SSTI Flashcards
what cells contribute to the innate immune system
keratinocytes and langerhan cells (epidermis)
what are the three main bacteria living on the skin?
staphylococcus
corynebacterium
propionibacterium ( most common, gram positive )
are cultures useful in non purulent infections?
no
what should patients with purulent infections get?
incisions & drainage + cultures
what should patients with systemic signs of infections receive
parenteral antibiotics at least until clinical improvements
SIRS
febrile (>100.4 )
hypothermic (<96.8)
RR >24 breath/min
leukocytosis
leukopenic
what are the 3 tenants of infectious diseases
source control x3
Impetigo causative organism
Group A streptococcus
Impetigo Treatment nonpharm
local wound care
Impetigo treatment
mild, low risk of transmission
topical abx
mupirocin or retapamulin BID
Impetigo
mild, multiple
PO abx with GAS and/or MSSA coverage
Penicillin
Amoxicillin-clav
cephalexin
clindamycin
dicloxacillin
Impetigo treatment
expensive lesions and /or failed initial therapy
consider PO MRSA coverage
SMX/TMP
Doxycycline
Linezolid
duration of therapy for Impetigo
5-7 days ( 5 for mild and 7 for more extensive disease)
impetigo is non purulent or purulent
non purulent
ecthyma causative organisms
Group A strept
MSSA/MSRA
Ecthyma treatment
mild
PO abx with GAS and/ or MSSA
Penicillin
Amoxicillin-clav
cephalexin
clindamycin
dicloxacillin
Ecthyma treatment
extensive lesions and/or failed
consider PO MRSA coverage
SMX/TMP
Doxycycline
Linezolid
Erysipelas/cellulitis causative organisms
pain, erythema/redness, warmth, swelling–> fever/chills, malaise, lymphangitis
Group A street
MRSA/MSSA
Group G, C
Erysipelas/cellulitis treatment
without systemic symptom of infections
streptococcus coverage
Penicillin
nafcillin/oxacillin
cephalexin
cefazolin
clindamycin
Erysipelas/cellulitis treatment
cellulitis with MRSA risk factors or critically ill
strep + MRSA coverage
Vanco
Linazolid
Daptomycin
ceftaroline
Clindamycin
what is the duration of ecthyma treatment
7 days
what is the duration for Erysipelas/cellulitis treatment with mild disease & hemodynamic stability treated PO
5 days but can be extended
ecthyma is non purulent or purulent
non purulent
erysipelas/ cellulitis is non purulent or purulent
non purulent
folliculitis is non purulent or purulent
purulent
folliculitis clinical manifestation and causative organisms
small pustule + are surrounding desquamation
skin flora including gram positives and fungi ( candid and malassezia)
related to contaminated water : aeromana, pseudonyms
how does folliculitis usually resolve
on its ow ( regression) or with drainage
folliculitis treatment
non-severe
topical anti infectives +/- saline compresses
mupirocin or ratapamulin BID
topical anti fungal
folliculitis treatment
severe
empiric therapy should cover pseudomonas
cefepime
piper/tazo
meropenem
folliculitis treatment duration
5-7 days ( 5 for mild and 7 for more extensive disease)
furuncles is non purulent or purulent
purulent
furuncles clinical manifestation and causative organisms
painful nodules –> spontaneously drains pus
s.aureus
sometimes CONS
carbuncles clinical manifestation and causative organism
several furuncles/ follicles
larger, deeper, indurated prices
fever, leukocytosis , malaise
s.aureus
sometimes CONS
Furuncle/Carbuncle/ abscess Treatment
non pharm
insision and drainage
cultures should be drawn from the I&D and used tor streamline therapy
Furuncle/Carbuncle/ abscess Treatment
no systemic signs of infection
I&D +/- short course of PO abx that covers MRSA
doxy
smx/tmp
linezolid
clindamycin
Furuncle/Carbuncle/ abscess Treatment
systemic signs od infection, immunocompromised or failure of initial therapy
I&D + empiric MRSA coverage
vancomycin
linezolid
daptomycin
ceftaroline
clindamycin
what is the duration of treatment for Furuncle/Carbuncle/ abscess
7-14 days from I & D ( 7days for milder disease)
pyomyositis is non purulent or purulent
purulent
pyomyositis clinical mamifestation and causative organism
infection of the skeletal muscle
painful, firm lump under the skin
likely mobility issues in affected muscles
s.aureus
sometimes CONS
pyomyositis
non pharm
insision and drainage
cultures should be drawn from the I&D and used tor streamline therapy
pyomyositis treatment
empiric
parental MRSA coverage
vancomycin
linezolid
daptomycin
ceftaroline
clindamycin
pyomyositis treatment
immunocompromise, penetrating trauma to area
MRSA coverage + broad gram neg
vancomycin
linezolid
daptomycin
ceftaroline
clindamycin
cefttriaxone
cefepime
piper/tazo
pyomyositis treatment duration
14-21 days from I & D
necrotizing fasciitis is non purulent or purulent
inon purulent
necrotizing fasciitis clinical manifestations and causative organisms
deep infection, can cause ischemic damage ad immune shock
surgical emergency
pain out of porportion**, crepitus ( gas forming organism) **
causative organism: depends :)
NF Type 1 (poly)
gram neg, anarobes, and skin flora
NF Type II (mono)
s.pyogenes or s.aureus ( typically MRSA)
NF Type III
Clostridium
vibrio
aeromonas
necrotizing fasciitis
nonpharm
immediate trip to OR + incision and drainage
culture should be drawn from OR
necrotizing fasciitis treatment
empiric ( all types)
broad parenteral abx to cover GN, MRSA, and anaerobes
vancomycin or linezolid
plus
piper/ tazo
or cefepie +metronidazole
necrotizing fasciitis treatment
Type II (s.pyogenes)
anti streptococcal drug of choice + antitoxin
penicillin + clindamycin
necrotizing fasciitis treatment
Type II (s. aureus)
anti streptococcal drug of choice
MSSA: naficillin or oxacillin or cefazolin
MRSA: vancomycin or linezolid
necrotizing fasciitis treatment
Type III
clostridium
penicillin + clindamycin
necrotizing fasciitis treatment
Type III
vibrio spp
Aeromanas spp
doxy+ ceftriaxone +ciprofloxacin
diabetic foot
ulcer on the foot that maybe associated w erthma, warmth, swelling, or purulence
s.aureus
gram neg ( including Pseudomonas )
diabetic foot treatment
non pharm
do not get superficial wound cultures
if deeper sample are available, they must be used to guide treatment
diabetic foot treatment
clinically uninfected
wound care, no abx
non
diabetic foot treatment
mild - moderate infection
local wound care + abx the covers GP
Penicillin
nafcillin/ oxacillin
cephalexin
cefazolin
clindamycin
vancomycin
linezolid
diabetic foot treatment
severe infections or concerns for MDRO
local wound care +abx that coves MRSA & pseudomonas
vancomycin or linezolid
plus
piper/ tazo or cefepime
animal/human bites causative organism
pasturella
Amox-clav
cat scratch disease
bartonella spp
azithromycin
