SSTI Flashcards
abscess and purulent cellulitis think what bugs
i. Bugs –> S. aureus (including MRSA – about 50% are d/t MRSA)
Nonpurulent Cellulitis think what bugs
Bugs -->Strep. Species (can also be caused by MSSA) vibrio vulnificus ( brackish water)
beta hemolytic strep
( pyogenes)
Necrotizing Skin & Soft tissue infection
Bugs –> Strep. Species, Anaerobes (Clostridium perfringens), S. aureus (MRSA), Gram negative species
what are special population you want to be aware of
people that have been in the hospital and have a wound infection
or people that work with sea water for a living
how to talk about amputations
BKA- below the kneww
AKA- above the knee
when evaluating SSTI
looking for pus
feel lit
if there is a fluctuance area that gives way think of PUS
can use ULS fo this evaluation
if you knick a cellulitis you’ll see this
abscess DONE
if no pus think
non purulent cellulitiis
or necrotizing infection
utility of uLS
can help look for pus pockets
might be a couple centimeters below the surface
what % of purulent infx are MRSA
60-80%
just consider it MRSA
caveat for purulent cellulitis
a lot of oral flora for IVDU
think things outside of staph areus
tx for abscess
vanco
bactrim
clindamyocin
DOXY
when do give anbx
LARGE
significant cellulitis
infants
immunocompramised
he was super conservative, but sighted benefit in trials with anbx
just educated pt on what to look out for and getting into hot soapy water frequently
sponatenous furuncle
NOT A SPIDER BITE
one species in mojave but brown recluse are around the Mississippi
staph areus is just gaining entry down into the follicle
how to treat an abscess
ring block with bupivicane (lasts longer than lidocaine)
cc for the top
need to walk away for 10 minutes
I&D
+/- ketamine
if a GIANT abscess
ketamin +propofol for general anesthesia
use the yankauer suction
use bupivicane for the end of a procedure
what is a loop drain
used for bigger abscess instead of packing
stick a kelly down to grasp loop material
run it through
what does cellulitis look like on U/S
cobble stoning swollen with edema
tx for non-purulent cellulitis
- Cephalexin PO/Cefazolin IV
best - Dicloxacillin PO
better for kids? - Clindamycin IV or PO
this will get MRSA MSSA and strep
but causes c. diff and it is expensive - Vancomycin IV
erysipelas
superfiical
sharply demarcated
host response to strep bacteria
tx of necrotizing
pip/taz- ZOSYN IV (unasyn too) \+ 2. Vancomycin IV \+ 3. Clindamycin IV
1 and 2 are cell wall active but in the case of clinda you will stop the endotoxin process
Polymicrobial / synergistic necrotizing bugs
i. Staph. of all kinds
ii. Strep. of all kinds
iii. Anaerobes of all kinds
iv. Gram negatives (less common)
monomicrobial bugs for necrotizing SSTI (NSTI)
i. Strep. pyogenes (Group A Strep.)
ii. Clostridium – perfringens…novyi, sordelli
iii. Vibrio vulnificus
iv. CA-MRSA (USA 300)
will only see gas if it is clostridium
(30% of necrotizing infection)
more stippled and loess bubbled (bubble if IVDU)
4 NSTI pattern recognition
- Infected diabetic foot ulcer
- Perineal infections
- unexplained musculoskeletal pain
- Injection Drug User- heroin
and ludwig’s
perineal infxs NSTI think
a. Fournier’s Gangrene
b. Get urology, CT, very serious
seen more commonly in men, maybe becaus e of the fascia
michelen mans syndrome
track marks ballooning in the arm of a IVDU
NSTI
leukocytosis of 35 or 40
clostridium spores is often found in black tar heroin these spore can germinate in necrotic muscle tissue
think about clostridium tentanus in hispanics
unexplained musculoskeletal painwith NSTI
blotchy margin of cellulitis
think about this if there is a black/purplish dot
group A strep pyogenes
anyone can get this
same strep that causes strep throat but certain strains are more likely to cause myositis
fasciitis with abnormal VS and on ULS fluid
again strep pyogenies
pain out of proportion with unexplained lactic acidosis
