SSTI Flashcards
What are the systemic symptoms criteria for SSTI?
Temperature>38or<36
Heartrate>90bpm,
Respiratoryrate>24bpm
WBC>12x10^9/Lor<4x10^9/L
What are the criteria for DFI and Pressure Ulcer
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)
Tx duration for impetigo/ ecthyma PO antibiotics
7 days
Tx for Impetigo, mild limited lesions
Topical Mupirocin BID x 5 days
Impetigo/ ecthyma: Empiric (no allergy)
Cloxacillin or cephalexin
Impetigo/ ecthyma: Empiric (penicillin allergy)
Clindamycin
Impetigo/ ecthyma: S. pyogenes
PO penicillin V, amoxicillin
Impetigo/ ecthyma: MSSA
PO Cloxacillin or cephalexin
Mainstay for purulent infection (furuncle, carbuncle, skin abscess, cellulitis)
Incision & drainage
When to do culture (from wound) for SSTI?
Wound with pus, exudate or tissues
When to do blood culture for SSTI?
severe cases with marked systemic symptoms of infection or immunocompromised patients
Tx for Mild, purulent infection (furuncle, carbuncle, skin abscess, cellulitis)
I&D or warm compress to promote drainage
Tx for moderate (with systemic sx), purulent infection (furuncle, carbuncle, skin abscess, cellulitis)
I & D PLUS
PO cloxacillin/ cephalexin / clindamycin (if allergy)
Tx for Severe, purulent infection (furuncle, carbuncle, skin abscess, cellulitis)
I & D PLUS
IV cloxacillin/ cefazolin/ clindamycin (penicillin allergy), vancomycin (last line)
Empiric MRSA for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)
Cotrimoxazole, doxycycline, clindamycin, vancomycin, daptomycin, linezolid
Empiric (gram‐neg, anaerobe) for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)
Augmentin
Tx duration for purulent infx (furuncle, carbuncle, skin abscess, cellulitis)
5-10d
Likely pathogen for impetigo
Staphlococci or streptococci
Bullous form of impetigo is caused by ____
Toxin-producing strains of S. aureus
Likely pathogen for nonpurulent (cellulitis, erysipelas)
S. pyogenes, less frequently S. aureus, water exposure (Aeromonas, Vibrio vulnificus, Psuedomonas)
Likely pathogen for purulent (furuncle, carbuncle, skin abscess, cellulitis)
Mainly S. aureus, some streptococci, skin abscess (gram negs & anaerobes), CA-MRSA (More for US)
Treatment for mild (no systemic signs), nonpurulent (cellulitis, erysipelas)
PO Penicillin V (if no need MSSA cover)/ cloxacillin/ cephalexin/ clindamycin (if allergy)
Treatment for moderate (systemic signs, some purulence), nonpurulent (cellulitis, erysipelas)
IV cefazolin/ clindamycin (penicillin allergy)
Treatment for severe (systemic signs, failed oral therapy, immunocompromised), nonpurulent (cellulitis, erysipelas)
IV: pip-tazo/ cefepime/ meropenem
If MRSA risk factor, add IV vancomycin, daptomycin, linezolid
x 5-10d; 14 days if immunocompromised
Non-pharm for non-purulent
- Ensure rest and limb elevation (drainage of edema and inflammatory
- Treat underlying conditions eg tinea pedis, skin dryness, limb edema substances)
Monitoring for SSTI
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
Definition for mild DFI
Infection of skin and SC tissue +
If erythema: ≤ 2 cm around ulcer
+ No signs of systemic infection
Organisms to cover for mild DFI
Staph aureus & streptococci
Definition for moderate DFI
Infection of deeper tissue (e.g. bone, joints); or
If erythema: > 2 cm
+ No signs of systemic infx
Definition of severe DFI
Infection of deeper tissue (e.g. bone, joints); or
If erythema: > 2 cm + Sign(s) of systemic infx
Organisms to cover for moderate DFI
Staph aureus + streptococci + anaerobes + gram negs (+/- pseudomonas)
Organisms to cover for severe DFI
Staph aureus + streptococci + anaerobes + gram negs (including pseudomonas)
PO antibiotics for mild DFI
PO cloxacillin/ cephalexin/ clindamycin (penicillin allergy)
-> MRSA cover: PO co-trimoxazole/ clindamycin/ doxycycline
IV antibiotics for moderate DFI
IV Augmentin
OR cefazolin/ ceftriaxone + metronidazole
-> MRSA cover: IV vancomycin/ linezolid/ daptomycin
IV antibiotics for severe DFI
IV pip-tazo
OR Cefepime + metronidazole
OR Meropenem
OR ciprofloxacin + clindamycin
-> MRSA cover: IV vancomycin/ linezolid/ daptomycin
Duration of tx for mild DFI, no bone involvement
1-2 weeks
Duration of tx for moderate DFI, no bone involvement
1-3 weeks
Duration of tx for severe DFI, no bone involvement
2-4 weeks
Duration of tx for Surgery – all infected bone and tissue removed (e.g. amputation)
2-5 days
Duration of tx for Surgery - Residual infected soft tissue
1-3 weeks
Duration of tx for Surgery – Residual viable bone
4-6 weeks
Duration of tx for No surgery or
Surgery – residual dead bone
≥ 3 months
Non-pharm for pressure ulcers
- Debridement of infected or necrotic tissue
– Local wound care (Avoid harsh chemicals; normal saline preferred)
– Relief of pressure (Turn or reposition every 2 hours)
4 factors contributing to pressure ulcers
- Pressure (amount and duration)
– Shearing force
– Moisture
– Friction
Non-pharm for DFI
- 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
