SSTI Flashcards

Question

Severe purulent cellulitis criteria & microb?

Answer 1

``` > 2 SIRS criteria + hypotension , rapid progression, immunosuppressed, comorbidities Streptococcus spp S. aureus gram-negatives (include P. aeruginosa) ```

Answer 2

``` IV antibiotics • Piperacillin/tazobactam • Cefepime • Meropenem If MRSA risk factor(s) add IV: - Vancomycin - Daptomycin - Linezolid ```

Answer 3

``` Streptococcus spp S. aureus Pasteurella multicide (animal) Eikenalla corrodens (human) Oral anaerobes (e.g. Prevotella spp., Peptostreptococcus spp.) ```

Answer 4

IV/PO antibiotics depends on severity • Amoxicillin/clavulanate • Ceftriaxone/cefuroxime + clindamycin/ metronidazole • Ciprofloxacin/levofloxacin + clindamycin/ metronidazole

Answer 5

assess response in 48-72h (2-3d) if improve switch from initial IV to PO for at least 5d; immunosuppressed 7-14d

Answer 6

* Bacteriemia * Endocarditis * Toxic shock * Glomerulonephritis * Lymphedema * Osteomyelitis * Necrotizing soft-tissue infections e.g. necrotizing fasciitis

Answer 7

- Immunosuppression - Critically ill e.g. hypotension caused by infection, in ICU - Failed antibx w/o MRSA coverage

Answer 8

``` – Purulent discharge; or – ≥ 2 signs or symptoms of inflammation: • Erythema • Warmth • Tenderness • Pain • Induration ```

Answer 9

Soft tissue or bone infections below the malleolus due to: • Skin ulceration (peripheral neuropathy) • Wound (trauma)

Answer 10

``` Bed sores Synergistic interaction between 4 factors: – Moisture – Pressure (amount and duration) – Shearing force – Friction ```

Answer 11

MILD: optional MODERATE – SEVERE: Deep tissue cultures (after cleansing, b4 antibx) ** avoid skin swabs

Answer 12

Infection of skin and SC tissue (erythema: ≤ 2 cm around ulcer) No signs of systemic infection (no SIRS) Streptococcus spp S. aureus

Answer 13

``` PO antibiotics 1-2weeks • Cephalexin • Cloxacillin • Clindamycin If MRSA risk factor(s) use PO: - Co-trimoxazole - Clindamycin - Doxycycline ```

Answer 14

1. Infection of deeper tissue (e.g. bone, joints) 2. Erythema: > 2 cm 3. No signs of systemic infection (no SIRS) Streptococcus spp S. aureus Gram-negatives (±P. aeruginosa) Anaerobes

Answer 15

``` Initial IV antibiotics 1-3weeks •Amoxicillin/clavulanate • Ceftriaxone* • Ertapenem If MRSA risk factor(s) add IV: - Vancomycin - Daptomycin - Linezolid *If no anaerobic coverage, add IV:  Metronidazole  Clindamycin May step-down to PO antibiotic(s) after patient improves ```

Answer 16

``` Sign(s) of systemic infection (with SIRS) Streptococcus spp S. aureus Gram-negatives (+P. aeruginosa) Anaerobes ```

Answer 17

``` Initial IV antibiotics 2-4weeks • Piperacillin/tazobactam • Cefepime* • Meropenem If MRSA risk factor(s) add IV: - Vancomycin - Daptomycin - Linezolid *If no anaerobic coverage, add IV:  Metronidazole  Clindamycin May step-down to PO antibiotic(s) after patient improves ```

Answer 18

Complications of DFI • Hospitalization • Osteomyelitis  amputation

Answer 19

Empirically cover Pseudomonas aeruginosa when: o Severe infection o Failure of antibiotics not active against Pseudomonas aeruginosa

Answer 20

``` 1. Wound care • Debridement • “Off-loading” • Apply dressings that promote a healing environment and control excess exudation 2. Foot care • Daily inspection • Prevent wounds and ulcers ```

Answer 21

1. Reduced mobility – E.g. spinal cord injuries, paraplegic 2. Debilitated by severe chronic diseases – E.g. multiple sclerosis, stroke, cancer 3. Reduced consciousness 4. Sensory and autonomic impairment – Incontinence (increase moisture in certain parts of skin) 5. Extremes of age 6. Malnutrition

Answer 22

1. Debridement of infected or necrotic tissue 2. Local wound care • Normal saline preferred • Avoid harsh chemicals 3. Relief of pressure • Turn or reposition every 2 hours • Also important for prevention

Answer 23

1.Neurpathy decrease pain sensation, muscle imbalance, dry 2. Vasculopathy atherosclerosis, PVD, hyperglycemia, hyperlipidemia 3. Immunopathy impaired immune response, more susceptible to infections, hyperglycemia