SSTI Flashcards
Risk factors for SSTI
Hx of SSTI
Peripheral artery disease
CKD
DM
IV drug use
Complications that get increased with infection
Ulcers
Bacteremia
Endocarditis
Osteomyelitis
Sepsis
Non- purulent SSTIs
Cellulitis and Erysipelas
patient presentation
Non-purulent SSTIs = No PUS
Patient presentation:
tender, erythema, swelling, warm to touch, and orange peel-like skin
Non- purulent SSTIs
Cellulitis and Erysipelas
Cultures for diagnosis
Skin/Blood cultures not routinely done
Blood cultures recommended IF: immunicompromised, severe infection, animal bites
Non- purulent SSTIs
Cellulitis and Erysipelas
Imaging for diagnosis
CT/MR imaging to rule out necrotizing fasciitis or presence of abscess
Classification of Non- purulent SSTIs: Cellulitis and Erysipelas
Mild, moderate, severe
Mild: No systemic signs of infection
Moderate: Systemic signs of infection (fever, chills)
Severe: Meets 2 of the SIRS criteria
Temp > 38 or <36
HR >90
RR > 24
WBC >12k or <4k
Non- purulent SSTIs
Cellulitis and Erysipelas
Causative pathogens
Streptococcus spp
A - pyogenes
MRSA if (ADD MRSA Coverage)
- penetrating trauma
- evidence of MRSA elsewhere
- Nasal colonization with MRSA
- IVDU
- SIRS/Severe infection
- Failed non-MRSA antibiotic regimen
MILD Non- purulent SSTIs
Cellulitis and Erysipelas
Treatment and duration
Duration 5 days
Oral
Penicillin VK
Cephalosporin
Dicloxacillin
Clindamycin
MODERATE Non- purulent SSTIs
Cellulitis and Erysipelas
Treatment and duration
Duration 5 days
IV antibiotic
- penicillin
- ceftriaxone
- cefazolin
- clindamycin
SEVERE Non- purulent SSTIs
Cellulitis and Erysipelas
Treatment and duration
Duration 5 days
Emergent surgical inspection/ debridement
Empiric therapy
- vancomycin + Piperacillin/Tazobactam (zosyn)
Once we get culture and susceptibility test back we can narrow based on results
types Purulent SSTIs
Purulent = PUS
1. Abscesses= collection of pus withing the dermis and deeper skin tissues
2. furuncles (boils) = small abscess that formation of the hair follicle
3. Carbuncles: infection involving severe adjacent follicles
Purulent SSTIs
Clinical presentation
Tender, red nodules, erythema, warm to touch, systemic signs of infection
Purulent SSTIs
Cultures for diganosis
ALL patients should get wound culture
Purulent SSTIs
Imaging for diagnosis
CT/MR imagining to confirm presence of abscess - not always done
Classification Purulent SSTIs
Mild, Moderate, Severe
Mild: No systemic signs of infection
Moderate: Systemic signs of infection (fever, chills)
Severe: Meets 2 of the SIRS criteria
Temp > 38 or <36
HR >90
RR > 24
WBC >12k or <4k
Purulent SSTIs
Causative pathogens
MRSA - BIG GUY - ALWAYS WANT TO COVER
MSSA
Streptococcus spp.
MILD Purulent SSTIs treatment
Incision and drainage
MODERATE Purulent SSTIs treatment and duration
incision and drainage
Duration of treatment 5 days
Empiric therapy
TMP/SMX or Doxycycline
Targeted antibiotics once culture and susceptibility results return
MRSA
- TMP/SMX
- doxycycline
MSSA
- Dicloxacillin or cephalexin
Severe Purulent SSTIs treatment and duration
Incision and drainage
Duration of treatment 5 days
Empiric antibiotics
- Vancomycin
- Daptomycin
- linezolid
Targeted therapy once we get susceptibility results back
MRSA:
- vancomycin
- linezolid
MSSA
- nafcillin
- Cefazolin
- Clindamycin
Characteristics of Necrotizing Fasciitis
and clinical presentation
Medical emergency
Profound systemic toxicity
change in color of skin to maroon/purple/black, crepitus (cracking of the skin), edema, severe pain
Necrotizing Fasciitis
cultures for diagnosis
Blood cultures are recommended given severe infection
Wound cultures likely obtained from surgery
Necrotizing Fasciitis
Imaging for diagnosis
CT/MR imaging to confirm necrotizing fasciitis or presence of abscess (will show us if gas is present)
Necrotizing Fasciitis
Common pathogens
Can be monomicrobial or polymicrobial
Streptococcus spp - pyogenes (most common)
CA-MRSA
Vibrio vulnificus
Aeromonas hydrophila
Peptostreptococcus spp.
clostridium perfringens
Necrotizing Fasciitis
Management and treatment
Surgical intervention + broad spectrum antibiotics
Duration: patient has improved clinically, and fever has been absent for 48-72 hours
Empiric therapy
- Vancomycin + zosyn piperacillin/tazobactam
after C and S results
S. pyogenes
- PNC plus clindamycin (due to the large amount of bacteria PNC cannot get to side of action whereas clindamycin can work in presence of large amount of bacteria) (linezolid in clinical use)
Polymicrobial
- Vancomycin + zosyn piperacillin/tazobactam
Impetigo Characteristics/ Diagnosis
Features
highly contagious superficial skin infection caused by skin abrasions
Clinical presentation
- small, painless, fluid filled vesicles that can lead to thick golden crusts
Cultures
- cultures for pus are recommended but not required
Impetigo management
Based on the amount of lesions and empiric therapy focuses on strep and staph coverage
Few lesions - Mupirocin topical x 5
Many lesions/ outbreak
streptococcus only - oral penicillin x 7 days
allergies/MRSA: Doxycycline, clindamycin, TMP/SMX oral x 7 days
Diagnosis
Animal/ human bites
patient presentation and cultures for diagnosis
Patient presentation
- cat bite: deep, sharp puncture wound
- Dog bite: Cellulitis signs and symptoms
Cultures - blood cultures are recommended in animal bites especially cats
Animal/ human bites
Causitive pathogens
Pasturella
Capnocytophaga spp.
strep
staph
B fragilis
Animal/ human bites treatment and duration
Established infection and preemptive
Established infection duration 7-14 days
Preemptive in patients who are immunocompromised, asplenia, moderate to severe bites, bites on face/hand, bites that penetrate joints
DOC: Amoxicillin/ clavulanate
alternative
- 2nd and 3rd gen cephalosporins + anerobic coverage
B-Lactam allergy
Cipro/levo + anaerobic coverage OR Moxifloxacin
Vaccines: Tdap if due, +/- rabies
