SSTI Flashcards
What is the duration of therapy for cellulitis?
5-14 days
What is the empiric treatment for pyomyositis?
Main pathogen: Staph aureus
Treat with vancomycin
What is the treatment duration for impetigo? What agent should be used?
Topical agent BID x 5 days (mupirocin ointment)
Oral agent if multiple lesions x 7 days
*Avoid Bactrim as it lacks Group A strep activity
How would you treat follicultis? Duration and agents?
Topical agents 2-4x daily x 7 days
- Clindamycin, erythromycin ointment, mupirocin ointment
- If PSA, use cipro or levo
What empiric treatment is recommended for human bites?
Unasyn or Augmentin
*Avoid Clindamycin, first generation cephalosporins and macrolides as it has poor activity against Eikenella corrodens
What empiric treatment is recommended for animal bites?
Augmentin or Doxy (PCN allergy)
Duration: 5-10 days, 7-14 days if severe
*Avoid Clindamycin, first generation cephalosporins and macrolides as it has poor activity against Pasteurella
How would you treat a cat scratch?
Azithromycin for Bartonella henselae OR doxycycline for bacillary angiomatosis
How would you treat a necrotizing infection due to Vibrio vulnificus?
Doxycycline + CTX
How would you treat a necrotizing infection due to Aeromonas hydrophilia?
Doxycycline + CTX or cipro
When should steroids be used for cellulitis and for how long should the steroids be given?
Prednisone 40 mg PO daily x 7 days in non-DM patients with cellulitis and multiple SIRS criteria
When should cellulitis prophylaxis be given? What abx should be given for prophylaxis?
If 3-4 Strep episodes/year, consider oral PCN VK or IM benzathine PCN
When should metronidazole be added as pre-op prophylaxis?
Surgeries in the biliary tract, appendectomy, colorectal, head/neck, urologic tract
What is the pre-op timing for abx?
60 min prior to incision, 120 min for vancomycin and FQs
What criteria requires intraop repeat administration?
Length of procedure (> 2 half-lives)
Obesity
Significant blood loss
How would you manage a surgical site infection with no evidence of systemic response (no fever, WBC, HR, extending erythema)?
I & D only
How would you manage a surgical site infection with evidence of systemic response? What are the systemic response criteria?
- T > 38.5
- WBC > 12 x 10^3 cells/mm^3
- HR > 110 BPM
- > 5 cm extending erythema or induration
I&D and 24-48 hrs of abx
*No need for abx if only fever up to 4 days after surgery
What is the difference in pathogen prevalence between different stages of PJI?
Early (1-3 months after implantation) - Staph aureus, CoNS but also GNR and enterococcus in addition to polymicrobial
Delayted/late (> 3 months after implantation) - likely Staph aureus, CoNS, Strep spp and culture negative
Describe the treatment phase and suppression phase in debridement and retain method in PJI with Staphlococcus?
Initial treatment: 2-6 weeks IV (4-6 weeks if no rifampin) + oral rifampin 600-900 mg daily
Treatment: 6 months total (knee) and 3 months (hips, shoulder, ankle)
Indefinite oral suppression
Describe the treatment phase and suppression phase in 1- stage exchange method in PJI with Staphlococcus?
Initial treatment: 2-6 weeks IV (4-6 weeks if no rifampin) + oral rifampin 600-900 mg daily and then high oral bioavailability management
Treatment: 3 months for all joint sites
Indefinite oral suppression
Describe the treatment phase and suppression phase in 2- stage exchange method in PJI with Staphlococcus?
4-6 weeks IV or high oral bioavailability with NO concurrent rifampin
Describe the treatment phase and suppression phase in permanent resection method in PJI with Staphlococcus?
4-6 weeks IV or high bioavailability oral with no concurrent rifampin
What is the treatment algorithm for non-Staph PJI for DAIR?
4-6 weeks IV or high oral bioavailability WITH
indefinite oral suppression
What is the treatment algorithm for non-Staph PJI for 1 stage exchange?
4-6 weeks IV or high oral bioavailability WITH
indefinite oral suppression
What is the treatment algorithm for non-Staph PJI for 2 stage exchange?
4-6 weeks IV or high oral bioavailability
What is the treatment algorithm for non-Staph PJI for permanent resection?
4-6 weeks IV or high oral bioavailability
What notable adverse effects does oritavancin have?
Osteomyelitis package insert warning
Rifampin drug interactions: CYP3A4/2D6 inducer, 2C9/2C19 inhibitor
What is the spectrum activity of delafloxacin and what is its dosing PO/IV?
Staph including MRSA, Strep, Enterococcus faecalis and GNR including PSA
300 mg IV Q12H
450 mg PO Q12H
What is the spectrum activity of omadacycline and what is its dosing PO/IV?
Staph including MRSA, Strep, Enterococcus faecalis and GNR including Enterobacter and Klebsiella
200 mg IV x day 1, 100 mg IV QD
450 mg PO x day 1 and 2, then 300 mg PO QD
*Must fast 4 hours prior to administration
How is mild DFI defined and treated?
Local infection involving skin/SQ tissue
- < 2 cm surrounding erythema
- Staph aureus, B hemolytic strep
Oral treatment
How is moderate DFI defined and treated?
Local infection involving deeper tissues (abscess, OM, fascitis)
- > 2 cm surrounding erythema
- < 2 systemic signs
- Staph aureus, B hemolytic strep, GNR, anaerobes
Use IV or oral
How is severe DFI defined?
- Local infection involving deeper tissues (OM, abscess)
- > 2 signs of SIRS (T > 38C, HR > 90 BPM, RR > 20, WBC > 12 x 10^3
- Prior abx use with no-PSA activity
- Staph aureus, B hemolytic strep, GNR, anaerobes
What is the empiric therapy for pediatric osteoarticular infections?
1st choice: Vancomycin or clindamycin due to high prevalence of Staph aureus infection
What are the empiric treatment by age according to the European pediatric guidelines for osteoarticular infection?
Up to 3 months: Cefazolin + gentamicin or beta lactam + cefotaxime
3 months to 5 years: Cefazolin (covers Kingella kingae) or cefuroxime or clindamycin
> 5 years
- Anti-staph PCN or cefazolin or clindamycin
What is the treatment duration for septic arthritis and OM in pediatric patients?
Septic arthritis: 2-4 days of IV therapy with a total of 2-3 weeks
OM: 3-4 days of IV therapy with a total of 3-4 weeks
