SSTI Flashcards
Which are the mildest types of SSTI
Impetigo and Ecthyma
Impetigo and Ecthyma mono or poly microbial
mono
impetigo and Ecthyma causative organisms
S. Aureus
Beta-hemolytic Streptococci
Bullous form caused by toxin producing strains of S. aureus
Empiric treatment for impetigo and ecthyma must cover with organisms
S.aureus AND b-hemolytic streptococci
Can topicals antibiotics be used in impetigo
yes
can topical antibiotics be used in ecthyma
no
What is the topical treatment for impetigo
mupirocin BD
duration: 5 days
When is oral antibiotics for impetigo and ecthyma used
impetigo: severe cases
ecthyma: all cases
What is the empiric oral treatment for impetigo and ecthyma
no allergies:
Cephalexin 250-500mg PO QDS or
cloxacillin 250-500mg PO QDS
penicillin allergies: clindamycin 200mg PO QDS
7 days
What is the culture directed therapy options for impetigo and ecthyma
S. Pyogenes: Penicillin VK 250-500mg PO QDS
MSSA: Cephalexin 250-500mg PO QDS or cloxacillin 250-500mg PO QDS
7 days
What are some specific risk factors for purulent SSTIs
close physical contact
crowded living quarters
sharing personal items
poor personal hygiene
What is the causative organism for purulent SSTIs
S. Aureus
What is the main treatment for purulent SSTIs
Incision and drainage
When do you use antibiotics for purulent SSTIs
unable to drain completely lack of response extensive disease involving several sites extremes of ages immunosuppressed signs of systemic illnesses
What are the signs of systemic illness (SIRS)
Temperature >38 or <36
HR >90bpm
RR > 24breaths per min
WBC > 12 x 10^9 or < 4 x 10^9
Outline the treatment options for SSTIs
MSSA only:
- Cloxacillin 250-500mg PO QDS or 1-2g IV Q4-6h
- Cephelexin 250-500mg PO QDS
- Cefazolin 1-2g IV Q8h
MRSA and MSSA:
- Doxycycline
- Cotrimoxazole 800/160mg PO BD
- Clindamycin 300mg PO QDS or 600mg IV Q8h
Outpatient 5-7 days
inpatient 7-14 days
What is cellulitis
acute inflammation epidermis, dermis and sometimes superficial fascia
What are some complications of cellulitis and erysipelas
bacteremia, endocarditis, toxic sock, glomerulonephritis, lymphedema, osteomyelitis, necrotising soft tissue infections (necrotising fasciitis)
What are the causative organisms for cellulitis and erysipelas
S. Aureus (purulent) and B-hemolytic streptococci (erysipelas)
The immunosuppressed are at risk for which additional causative organisms involved in cellulitis and erysipelas
Streptococcus pneumonia, E.coli, Serratia marcescens, Pseudomonas aeruginosa
The chronic liver.renal disease patients are at risk for which additional causative organisms involved in cellulitis and erysipelas
Vibrio spp., E.coli, pseudomonas aeruginosa
What is the treatment for mild cellulitis and erysipelas with no SIRS?
PO Antibiotics
- penicillin VK 250-500mg PO QDS
- Cloxacillin 250-500mg PO QDS
- Cephalexin 250-500mg PO QDS
- clindamycin 300mg PO QDS
if MRSA risk factors, use PO:
- cotrimoxazole 800/160mg PO BD
- clindamycin 300mg PO QDS
- Doxycycline
What is the treatment for moderate cellulitis and erysipelas with 1 SIRS criteria
treat like mild PO Antibiotics - penicillin VK 250-500mg PO QDS - Cloxacillin 250-500mg PO QDS - Cephalexin 250-500mg PO QDS - clindamycin 300mg PO QDS
if MRSA risk factors, use PO:
- cotrimoxazole 800/160mg PO BD
- clindamycin 300mg PO QDS
- Doxycycline
What is the treatment for moderate cellulitis and erysipelas with 2 or more SIRS criteria
IV
- cloxacillin 1-2g IV Q4-6h
- cefazolin 1-2g IV Q8h
- clindamycin 600mg IV Q8h
MRSA risk factors:
- Vancomycin 15mg/kg Q8-12h
- Daptomycin
- Linezolid
What is the treatment for severe cellulitis and erysipelas with 2 or more SIRS criteria witth hypotension, rapid progression, immunosuppression or comorbitdities
IV
- Zosyn 4.5g IV Q4-6h
- Cefapime 2g IV Q8H
- meropenem
MRSA:
- Vancomycin 15mg/kg IV Q8-12h
- Daptomycin
- Linezolid
What is the organism to treat if there was an animal bite
Pasteurella multocida
What is the organism to treat if there is a human bite
eikenella corrodes
What is the treatment for bite wounds
- Augmentin
- Ceftriaxone or cefuroxime + clindamycin or metronidazole
cipro or levo + clindamycin or metronidazole
What is the causative organisms for DFI
S. Aureus and Streptococcus spp.
Gram neg bacilli:
- E.coli, Klebsiella spp., Proteus spp.
Anaerobes
- Peptostreptococcus spp., Veillonella spp., bacteriedes
What is the treatment for mild DFI
Cephalexin 250-500mg PO QDS
Cloxacillin 250-500mg PO QDS
Clindamycin 300mg PO QDS
MRSA:
Cotrimoxazole 800/160mg PO BD
Clindamycin 250-500mg PO QDS
Doxycycline
What is the definition mild DFI
infection of skin tissue + if erythema <2cm around ulcer + no SIRS
What is the definition of moderate DFI
infection of deeper tissue or if erythema > 2cm + 2 SIRS
What is the treatment for moderate DFI
Initial IV antibiotics
- Amoxicillin/caluvulanate 1-2g IV 8h
- ceftriaxone
- Ertapenem
MRSA: add IV
- Vancomycin 15mg/kg q8-12h
- daptomycin
- Linezolid
if no anaerobic coverage: add IV
- Metronidazole 500mg IV TDS
- clindamycin 600mg IV q8h
What is the definition of severe DFI
have SIRS
What is the treatment for severe DFI
Initial IV antibiotics
- Zosyn 4.5g IV q6-8h
- cefepime 2g IV q8h
- meropenem
MRSA: add IV
- Vancomycin 15mg.kg Q8-12h
- daptomycin
- Linezolid
if no anaerobic coverage: add IV
- Metronidazole 500mg IV TDS
- clindamycin 600mg IV q8h
What are the pressure ulcers risk factors
reduced mobility debilitated by severe chronic diseases reduced consciousness sensory and autonomic impairment extremes of ages malnutrition
What is the stage 1 clinical presentation of pressure ulcers
abrasion of epidermis
irregular area of tissue swelling
no open wound
What is the stage 2 clinical presentation of pressure ulcers
extends through the dermis
open wound
What is the stage 3 clinical presentation of pressure ulcers
extends deep into subq fat
open sore or ulcer
What is the stage 4 clinical presentation of pressure ulcers
muscle and bone
deep sore or ulcer
what are the causative organisms for pressure ulcers
S. Aureus and Streptococcus spp.
Gram neg bacilli:
- E.coli, Klebsiella spp., Proteus spp.
Anaerobes
- Peptostreptococcus spp., Veillonella spp., bacteriedes
