SSTI

Question 1

Definition of recurrent MRSA SSTI

Answer 1

Two or more SSTI episodes at different sites in 6 months

Question 2

MRSA decolonization strategies - first line

Answer 2

Mupirocin BID x5-10 days plus/minus chlorhexidine or dilute bleach baths

Question 3

MRSA decolonization strategies - second line

Answer 3

If topical decolonization fails: PO abs + rifampin

Question 4

Rationale for adding antimicrobials to I & D for cutaneous abscess

Answer 4

Incomplete response to I &D, systemic symptoms, multiple sites, concomitant cellulitis, comorbidities, immunosuppression, extremes of age, abscess on hand/face/genitals, associated septic phlebitis

Question 5

Treatment of impetigo

Answer 5

Mupirocin or retapamulin x5 days; dicloxacillin or cephalexin x5-10 days

Question 6

Patients who should receive preemptive antimicrobials after a bite wound, even if not clearly infected

Answer 6

Immune compromised, asplenic, advanced liver disease, edema of wounded area, involvement of hands/face/feet, involvement of joint capsule

Question 7

Regimens for animal and human bites

Answer 7

Amox/clav (1st-line), doxy, moxi, cipro/levo + flagyl/clinda

Question 8

Indications for tetanus toxoid for bite wounds

Answer 8

Tetanus toxoid should be administered to patients if they have not received the vaccination within 10 years for clean wounds, and within 5 years for dirty wounds

Question 9

Candidates for prophylaxis for recurrent cellulitis

Answer 9

3-4 or more episodes per year despite attempt to control predisposing factors

Question 10

Options for prophylaxis of recurrent cellulitis

Answer 10

PCN PO BID or IM Benzathine PCN q2-4 weeks

Question 11

Therapy of necrotizing fasciitis suspected due to V. Vulnificus

Answer 11

Doxycycline + Ceftriaxone

Question 12

Therapy for necrotizing fasciitis known or suspected due to Aeromonas hydrophila

Answer 12

Doxycycline + (Ciprofloxacin or Ceftriaxone)

Question 13

IDSA and Pedis Grade and management for diabetic foot wound with: no purulent discharge, no systemic symptoms

Answer 13

PEDIS 1, IDSA not infected; no antimicrobials

Question 14

IDSA and Pedis Grade and management for diabetic foot wound with: erythema <2 cm, no systemic symptoms

Answer 14

PEDIS 1, IDSA Mild; Augmentin, cephalexin, dicloxacillin, clindamycin, levofloxacin - TMP/SMX or doxy if suspected MRSA

Question 15

IDSA and Pedis Grade and management for diabetic foot wound with: erythema >2cm or deeper involvement but no systemic symptoms

Answer 15

PEDIS 3, IDSA Moderate; IV or high bioavailable PO: Unasyn, CTX, Erta, (levo/cipro) + clinda, moxi, Tigecycline; all with Vanco or dapto for suspected MRSA

Question 16

IDSA and Pedis Grade and management for diabetic foot wound with: any systemic symptoms

Answer 16

PEDIS 4, IDSA severe: cover Pseudomonas, anaerobes, MRSA

Question 17

Time period classifications for prosthetic joint infections relative to implantation time

Answer 17

Early: 1-3 months; Delayed: >3 months to 1-2 years; Late >1-2 years

Question 18

Candidates for debridement/retention of PJI

Answer 18

Debridement and retention of the prosthesis can be considered for patients who have a well-fixed prosthesis without a sinus tract, who are within 30 days of prosthesis implantation (or less than 3 weeks from infection onset), or who are at high risk of complications from alternative procedures