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3124 ca2 > SSTI > Flashcards

SSTI Flashcards

1
Q

what are the normal protecting factors in skin

A 
- dry - inhibits growth 
fatty acids 
acidic ph 
renewal of epidermis - bact removed 
low temp - inhibit growth
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2
Q

what causes ssti

pathophysiology

A

injury diseases - lead to disruption of normal host defences
= normal skin bact penetrates depper
= other bact introduces
= excessive bact growth

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3
Q

risk factors of ssti

A
  • innocula with high bact eg dirty knife
  • excessive moisture
  • red blood supply ( dec wbc , inc infection risk )
    bacterial nutrients eg diabetic
    poor hygiene
    sharing personal items
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4
Q

4 categories for classification of ssti

A

severity - mild mod severe
depth - superficial or deep uncomp or comp
presence of absence of discharge - purulent or non purulent
microbiology
- single pathogen ( pri ) or polymicrobial ( secondary )

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5
Q

impetigo and ecthyma category

A 
mild, 
uncomplicated,
 purulent or non  ,
 primary 
epidermic or up to the dermal epidermal junction
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6
Q

impetigo treatment for mild

A

mupirocin bd 5 days topical

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7
Q

severe impetigo ( not common ) or all ecthyma treatment

A 
empiric w no allergy OR MSSA CULTURE DIRECTED  
cephalexin or cloxacillin 
if pen allergy use clindamycin 
culture directed for s.pyogenes use 
penicillin vk

7 days for all

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8
Q

hair follicles which 3 types

think of the clue related to hair

A

furuncles
carbuncles
cutaneous abscesses

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9
Q

furuncles /boils
carbuncles
cutaneous abscess
differeniate btwn them

A

furuncles - 1 hair follicle

carbuncles - few adjacent hair follicles
- small abscess

cutaneous abscess

  • pus collection
  • not necessary near foliccle
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10
Q

mainstay treatment for fur carb cute

A

incision and drainage

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11
Q

when to use ab for fur carb cute

A
  • if cant drain fully
  • no response to draining
  • extensive and alot of sites involved
  • v old or v young
  • immunosuppressed
  • sirs critera
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12
Q

what are the sirs critera

A 
1. fever > 38 deg 
or temp < 36 
2. rr > 24 breaths / min 
3. HR > 90 bpm 
4. WBC < 4x 10^9/L or > 12x10^9/L
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13
Q

AB treatment for fur carb cute

and duration

A

mssa only
= cloxacillin, cephalexin or cefazolin

mssa, mrsa

  • clindamycin
  • trimethoprim/sulfamethoxazole
  • doxycycline

outpatinet 5-7 days
inpatient 7-14 days

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14
Q

cellulitis affect what and purulence

A

dermis to fascia

can be purulent or non purulent

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15
Q

erysipelas affect what and purulence

A

superficial dermis

non purulent

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16
Q

cellulitis and erysipelas complications 7

A
  1. bacteremia
  2. endocarditis
  3. toxic shock
  4. glomerulonephritis
  5. lymphedema
  6. osteomyolitis
  7. necrotising soft-tissue infections eg necrotisng fasciitis
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17
Q

types of microbio cultures

A
  1. cultaneous aspirates
  2. tissue samples from bipsies
  3. blood
  4. peripheral skin swab but may not be causation organism
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18
Q

MRSA risk factors

A
  1. immunosuppression
  2. failed treatment priot without mrsa coverage
  3. critically ill - hypotensive
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19
Q

cellulitis and erysipelas
categorise severity
and what to cover

A

mild - no sirs - cover strep spp

mod - 2 or more sirs
- cover s.aureus also

severe - more than 2 sirs + hypo <100, rapid prog, immunosuppression, comorb = cover p.aureg also ( gram neg )

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20
Q

treatment for mild non purulent cellulitis/erysipelas

and treatment for mild PURULENT cellulitis/erysipelas

A 
po 
pen vk - narrowest 
cloxacillin 
cephalexin 
^ broader 
clindamycin for allergy
if purulent must cover s.aureus also 
cefalexin 
cloxacillin
clindamycin 
and if mrsa risk factors add any one of the 3 mild ones
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21
Q

treatment for moderate non purulent cellulitis/erysipelas

A

if only 1 sirs treat for same as mild
pen v, cloxacillin, cephalexin, clindamycin
preferably cloxacillin and cephalexin bc broader

if 2 sirs or above fails
then use
IV - cefazolin, penicillin G
or clindamycin ( allergy )

22
Q

treatment for severe non purulent cellulitis /erysipelas

A

iv -
piptazo
cefepime
meropenem

if mrsa risk factors 
add iv vanco 
daptomycin or 
linezolid 
^ last 2 more ex and broader , vanco common
23
Q

3 abs for coverage of mrsa in milder cases

A

clindamycin
trimethoprim, sulfamethoxazole
doxycycline

24
Q

3bs for coverage of mrsa in more SEVERE cases

A

vancomycin
daptomycin
linezolid

25
Q

diff between cefalexin and cefazolin

A

both cover strep and staph

cefazolin only iv
alternative for anti staph penicillins in patients allergic to penicillins

26
Q

diff between pen g and pen v

A

pen v is oral ( vomit )

pen g is parental

27
Q

treatment for moderate PURULENT cellulitis/erysipelas

A 
cover for staph aureus also 
if only 1 sirs criteria 
- cefalexin 
- cloxacillin 
- clindamycin

2 sirs criteria or if above fails
iv cefazolin
cloxacillin
clindamycin

if mrsa risk factor add any one of the severe ones

28
Q

treatment for severe purulent cellulitis/erysipelas

A

same as non purulent
iv piptazo
cefepime
meropenem

and if mrsa risk factor then add one of the 3 severe ones

29
Q

cellulitis from bite wounds organisms

A 
s.aureus 
strep spp 
animal - pasteurella multocida 
human - eikenella corrodens 
oral anerobes eg prevotella spp, peptostreptococcus spp
30
Q

treatment for bite cellulitis

what to cover then whats the treatment

A

augmentin ( gram neg )

ceftriaxone/cefuroxime
or
cipro/levo for pen allergy

add clindamycin or metronidazole if need anaerobic coverage
po or iv depends on severity

31
Q

monitoring for cellulutis and erysipelas

when to look for changes
when t o switch to oral
duration of ab
what if no culture results

A

2-3 days response

switch to po if afebrile 48 hrs and clinical improvement
- if no culture then choose oral agent w similar coverage as initial iv agent

ab for 5 days at least
if immunocompromsed 7-14 days

32
Q

3 pathophysiology paths for dfi

A
  1. neuropathy
    peripheral - dec pain sensation and altered pain response
    motor - muscle imbalance
    autonomic - inc dryness cracks and fissures
  2. vasculopathy
    - early atherosclerosis
    - peripheral vascular disease
    - worsened by hyperglycemia and hyperlipidemia
  3. immunopathy
    impaired immune response
    - inc susceptibility to infections
    - worsened by hyperglycemia

all these cause ulcer formation or wounds
- bacterial colonisation, penetration, proliferation
= dfi

33
Q

dfi and PU

diagnosis criteria

A

purulent discharge or at least 2 signs of inflammation

erythema 
warmth 
tenderness 
pain 
induration ( localised hardening of the sst)
34
Q

dfi and Pu microbio

when gram neg present

when anaerobes present

A

strep and staph aureus most common

gram neg when chronic or prev treated w ab
- ecoli, klebsiella, proteus spp

anaerobic when ishchaemic or necrotic
- peptostreptococcus, veillonella , bacteriodes

35
Q

when to culture for dfi and pui

A

dont culture if not infected - dont culture
how deep is not related to whether infected

mod to severe

  • use tissue culture after cleansing and before starting ab
  • dont use skin swab
36
Q

when to empirically cover pseudomonas aeruginosa

A

severe

prev treatment failure when not active against p.aerug

37
Q

dfi and pui mild classification and what to treat and treatment

duration

A

classification

  • no sirs
  • erythema 2 cm orless around the ulcer
  • skin and sc infection
cover strep and staph 
po
cloxacillin 
cephalexin 
clindamycin

if mrsa risk factor add one of 3 mild one po
( trimethoprim, sulfomethoxazole
doxycycline , clindamycin)

duration 1-2 weeks

38
Q

dfi and pui moderate classification
what to treat and
treatment

duration

A

classification

  • no sirs
  • infection of deeper tissues like bone or joints
  • erythema >2cm around ulcer

cover
strep, staph , gram neg , anaerobes

treatment 
IV 
amox/clav 
ertapenem( reserved for esbl) 
ceftriaxone + metronidazole/clindamycin ( for anaerobic coverage )

if mrsa risk factor add one of 3 iv severe options
vanco, dapto, linezolid

and strep down to po if improvement

duration 1-3 weeks

39
Q

dfi and pui severe classification

what to cover

and treatment
and duration

A

classification - as long as 1 sirs criteria present

cover strep, staph,
gram neg including p.aerug and anaerobes

treatment
iv piptazo
meropenem
cefepime + metronidazole/clindamycin for anaerobic coverage

if mrsa risk factor add one of 3 iv severe options
vanco, dapto, linezolid

can step down to po if patient improves

duration 2-4 weeks

40
Q

duration of dfi and pui treatment for bone involved

A

surgery amputated
2-5 days

surgery w infected tissue left
1-3 weeks

surgery w residual viable bone - 4-6 weeks

no surgery or surgery w residual dead bone
- at least 3 months

41
Q

for dfi and pui do we continue ab until complete wound healing

A

no
ab may resolve th einfection but ulcer or wound may take longer to heal, not necessary to continue ab til wound healing ocurs

42
Q

dfi wound care

and foot care

A

wound care

  • debridement - procedure to remove infected tissue
  • offloading - supporitive shoes
  • dressing for healing environemnt and control excess exudation

foot care

  • daily inspection
  • prevent wound and ulcers
43
Q

4 factors causing pressure ulcers

A

moisture
pressure
shearing force
friction

44
Q

risk factors for pressure ulcers ( PU ) 6

A 
red mobility 
debilitated 
red consciousness 
sensory and autonomic impairment eg incontinence 
extreme age 
malnutriiton
45
Q

pui adjuctive measures

what kind of liquid to use

A

debridement
local wound care
- normal saline and avodi harsh chemicals

relief of pressure
turn every 2 hrs
for prevention

46
Q

antibiotic dosing

A 
Amoxicillin/clavulanate 625mg PO BD-TDS*; 1.2g IV Q8H*
Cefepime 2g IV Q8H*
Cefazolin 1-2g IV Q8H*
Cefepime 2g IV Q8H*
Cephalexin 250-500mg PO QDS*
Cloxacillin 250-500mg PO QDS; 1-2g IV Q4-6H
Penicillin G 2-4 million units Q4-6H*
Penicillin VK 250-500mg PO QDS
Piperacillin/tazobactam 4.5g IV Q6-8H*

Trimethoprim/sulfamethoxazole 800/160mg PO BD*
Vancomycin 15mg/kg Q8-12H
Clindamycin 300mg PO QDS; 600mg IV Q8H
Metronidazole 500mg PO/IV TDS

47
Q

is nausea and vomitting an allergy

and whats considered true allergy

A

no
its side effect

anaphylaxis , hives

48
Q

diff between ertapenem and meropenem/imipenem

A

mero and imipenem covers p.aureg - used for severe dfi/pui

erta dosent - use for moderate dfi/pui
but we like to reserve this class for esbls !
49
Q

diff between augmentin and piptazo

A

piptao covers p.aerug -severe dfi/pui

augmentin dosent - used for moderate dfi/pui

50
Q

diff between cefepime and ceftriaxone

A

cefepime - 4th gen covers p.aureg used for severe dfi/pui

ceftriaxone -3rd gen - dosent cover so used for moderate dfi/pui

3124 ca2 (5 decks)

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