SSTI/DFI Flashcards by joelle wasikowski

risk factors for SSTIs

hx of SSTI
PAD
CKD
DM
IV drug use

How well did you know this?

Not at all

Perfectly

complications from SSTIs

osteomyelitis
bacteremia
ulcers
endocarditis
sepsis

How well did you know this?

Not at all

Perfectly

patient presentation of non-purulent SSTIs

tender
erythema
warm to touch
orange peel like skin
malaise, fever, systemic

How well did you know this?

Not at all

Perfectly

are skin cultures recommended in non purulent SSTIs

How well did you know this?

Not at all

Perfectly

are blood cultures recommended in non purulent SSTIs

only in immunocompromised
severe infection
animal bites

How well did you know this?

Not at all

Perfectly

mild SSTIs classification

no systemic symptos

How well did you know this?

Not at all

Perfectly

moderate SSTIs classification

systemic signs of infection (fever, chills)

How well did you know this?

Not at all

Perfectly

severe SSTIs classification

SIRS criteria (meets 2)
- temp >38 or <36
- RR >24
- HR >90
- WBC >12 or <4k

How well did you know this?

Not at all

Perfectly

causative pathogens of non purulent SSTIs

group streps (all but pneumo)
mostly strep pyogenes
- also MRSA

How well did you know this?

Not at all

Perfectly

MRSA risk in non purulent factors

penetrating trauma
MRSA elsewhere
IV drug use
SIRS/Severe inf
failed non MRSA coverage

How well did you know this?

Not at all

Perfectly

non-purulent mild treatment

oral
penicillin VK
cephalosporin
dicloxacillin
clindamycin

How well did you know this?

Not at all

Perfectly

non-purulent moderate treatment

IV
penicillin
ceftriaxone
cefazolin
clindamycin

How well did you know this?

Not at all

Perfectly

non-purulent severe treatment

piperacillin/tazo
+
vancomycin

How well did you know this?

Not at all

Perfectly

duration of therapy for non-purulent SSTIs

5 days

How well did you know this?

Not at all

Perfectly

what is an abscess

collection of pus within dermis and deeper skin tissues

How well did you know this?

Not at all

Perfectly

what is a furuncle

boil, small abscess at formation of hair folicle

How well did you know this?

Not at all

Perfectly

what is a carbuncle

infection involving several adjacent hair folicles

How well did you know this?

Not at all

Perfectly

presentation of purulent SSTIs

tender
red nodules
warm to touch
systemic signs

How well did you know this?

Not at all

Perfectly

are wound cultures recommended in purulent SSTI

yes wound cultures in abscesses, carbuncles and patients with systemic signs of infections

How well did you know this?

Not at all

Perfectly

causative pathogens of purulent SSTIs

MRSA - mainly
MSSA
strep

How well did you know this?

Not at all

Perfectly

mild treatment purulent SSTIs

incision and drainage only

How well did you know this?

Not at all

Perfectly

moderate treatment purulent SSTIs

incision and drainage
culture and suseptibility
oral empiric:
- TMP-SMX
- doxycycline
targeted MSSA:
- dicloxacillin
- cephalexin
targeted MRSA
- TMP-SMX
- doxycycline

How well did you know this?

Not at all

Perfectly

severe treatment purulent SSTIs

incision and drainage
culture and suseptibility
empiric:
- vancomycin
- daptomycin
- linezolid
MRSA:
same as empiric
MSSA:
- cefazolin
- nafcillin
- clindamycin

duration of treatment purulent SSTIs

5 days

what is necrotizing fasciitis

emergency - morbidity and mortality

presentation of necrotizing fasciitsi

profound systemic toxicity change in skin color to purple / black

are blood cultures or wound cultures obtained in necrotizing fasciitis

yes both

causative pathogens of necrotizing fasciitis

monomicrobial or polymicorbial - strep pyognes - MRSA - vibrio vulnificus - aeromonas hydrophila - c. perfringens - peptostreptococcus

necrotizing fasciitis treatment

emergent surgery and broad spec piperacillin/tazobactam + vancomycin if strep pyogenes: - penicillin + clindamycin if polymicorbial - piperacillin/tazobactam + vanc

how long do we continue treatment for necro fasc

fever gone for 48 hours improvement clinically further debridgement not needed

why do we give clindamycin with penicillin in SSTIs

clindamycin inhibits strep toxin production creates inoculum effect and helps penicillin get to site

what is impetigo

highly contagious superficial skin infection caused by skin abrasions

impetigo risk factors

children hot/humid weather

presentation of impetigo

small painless fluid filled vescicles leading to thick golden crusts - not systemic signs

do we get cultures in impetigo

cultures recommended

treatment for impetigo

few lesions - topical mupirocin x 5 days many lesions/outbreak: - dicloxacillin or cephalexin strep only: - penicillin allergies to PCN or MRSA: - doxycycline - TMP-SMX - clindamycin

presentation of cat bites

deep puncture wound

presentation of dog/human bites

cellulitis signs, red warm painful

are cultures recommended in animal bites

yes

causative pathogens in animal bites

anaerobes pasturella dogs - capnocytophage humans - strep, eikenella

treatment of human/animal bites

amoxicillin/clav 2nd line: - 2nd or 3rd gen cephalo + clinda/metro if PCN allergy - cipro/levo + anaerobic (clinda/metro) - moxifloxacin

how long should we give treatment for established infection from animal bite

7-14 days

how long should we give treatment for preemptive in animal bites

3-5 days

who do we give preemptive treatment to in animal bites

immunocompromised asplenia moderate to severe bites face/hand penetrate joints

diabetic foot infection risk factors

neuropathy angiopathy/ischemia poor wound healing immunologic defects

are cultures obtained in DFI?

not in mild

causative pathogens of DFI

strep staph pseudomonas (soaking) anaerobes (chronic) enterobacteriac enterococcus

MRSA risk factors in DFI

MRSA somewhere else recent hospitalization failed non MRSA local prev >30-50% (indy)

pseudomoans risk factors in DFI

history of pseudomonas inf soaking in water warm climate severe infection failed non pseudomonal tx

treatment DFI mild

dicloxacillin cephalexin clindamycin if recent abx - amox/clav - levo/moxi if MRSA - doxycycline - TMP/SMX

duration of treatment mild DFI

1-2 weeks

treatment moderate DFI

amox/clav moxifloxacin if pseudomonas, switch to: - cipro/levo + clinda/metro if MRSA, add: - vanc - linezolid - TMP-SMX - doxycycline

treatment duration DFI

2-3 weeks

treatment severe DFI

piperacillin/tazo carbapenem cefepime + clinda/metro if MRSA: add - vanc - linezolid - dapto

treatment duration severe DFI

2-3 weeks