E. coli, P. aeruginosa
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14
Q

When are cultures required?

A
  1. Impetigo and ecthyma: not needed
  2. Purulent infection: culture pus
  3. Cellulitis and erysipelas: only if purulent after I&D, immunosuppressed, SIRS -> preferred cutaneous aspirate/biopsy
  4. Moderate - severe DFI: deep tissue cultures after cleansing & before abx initiation
  5. Pressure ulcers: deep tissue cultures or biopsy
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15
Q

What are the common organisms in bite wounds cellulitis?

A

Staphylococcus aureus, Streptococcus spp

(animal) Pasteurella multocida
(human) Eikenella corrodens
(anaerobes) Prevotella spp., Peptostreptococcus spp.

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16
Q

What are the treatment options for bite wound cellulitis?

A

IV or PO depends on severity of infection

  1. Augmentin
  2. Clindamycin/metronidazole AND
  3. Ceftriaxone/cefuroxime OR ciprofloxacin/levofloxacin
17
Q

Monitoring for cellulitis & erysipelas

A
  1. Clinical response: fever, pain, swelling, erythema, warmth
  2. Change to PO if initial IV: 48h afebrile, clinical improvement
  3. Otherwise consider resistant organisms and alternative causes
18
Q

What are the treatment options for cellulitis & erysipelas (non-purulent)?

A

No SIRS: (strep only) Penicillin VK, cloxacillin, cephalexin, clindamycin
1-2 SIRS: (strep + SA) 2 SIRS or Tx failure - IV cefazolin, penicillin G, clindamycin
>2 SIRS: (strep + SA + P. aeruginosa + Gram -ve) IV piperacillin/tazobactam, cefepime, meropenem
(MRSA) IV vancomycin, daptomycin, linezolid

19
Q

What is the difference in treatment options between purulent and non-purulent cellulitis & erysipelas?

A

No SIRS: (strep + SA) no penicillin VK, (MRSA) PO
1-2 SIRS: (strep + SA) 2 SIRS or Tx failure - no IV penicillin G, add IV cloxacillin
(MRSA) IV vancomycin, daptomycin, linezolid also for 1-2 SIRS

20
Q

When are PO drugs used for MRSA?

A 
PO cotrimoxazole, clindamycin, doxycycline
Mild purulent cellulitis & erysipelas
Mild DFI (no SIRS, skin & SC tissue, erythema <2cm)
21
Q

Classification of DFI

A

Mild: no SIRS, skin & SC tissue, erythema <2cm
Moderate: no SIRS, deep tissue, erythema >2cm
Severe: SIRS

22
Q

What is the classification for severe cellulitis & erysipelas?

A

> 2 SIRS + hypotension, rapid progression, immunosuppressed or comorbidities

23
Q

What are the areas of DFIs?

A

Soft tissue or bone infections below the malleolus
– Skin ulceration (peripheral neuropathy)
– Wound (trauma)

24
Q

What are the complications of DFIs?

A

Complications
– Hospitalization
– Osteomyelitis amputation

25
Q

What are the doses of natural penicillins?

A

Penicillin G: IV 2-4 million units q4-6h

Penicillin VK: PO 250-500mg QDS

26
Q

What are the doses of IV cephalosporins? (cefazolin, cefepime)

A

Cefazolin IV 1-2g Q8H

Cefepime IV 2g Q8H

27
Q

What are the doses for drugs used for MRSA? (cotrimoxazole, piperacillin/tazobactam, vancomycin)

A

Trimethoprim/sulfamethoxazole PO 800/160mg BD
Piperacillin/tazobactam IV 4.5g Q6-8H
Vancomycin IV 15mg/kg Q8-12H

28
Q

Causes of pressure ulcers

A

Synergistic interaction between:

  • Moisture
  • Pressure
  • Shear forces
  • Friction
29
Q

Risk factors for pressure ulcers

A
  1. reduced mobility: spinal cord injury
  2. chronic diseases
  3. very young/old
  4. reduced consciousness
  5. sensory or autonomic impairment: e.g. incontinence
  6. malnutrition
30
Q

Adjunctive treatment + prevention of pressure ulcers

A
  1. debridement of infected/necrotic tissue
  2. wound care: normal saline preferred
  3. relief of pressure: reposition/turn every 2h
31
Q

What are the doses of the drugs used for mild purulent cellulitis?

A

Cephalexin PO 250-500mg QDS
Cloxacillin PO 250-500mg QDS, IV 1-2g Q4-6h
Clindamycin PO 300mg QDS, IV 600mg Q8H

32
Q

What is the dose for metronidazole?

A

500mg PO/IV TDS

33
Q

What is the dose for augmentin?

A

PO 625mg BD-TDS, IV 1.2g Q8H

PR3124 CA2 (4 decks)

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