SSTI Flashcards
Risk Factors
- Hx of SSTI
- ___
- ___
- ___
- ___ drug use
- PAD
CKD - DM
- IV
Complications
- ___
- bacteremia
- endocarditis
- ___
- sepsis
- ulcers
- osteomyelitis
3 Types pf SSTIs
1) Non-purulent
2) Purulent
3) Necrotizing Fasciitis
Non-Purulent SSTIs: cellulitis and erysipelas
Non-purulent = No ___
Diagnosis
Pt Presentation
- tender, erythema, swelling, warm to touch
- orange peel like skin
Cultures
- skin/blood cultures NOT routinely done
- blood cultures recommended if: ___ , ___ , and ___
Imaging
- CT/MR imaging to rule out necrotizing faciitis or presence of abscess
- Pus
- immunocompromsied, severe infection, animal bites
Classification of Non-Purulent SSTIs
Mild
- NO systemic signs of infection
Moderate
- systemic signs of infection
Severe
- Meet SIRS criteris
- Temp > ___ C or < ___ C
- HR > ___ bpm
- RR > __ bpm
- WBC > ___ k or < __ k
- 38, 36
- 90
- 24
- 12, 4
Causative Pathogens - Non-Purulent SSTIs
___ spp.
- A
- B
- C
- F/G
MRSA if:
- penetrating trauma
- evidence of MRSA elsewhere
- Nasal colonization with MRSA
- IVDU
- ___ / ___ infection
- failed non-MRSA Abx regimen
- Streptococcus
- S. pyogenes
- S. agalactiae
- S. equismills
- S. anginosus
- SIRS/severe
Management: Non-Purulent SSTIs
Duration: __ days
Mild: oral Abx (4)
Moderate: IV Abx (4)
Severe: emergent surgical inspection/debridement
empiric Abx
- ___ PLUS ___ / ___
- run culture and sensitivity
- narow based on test
5
Mild:
- PCN VK
- cephalosporin
- dicloxacillin
- clindamycin
Moderate
- PCN
- ceftriaxone
- cefazolin
- clindamycin
Severe
- vancomycin, piperacillin/tazobactam
Purulent SSTIs: Abscesses, Furuncles, and Carbuncles
Purulent = ___
- ___ : collection of pus within the dermis and deeper skin tissues
- ___ (boils): small abscess that forms on the hair follicle
- ___ : infection involving several adjacent follicles
- pus
- abscesses
- furuncles
- carbuncles
Diagnosis Purulent SSTIs
Pt Presentation
- tender, red __ , erythema, warm to touch
- ___ signs of infections
Cultures
- wound cultures are recommended for all ___ , ___ and patients with ___ signs of infection, regardless of severity
Imaging
- CT/MR imaging to confirm presence of abscess
- nodules
- systemic
- abscesses, carbuncles, systemic
Classification of Purulent SSTIs
Mild
- no systemic signs of infection
Moderate
- systemic signs of infection
Severe
- meets SIRS criteria
- Temp > ___ C or < ___ C
- HR > ___ bpm
- RR > __ bpm
- WBC > ___ k or < __ k
- 38, 36
- 90
- 24
12, 4
Causative Pathogens
Purulent SSTIs (3)
1) MRSA
2) MSSA
3) Streptococcus spp.
Management Purulent SSTIs
Duration: ___ days
Mild
- incision and drainage
Moderate
- incision and drainage
- culture and sensitivity
Empiric Abx
- ___ / ___ or ___
Targeted Abx
MRSA
- ___ / ___
- ___
MSSA
- ___ or ___
Severe
- incision and drainage
- culture and sensitivity
Empiric Abx
- ___
- ___
- ___
Targeted Abx
MRSA - empiric
MSSA
- ___
- ___
- ___
5
Moderate Empiric
- TMP/SMX, doxycycline
Moderate Targeted Abx
MRSA
- TMP/SMX, doxycycline
MSSA
- dicloxacillin, cephalexin
Severe Empiric
- Vancomycin, daptomycin, linezolid
Severe Targeted Abx
MSSA
- nafcillin, cefazolin, clindamycin
Necrotizing Faciitis - diagnosis
Medical emergency!
- high morbidity and mortality
Pt Presentation
- profound ___ toxicity
- change in color of skin to ___ , crepitus, edema, severe pain
Cultures
- blood cultures are recommended given ___ infection
- wound cultures likely obtained from surgery
Imaging
- CT/MR imaging to confirm necrotizing fasciitis or presence of abscess
- systemic
- purple/black
- severe
Causative Pathogens: Necrotizing Fasciitis
- ___ spp.
- CA-MRSA
- Vibrio vulnificus
- Peptostreptococcus spp.
- Aeromonas hydrophila
- Clostridium perfringens
monomicrobial and polymicrobial, can go either way
- Streptococcus
Management: Necrotizing Fasciitis
Surgical intervention + broad spectrum Abx
Duration
- further debridement is no longer necessary
- pt has improved clinically
- fever has been absent for ___ - __ hrs
SEVERE
- Emergent Surgical Inspection/Debridement
Empiric Abx
- ___ PLUS ___ / ___
Culture and Sensitivity
Targeted Abx
S. pyogenes
- ___ PLUS ___
Polymicrobial
- ___ PLUS ___ / ___
48-72
Empiric Abx
- Vancomycin PLUS piperacillin/tazobactam
Targeted Abx
S. pyogenes
- PCN PLUS Clindamycin
Polymicrobial
- Vancomycin PLUS piperacillin/tazobactam
Necrotizing Fasciitis
Why Clindamycin
- inhibits ___ toxin production
- ___ effect
- streptococcal
- inoculum
Impetigo - Characteristics/Diagnosis
Features
- highly ___ superficial skin infection caused by skin abrasions
- common in children and in hot/humid weather
Pt Presentation
- small, painless, fluid filled vesicles that can lead to ___ ___ ___
- systemic signs of infection are rare
Cultures
- cultures from pus/exudates are recommended but not required
- contagious
- thick golden crusts
Impetigo Management
Few lesions (topical x 5 days)
- ___
Many lesions/outbreak (oral x 7 days)
- ___ or ___
Streptococcus ONLY
- ___
Allergies/MRSA
- ___
- ___
- ___
- mupirocin
- dicloxacillin, cephalexin
- PCN
- doxycycline, clindamycin, TMP/SMX
Animal/Human Bites (Diagnosis)
Pt Presentation
- Cat Bites: deep, sharp ___ wound
- Dog/human bites: ___ s/s
Cultures are recommended in ___ bites
- puncture
- cellulitis
- animal
Causative Pathogens - Animal Bites
Causative Pathogens - Human Bites
Management of Animal/Human Bites
Bites
Established Infection
- x __ - __ days
Preemptive
- x __ - __ days
- immunocompromised
- asplenia
- moderate to severe bites
- bites on ___ / ___
- bits that penetrate ___
Treatment
DOC
- ___ / ___
Alternative
- __ / __ gen cephalosporin + ___ coverage
B-lactam Allergy
- ___ / ___ + ___ coverage
- moxifloxicin
Vaccines
- Tdap if due, +/- rabies
- 7-14
- 3-5
- face/hands
- joints
DOC
- amoxicillin/clavulanate
Alternative
- 2nd/3rd, anaerobic
Allergy
- ciprofloxacin/levofloxacin, anaerobic
- moxifloxacin
