SSTI/DFI Flashcards
risk factors for SSTIs
hx of SSTI
PAD
CKD
DM
IV drug use
complications from SSTIs
osteomyelitis
bacteremia
ulcers
endocarditis
sepsis
patient presentation of non-purulent SSTIs
tender
erythema
warm to touch
orange peel like skin
malaise, fever, systemic
are skin cultures recommended in non purulent SSTIs
no
are blood cultures recommended in non purulent SSTIs
only in immunocompromised
severe infection
animal bites
mild SSTIs classification
no systemic symptos
moderate SSTIs classification
systemic signs of infection (fever, chills)
severe SSTIs classification
SIRS criteria (meets 2)
- temp >38 or <36
- RR >24
- HR >90
- WBC >12 or <4k
causative pathogens of non purulent SSTIs
group streps (all but pneumo)
mostly strep pyogenes
- also MRSA
MRSA risk in non purulent factors
penetrating trauma
MRSA elsewhere
IV drug use
SIRS/Severe inf
failed non MRSA coverage
non-purulent mild treatment
oral
penicillin VK
cephalosporin
dicloxacillin
clindamycin
non-purulent moderate treatment
IV
penicillin
ceftriaxone
cefazolin
clindamycin
non-purulent severe treatment
piperacillin/tazo
+
vancomycin
duration of therapy for non-purulent SSTIs
5 days
what is an abscess
collection of pus within dermis and deeper skin tissues
what is a furuncle
boil, small abscess at formation of hair folicle
what is a carbuncle
infection involving several adjacent hair folicles
presentation of purulent SSTIs
tender
red nodules
warm to touch
systemic signs
are wound cultures recommended in purulent SSTI
yes wound cultures in abscesses, carbuncles and patients with systemic signs of infections
causative pathogens of purulent SSTIs
MRSA - mainly
MSSA
strep
mild treatment purulent SSTIs
incision and drainage only
moderate treatment purulent SSTIs
incision and drainage
culture and suseptibility
oral empiric:
- TMP-SMX
- doxycycline
targeted MSSA:
- dicloxacillin
- cephalexin
targeted MRSA
- TMP-SMX
- doxycycline
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
