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PR3151 - Therapeutics > SSTI > Flashcards

SSTI Flashcards

1
Q

What are the systemic symptoms criteria for SSTI?

A

Temperature>38or<36
Heartrate>90bpm,
Respiratoryrate>24bpm
WBC>12x10^9/Lor<4x10^9/L

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2
Q

What are the criteria for DFI and Pressure Ulcer

A

Purulent discharge

OR

≥ 2 signs & symptoms of inflammation: erythema, warmth, tenderness,
pain, induration (thickening and hardening of soft tissues of the body, specifically the skin)

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3
Q

Tx duration for impetigo/ ecthyma PO antibiotics

A

7 days

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4
Q

Tx for Impetigo, mild limited lesions

A

Topical Mupirocin BID x 5 days

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5
Q

Impetigo/ ecthyma: Empiric (no allergy)

A

Cloxacillin or cephalexin

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6
Q

Impetigo/ ecthyma: Empiric (penicillin allergy)

A

Clindamycin

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7
Q

Impetigo/ ecthyma: S. pyogenes

A

PO penicillin V, amoxicillin

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8
Q

Impetigo/ ecthyma: MSSA

A

PO Cloxacillin or cephalexin

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9
Q

Mainstay for purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

A

Incision & drainage

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10
Q

When to do culture (from wound) for SSTI?

A

Wound with pus, exudate or tissues

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11
Q

When to do blood culture for SSTI?

A

severe cases with marked systemic symptoms of infection or immunocompromised patients

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12
Q

Tx for Mild, purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

A

I&D or warm compress to promote drainage

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13
Q

Tx for moderate (with systemic sx), purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

A

I & D PLUS
PO cloxacillin/ cephalexin / clindamycin (if allergy)

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14
Q

Tx for Severe, purulent infection (furuncle, carbuncle, skin abscess, cellulitis)

A

I & D PLUS
IV cloxacillin/ cefazolin/ clindamycin (penicillin allergy), vancomycin (last line)

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15
Q

Empiric MRSA for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)

A

Cotrimoxazole, doxycycline, clindamycin, vancomycin, daptomycin, linezolid

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16
Q

Empiric (gram‐neg, anaerobe) for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)

A

Augmentin

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17
Q

Tx duration for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)

A

5-10d

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18
Q

Likely pathogen for impetigo

A

Staphlococci or streptococci

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19
Q

Bullous form of impetigo is caused by ____

A

Toxin-producing strains of S. aureus

20
Q

Likely pathogen for nonpurulent (cellulitis, erysipelas)

A

S. pyogenes, less frequently S. aureus, water exposure (Aeromonas, Vibrio vulnificus, Psuedomonas)

21
Q

Likely pathogen for purulent (furuncle, carbuncle, skin abscess, cellulitis)

A

Mainly S. aureus, some streptococci, skin abscess (gram negs & anaerobes), CA-MRSA (More for US)

22
Q

Treatment for mild (no systemic signs), nonpurulent (cellulitis, erysipelas)

A

PO Penicillin V (if no need MSSA cover)/ cloxacillin/ cephalexin/ clindamycin (if allergy)

23
Q

Treatment for moderate (systemic signs, some purulence), nonpurulent (cellulitis, erysipelas)

A

IV cefazolin/ clindamycin (penicillin allergy)

24
Q

Treatment for severe (systemic signs, failed oral therapy, immunocompromised), nonpurulent (cellulitis, erysipelas)

A

IV: pip-tazo/ cefepime/ meropenem
If MRSA risk factor, add IV vancomycin, daptomycin, linezolid
x 5-10d; 14 days if immunocompromised

25
Q

Non-pharm for non-purulent

A
  • Ensure rest and limb elevation (drainage of edema and inflammatory
  • Treat underlying conditions eg tinea pedis, skin dryness, limb edema substances)
26
Q

Monitoring for SSTI

A

1) Should get better within 2-3 days; Else, assess indication and/or choice of antibiotics
2) Check that there is no progression of lesion or development of complication
3) Switch to oral antibiotic when pt is better
4) Repeat culture not needed for those who responded
5) Absence of ADR & allergies

27
Q

Definition for mild DFI

A

Infection of skin and SC tissue +
If erythema: ≤ 2 cm around ulcer
+ No signs of systemic infection

28
Q

Organisms to cover for mild DFI

A

Staph aureus & streptococci

29
Q

Definition for moderate DFI

A

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

30
Q

Definition of severe DFI

A

Infection of deeper tissue (e.g. bone, joints); or
If erythema: > 2 cm + Sign(s) of systemic infx

31
Q

Organisms to cover for moderate DFI

A

Staph aureus + streptococci + anaerobes + gram negs (+/- pseudomonas)

32
Q

Organisms to cover for severe DFI

A

Staph aureus + streptococci + anaerobes + gram negs (including pseudomonas)

33
Q

PO antibiotics for mild DFI

A

PO cloxacillin/ cephalexin/ clindamycin (penicillin allergy)

-> MRSA cover: PO co-trimoxazole/ clindamycin/ doxycycline

34
Q

IV antibiotics for moderate DFI

A

IV Augmentin
OR cefazolin/ ceftriaxone + metronidazole

-> MRSA cover: IV vancomycin/ linezolid/ daptomycin

35
Q

IV antibiotics for severe DFI

A

IV pip-tazo
OR Cefepime + metronidazole
OR Meropenem
OR ciprofloxacin + clindamycin

-> MRSA cover: IV vancomycin/ linezolid/ daptomycin

36
Q

Duration of tx for mild DFI, no bone involvement

A

1-2 weeks

37
Q

Duration of tx for moderate DFI, no bone involvement

A

1-3 weeks

38
Q

Duration of tx for severe DFI, no bone involvement

A

2-4 weeks

39
Q

Duration of tx for Surgery – all infected bone and tissue removed (e.g. amputation)

A

2-5 days

40
Q

Duration of tx for Surgery - Residual infected soft tissue

A

1-3 weeks

41
Q

Duration of tx for Surgery – Residual viable bone

A

4-6 weeks

42
Q

Duration of tx for No surgery or
Surgery – residual dead bone

A

≥ 3 months

43
Q

Non-pharm for pressure ulcers

A
  • Debridement of infected or necrotic tissue
    – Local wound care (Avoid harsh chemicals; normal saline preferred)
    – Relief of pressure (Turn or reposition every 2 hours)
44
Q

4 factors contributing to pressure ulcers

A
  • Pressure (amount and duration)
    – Shearing force
    – Moisture
    – Friction
45
Q

Non-pharm for DFI

A
  • Wound care (debridement, off loading, apply dressings that promote a healing environment & control excess exudate)
  • Foot care (daily inspection & prevent wound and ulcers)
  • Optimal glycemic control

PR3151 - Therapeutics (8 decks)

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