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SSTI Flashcards

1
Q

Treatment for impetigo?

A

Mupirocin BD

Treatment duration: 5 days

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2
Q

Oral Abx for impetigo and ecthyma?

A

No allergy:

Cephalexin 250-500mg QDS
Cloxacillin 250-500mg QDS

Allergy:

Clindamycin 300mg QDS

Duration: 7 days

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3
Q

Treatment for purulent SSTI?

A

Mainstay is I&D

Unless indication for adjunctive Abx:

  • cannot drain completely
  • lack of response to I & D
  • extensive disease
  • extremes of age
  • immunosuppressed
  • SIRS criteria
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4
Q

What are the 4 SIRS criteria

A

Temperature > 38

HR > 90

RR > 24

WBC > 12

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5
Q

What adjunctive abx therapy to use for purulent SSTI?

A

Organism is Staph Aureus

MSSA:

  • PO Cloxacillin 250-500mg QDS
  • PO Cephalexin 250-500mg QDS

MSSA, MRSA:

  • Clindamycin PO 300mg QDS
  • Cotrimoxazole 960mg BD
  • Doxycycline

Duration:

Outpatient is 5-7 days

Inpatient is 7-14 days

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6
Q

Causative organisms for cellulitis and erysipelas?

A

Staph aureus

Beta hemolytic strep -> almost always causes erysipelas

If immunosuppression -> also at risk for Strep Pneumoniae, E. coli, Serratia, Pseudomonas

If chronic liver or renal disease -> also at risk for Vibrio, E. coli and pseudomonas

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7
Q

Criteria and organisms to cover for mild non purulent cellulitis/erysipelas?

A

No SIRS criteria

Strep

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8
Q

Treatment for mild non purulent cellulitis/erysipelas?

A

PO Penicillin VK 250-500mg QDS

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9
Q

Criteria and organisms to cover for moderate non purulent cellulitis / erysipelas?

A

> = 1 SIRS criteria

Strep plus minus staph

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10
Q

Treatment options for moderate non purulent cellulitis or erysipelas?

A

If only 1 SIRS criteria:

PO Penicillin VK 250-500mg QDS

PO Cloxacillin 250-500mg QDS (preferred because patient is sicker)

PO Cephalexin 250-500mg QDS (preferred because patient is sicker so cover for staph)

If 2 or more SIRS criteria,

IV Cefazolin 1-2g Q8H

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11
Q

Criteria and Organisms for severe non purulent cellulitis or erysipelas ?

A

> 2 SIRS criteria + hypotension/rapid progression/immunosuppression/comorbidities

Strep + Staph + gram negative (including pseudomonas)

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12
Q

Treatment for severe non purulent cellulitis or erysipelas?

A

IV Pip/Tazo 4.5g Q6-8H

IV Cefepime 2g Q8H

If there is MRSA risk factors:

add on IV vancomycin 15mg/kg Q8-12H

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13
Q

What are the 3 MRSA risk factors?

A
  • Critically ill (admission to ICU)
  • immunosupressed
  • failure of abx without MRSA coverage
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14
Q

Criteria & Organisms for Mild Purulent cellulitis or erysipelas?

A

No SIRS criteria

Strep + Staph

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15
Q

Treatment for mild purulent cellulitis or erysipelas?

A

PO Cephalexin 250-500mg QDS
PO Cloxacillin 250-500mg QDS

If there are MRSA risk factors, use:
PO Clindamycin 300mg QDS
PO Co trimoxazole 960mg BD

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16
Q

Criteria and organisms for moderate purulent cellulitis or erysipelas?

A

1 or more SIRS criteria

Strep + Staph

17
Q

Treatment for moderate purulent cellulitis or erysipelas?

A

Only 1 SIRS criteria:

PO Cephalexin 250-500mg QDS
PO Cloxacillin 250-500mg QDS

2 or more SIRS criteria:

IV Cefazolin 1-2g Q8H
IV Cloxacillin 1-2g Q4-6H

If there are MRSA risk factors, use:

IV Vancomycin 15mg/kg Q8-12H

18
Q

Criteria and organisms for severe purulent cellulitis or erysipelas?

A

> 2 SIRS criteria + hypotension/rapid progression/immunosuppression/comorbidities

Strep + staph + gram neg including pseudomonas

19
Q

Treatment for severe purulent cellultis or erysipelas?

A

IV Pip/tazo 4.5g Q6-8H

IV cefepime 2g Q8H

If risk factors for MRSA:

Add on IV vancomycin 15mg/kg Q8-12H

20
Q

Organisms for cellulitis from bite wounds

A
  • staph
  • strep
  • pasteurella multocida (animal bite)
  • eikenella corrodens (human bite)
  • oral anaerobes
21
Q

Treatment for cellulitis from bite wound?

A
  • Augmentin PO 625mg TDS
  • Cefuroxime PO 250mg BD + Clindamycin PO 300mg QDS / Metronidazole PO 500mg TDS
  • Ciprofloxacin/levofloxacin + Clindamycin / Metronidazole
22
Q

Duration of treatment for cellulitis and erysipelas?

A

5 days

23
Q

Pathophysiology of DFI?

A

Neuropathy

Vasculopathy

Immunopathy

24
Q

Definition of Infection in DFI

A

Purulent discharge OR

2 or more signs of inflammation

  • erythema
  • warmth
  • tenderness
  • pain
  • induration
25
Q

Organisms causing DFI?

A

Staph

Strep

26
Q

Definition and organisms for MILD DFI?

A

Infection of skin and SC tissue +
If erythema: ≤ 2 cm around ulcer +
No signs of systemic infection (i.e. no SIRS)

Strep + staph

27
Q

Treatment for MILD DFI?

A

PO Cephalexin 250-500mg QDS
PO Cloxacillin 250-500mg QDS

If there are MRSA risk factors, use:
PO Clindamycin 300mg QDS
PO Co trimoxazole 960mg BD

28
Q

Definition and organisms for MODERATE DFI?

A

Infection of deeper tissue (e.g. bone, joints); or
If erythema: > 2 cm +
No signs of systemic infection (i.e. no SIRS)

Strep + staph + gram negative plus minus pseudomonas + anaerobes

29
Q

Treatment for MODERATE DFI?

A

IV Augmentin 1.2g Q8H

If MRSA risk factors,
add IV vancomycin 15mg/kg Q8-12H

30
Q

Definition and organisms of SEVERE DFI

A

SIRS criteria

Strep + staph + gram neg including pseudomonas + anaerobes

31
Q

Treatment for SEVERE DFI?

A

IV Pip/tazo 4.5g Q6-8H

If MRSA risk factors, add IV vancomycin 15mg/kg Q8-12H

32
Q

Treatment duration for DFI?

A

Assuming NO bone involvement,

Mild 1-2 weeks
Moderate 1-3 weeks
Severe 2-4 weeks

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