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BCIDP > SSTI > Flashcards

SSTI Flashcards

1
Q

What is the duration of therapy for cellulitis?

A

5-14 days

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2
Q

What is the empiric treatment for pyomyositis?

A

Main pathogen: Staph aureus

Treat with vancomycin

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3
Q

What is the treatment duration for impetigo? What agent should be used?

A

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

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4
Q

How would you treat follicultis? Duration and agents?

A

Topical agents 2-4x daily x 7 days

  • Clindamycin, erythromycin ointment, mupirocin ointment
  • If PSA, use cipro or levo
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5
Q

What empiric treatment is recommended for human bites?

A

Unasyn or Augmentin

*Avoid Clindamycin, first generation cephalosporins and macrolides as it has poor activity against Eikenella corrodens

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6
Q

What empiric treatment is recommended for animal bites?

A

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

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7
Q

How would you treat a cat scratch?

A

Azithromycin for Bartonella henselae OR doxycycline for bacillary angiomatosis

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8
Q

How would you treat a necrotizing infection due to Vibrio vulnificus?

A

Doxycycline + CTX

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9
Q

How would you treat a necrotizing infection due to Aeromonas hydrophilia?

A

Doxycycline + CTX or cipro

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10
Q

When should steroids be used for cellulitis and for how long should the steroids be given?

A

Prednisone 40 mg PO daily x 7 days in non-DM patients with cellulitis and multiple SIRS criteria

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11
Q

When should cellulitis prophylaxis be given? What abx should be given for prophylaxis?

A

If 3-4 Strep episodes/year, consider oral PCN VK or IM benzathine PCN

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12
Q

When should metronidazole be added as pre-op prophylaxis?

A

Surgeries in the biliary tract, appendectomy, colorectal, head/neck, urologic tract

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13
Q

What is the pre-op timing for abx?

A

60 min prior to incision, 120 min for vancomycin and FQs

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14
Q

What criteria requires intraop repeat administration?

A

Length of procedure (> 2 half-lives)
Obesity
Significant blood loss

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15
Q

How would you manage a surgical site infection with no evidence of systemic response (no fever, WBC, HR, extending erythema)?

A

I & D only

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16
Q

How would you manage a surgical site infection with evidence of systemic response? What are the systemic response criteria?

A
  • 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

17
Q

What is the difference in pathogen prevalence between different stages of PJI?

A

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

18
Q

Describe the treatment phase and suppression phase in debridement and retain method in PJI with Staphlococcus?

A

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

19
Q

Describe the treatment phase and suppression phase in 1- stage exchange method in PJI with Staphlococcus?

A

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

20
Q

Describe the treatment phase and suppression phase in 2- stage exchange method in PJI with Staphlococcus?

A

4-6 weeks IV or high oral bioavailability with NO concurrent rifampin

21
Q

Describe the treatment phase and suppression phase in permanent resection method in PJI with Staphlococcus?

A

4-6 weeks IV or high bioavailability oral with no concurrent rifampin

22
Q

What is the treatment algorithm for non-Staph PJI for DAIR?

A

4-6 weeks IV or high oral bioavailability WITH

indefinite oral suppression

23
Q

What is the treatment algorithm for non-Staph PJI for 1 stage exchange?

A

4-6 weeks IV or high oral bioavailability WITH

indefinite oral suppression

24
Q

What is the treatment algorithm for non-Staph PJI for 2 stage exchange?

A

4-6 weeks IV or high oral bioavailability

25
Q

What is the treatment algorithm for non-Staph PJI for permanent resection?

A

4-6 weeks IV or high oral bioavailability

26
Q

What notable adverse effects does oritavancin have?

A

Osteomyelitis package insert warning

Rifampin drug interactions: CYP3A4/2D6 inducer, 2C9/2C19 inhibitor

27
Q

What is the spectrum activity of delafloxacin and what is its dosing PO/IV?

A

Staph including MRSA, Strep, Enterococcus faecalis and GNR including PSA

300 mg IV Q12H
450 mg PO Q12H

28
Q

What is the spectrum activity of omadacycline and what is its dosing PO/IV?

A

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

29
Q

How is mild DFI defined and treated?

A

Local infection involving skin/SQ tissue

  • < 2 cm surrounding erythema
  • Staph aureus, B hemolytic strep

Oral treatment

30
Q

How is moderate DFI defined and treated?

A

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

31
Q

How is severe DFI defined?

A
  • 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
32
Q

What is the empiric therapy for pediatric osteoarticular infections?

A

1st choice: Vancomycin or clindamycin due to high prevalence of Staph aureus infection

33
Q

What are the empiric treatment by age according to the European pediatric guidelines for osteoarticular infection?

A

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

34
Q

What is the treatment duration for septic arthritis and OM in pediatric patients?

A

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

BCIDP (13 decks)

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