SSTI Flashcards
Uncomplicated SSTIs
- Superficial infections
ex. cellulitis, impetiginous lesions, furuncles, simple abscesses - Treatment usually requires abx and/or simple incision and drainage
Complicated SSTIs
- Deep soft tissue infections
ex. infected burns, ulcers, major abscesses - May require surgical interventions
- Significant underlying disease state which complicates response to treatment
Main pathogens in SSTIs
- Staph aureus (puss)
- Strep pyogenes (red/hot)
Indications for abx use in abscesse management
- Systemic signs of infection
- Cellulitis or phlegmon
- Immunocompromised
- Certain foreign bodies
Cellulitis
- Group A strep
- S. aureus
- Swelling, redness, edema, pain, non-elevated, poorly defined
Treatment of mild purulent SSTIs
- Simple incision and drainage
Empiric treatment of moderate purulent SSTIs
-Bactrim
or
-Doxycycline
MRSA treatment of moderate purulent SSTIs
-Bactrim
MSSA treatment of moderate purulent SSTIs
-Dicloxacillin
or
-Cephalexin
Empiric treatment of severe purulent SSTIs
- Vancomycin
- Daptomycin
- Linezolid
- Ceftaroline
MRSA treatment of severe purulent SSTIs
- -Vancomycin
- Daptomycin
- Linezolid
- Ceftaroline
MSSA treatment of severe purulent SSTIs
- Nafcillin
- Cefazolin
- Clindamycin
Treatment of mild non-purulent SSTIs
Oral
- Penicillin VK
- Cephalosporin
- Dicloxacillin
- Clindamycin
Treatment of moderate non-purulent SSTIs
Intravenous
- Penicillin
- Ceftriaxone
- Cefazolin
- Clindamycin
Treatment of severe non-purulent SSTIs
Intravenous
-Vancomycin
Plus
-Zosyn
Treatment of defined necrotizing infection with strep pyogens
-Penicillin + Clindamycin
or
-Doxycycline plus Ceftazidime/Ciprofloxacin
Erysipelas patho
- Most commonly group A strep
- infants, young children, elderly, nephrotic syndrome
Erysipelas treatment
-Mild to moderate non-purulent SSTI
-Penicillin
-Ceftriaxone
-Cefazolin
-Clindamycin
IV or PO depending of the setting
Impetigo patho
- Group A strep (no bullous)
- Staph aureus (bullous)
- More common in children
Impetigo treatment
-< 10 lesions = topical mupirocin >10 lesions Bactrim or Doxycycline
Necrotizing fasciitis patho
Most common bugs
- Group A strep
- S. aureus
- Clostridium sp.
Treatment of necrotizing fasciitis
-PCN G + clindamycin add -Vancomycin if MRSA is suspected Polymicrobial? Treat with -Vanco + Zosyn + Imipenem
Diabetic foot infections (DFI) patho
- S. aureus is the most common pathogen
- gram positive aerobes ^^
Treatment of DFI
- Local wound care
- Immobilization
- Drainage
- Abx (2 weeks, 6 weeks if osteomyelitis)
- Amputation (last resort)
Classifications of DFI
-1 = uninfected
-2 = mild infection
-3 = moderate infection
-4 = severe infection
1+2 = not limb threatening
3 = possibly limb threatening
4 = limb threatening
Mild DFI MSSA (strep spp)
All are appropriate monotherapy options
- Dicloxacillin
- Clindamycin
- Cephalexin
- Levofloxacin
- Augmentin
Mild DFI MRSA
-Doxycycline
or
-Bactrim
Moderate to Severe DFI MSSA
- Levofloxacin
- Moxifloxacin
- Cefoxitin
- Ceftriaxone
- Unasyn
- Ertapenem
- Clindamycin + cipro/levo
- Imipenem-cilastatin
Moderate to Severe DFI MRSA
- Linezolid
- Daptomycin
- Vancomycin
Moderate to severe DFI P. aeruginosa
-Zosyn
Moderate to sever MRSA DFI Enterobacteriacae, Pseudomonas, and obligate anaerobes
-Vanco Plus one of the following -Zosyn -Ceftazidime -Cefepime -Carbapenem
Dog bite most common pathogen
-Pasteurella canis
Dog bit treatment
- Augmentin bid
- Duration 10 to 14 days
Cat bite most common pathogen
-Pasteurella multocida
Cat bite treatment
- Augmentin
- Duration 10 to 14 days
Human bite patho
- Polymicrobial
- Ya NASTY
Human bite “early” treatment
- Augmenting
- Duration 5 days
Human bite “late” treatment
- Unasyn
- Cefoxitin
- Zosyn
- Clindamycin + cipro or bactrim (10mg/kg/day)
