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OU Module ID Fall 2018 > SSTI, DFI, BJI > Flashcards

SSTI, DFI, BJI Flashcards

1
Q

What are the classifications of skin infections?

A
  • Purulent

- Non-purulent

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2
Q

Purulent skin infections common organism

A
  • Staphylococcal -> MSSA, MRSA

- if you have pus, it’s most likely this organism

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3
Q

Non-purulent skin infections common organism

A

Streptococci

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4
Q

What are the classifications of purulent SSTI’s?

A

mild, moderate, and severe

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5
Q

Treatment for mild purulent SSTI’s

A
  • Incision and drainage (I and D) alone in most cases
  • Warm moist compresses
  • Antibiotic therapy under certain conditions
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6
Q

For mild purulent SSTI’s, what are the conditions that would require antibiotic therapy?

A
  • Abscess in area difficult to completely drain
  • Associated comorbidities or immunosuppression
  • Associated septic phlebitis
  • Extremes of age
  • Lack of response to I and D alone
  • Severe or extensive disease
  • Signs and symptoms of systemic illness
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7
Q

Treatment for moderate purulent SSTI’s

A
  • I and D with empiric oral antibiotics directed against CA-MRSA -> Clindamycin, doxycycline, Bactrim
  • If MSSA is isolated -> Cephalexin, Dicloxacillin
  • Warm moist compresses
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8
Q

Treatment for severe purulent SSTI’s

A
  • I and D and intravenous antibiotics directed against MRSA -> Ceftaroline, Dalbavancin / oritavancin / telavancin, Daptomycin, Linezolid / tedizolid, Vancomycin
  • If MSSA is isolated -> Cefazolin, clindamycin, oxacillin, nafcillin (clinda will not be used first)
  • Warm, moist compresses
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9
Q

Treatment for mild non-purulent SSTI’s

A
  • Oral antibiotics (outpt) targeting streptococci (may also want to target staphylococci) -> Penicillin VK, Cephalexin, Clindamycin, Dicloxacillin (use clinda and dicloxa if you’re concerned about staph)
  • Immobilization and elevation of the affected extremity
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10
Q

Treatment for moderate non-purulent SSTI’s

A
  • IV antibiotics (inpt) -> Penicillin G, Cefazolin, Ceftriaxone, Clindamycin
  • Switch to oral therapy once there is clinical response (oral Keflex)
  • Immobilization and elevation of the affected extremity
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11
Q

For a moderate infection, if you are concerned about MRSA, which agents would you use?

A
  • Ceftaroline
  • Dalbavancin
  • Daptomycin
  • Linezolid
  • Oritavancin
  • Tedizolid
  • Telavancin
  • Vancomycin
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12
Q

Treatment for severe non-purulent SSTI’s

A
  • Surgical debridement and IV antibiotics (want to cover anaerobe and gram -)
  • Vancomycin + imipenem-cilastatin
  • Vancomycin + meropenem
  • Vancomycin + piperacillin-tazobactam
  • Immobilization and elevation of the extremity
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13
Q

Duration of therapy for SSTI’s

A
  • Outpatients: 5 days; may extend if slow to respond to therapy
  • Inpatients: 7-10 days
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14
Q

Patient education for SSTI’s

A
  • Cover any draining wounds with clean and dry bandages
  • Bathe regularly
  • Clean hands regularly
  • Clean hands after touching area of infection or any item that has been in contact with a draining wound
  • Avoid reusing or sharing any personal items that may have contacted the infected site
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15
Q

What are the newer agents for SSTI’s?

A
  • Tedizolid
  • Telavancin
  • Dalbavancin / oritavancin
  • Delafloxacin
  • Omadacycline
  • Guidelines unclear about place in therapy for these agents
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16
Q

What is the biggest limitation for SSTI agents?

A

cost

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17
Q

Which organisms cause Necrotizing Fasciitis?

A
  • Mono- or polymicrobial
  • S. pyogenes (“flesh-eating” bacteria)
  • S. aureus (less common than strep)
  • Vibrio vulnificus, Aeromonas hydrophila
  • Anaerobic streptococci (Peptostreptococcus)
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18
Q

(general) treatment of Necrotizing Fasciitis

A
  • Immediate surgical debridement!
  • Repeat surgical debridement
  • Antibiotic therapy active against aerobes (MRSA) and anaerobes
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19
Q

How long do you continue treatment for Necrotizing Fasciitis?

A
  • Continue treatment until debridement is no longer needed
  • Clinical improvement has occurred
  • Afebrile for 48-72 hours
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20
Q

What are the agents that you use for empiric therapy for Necrotizing Fasciitis and Fournier Gangrene?

A
  • One of these: Vancomycin, Daptomycin, Linezolid
  • And one of these: Piperacillin / tazobactam, Imipenem / cilastatin, Meropenem, Doripenem, Ertapenem, Ceftriaxone AND metronidazole, Fluoroquinolone AND metronidazole
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21
Q

Which organisms are involved with necrotizing infections specifically Fournier Gangrene?

A
  • Mixed
  • MSSA and MRSA
  • Pseudomonas
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22
Q

Which organisms are responsible for impetigo?

A
  • MSSA
  • MRSA
  • Beta-hemolytic streptococci
23
Q

What is the treatment for impetigo?

A
  • Topical for localized infection: mupirocin or retapamulin twice daily for 5 days
  • New topical drug: ozenoxacin (MSSA, MRSA, Strep. pyogenes) twice daily for 5 days
  • Empiric treatment for systemic symptoms or multiple lesions (MSSA & S. pyogenes coverage): dicloxacillin, cephalexin, amoxicillin-clavulanate for 7 days
  • If MRSA suspected/confirmed: sulfamethoxazole-trimethoprim, doxycycline, or clindamycin
  • Local care: soaking in warm water to facilitate crust removal
24
Q

Which organism are involved in animal and human bite wounds?

A
  • Mouth flora: anaerobes
  • Victim’s skin flora: staphylococci and streptococci
  • Purulent wounds are most likely to be: Polymicrobial, Aerobes. and anaerobes
  • Non-purulent are most likely to be: Streptococci, Staphylococci
  • Pasteurella spp. (animal bites)
  • Eikenella corrodens (human bites)
25
Q

What are the two drugs of choice (IV and PO) for animal and human bite wounds?

A
  • Oral: Amoxicillin / clavulanate
  • Intravenous: Ampicillin / sulbactam
  • If using alternate therapy, just make sure that you have anaerobic and staph coverage
26
Q

What is the duration of treatment of infected bite wounds?

A
  • 5-10 days of oral antibiotic therapy

* Intravenous therapy for 7-14 days

27
Q

What are the classifications of diabetic foot infections (DFI)?

A
  • Mild
  • Moderate
  • Severe
28
Q

Mild diabetic foot infections (DFI)

A
  • Local infection involving only the skin and the subcutaneous tissue
  • If erythema is present, must be greater than 0.5 cm but less than or equal to 2 cm
  • Exclude other causes of inflammatory skin response (trauma, gout, etc.)
29
Q

Moderate diabetic foot infections (DFI)

A
  • Local infection involving only the skin and the subcutaneous tissue
  • Erythema greater than 2 cm or involving structures deeper than skin and subcutaneous tissues (abscess, osteomyelitis, septic arthritis, fasciitis) AND no systemic inflammatory response signs (described below)
30
Q

Severe diabetic foot infections (DFI)

A

Local infection (as described above) with signs of SIRS as manifested by greater than 2 of the following:

  • Temperature > 38 C or < 36 C
  • Heart rate > 90 bpm
  • Respiratory rate > 20 breaths/min or PaCo2 < 32 mmHg
  • WBC > 12,000 or < 4000 cells/microliter or greater than or equal to 10% immature forms (bands)
31
Q

Define local infection

A 
Presence of at least 2 of the following: 
• Local swelling or induration 
• Erythema 
• Local tenderness or pain 
• Local warmth 
• Purulent discharge
32
Q

Treatment Considerations for DFIs

A
  • Is there evidence of infection?
  • Is the infection mild, moderate, or severe?
  • Is there high risk of MRSA?
  • Has the patient received antibiotics in the past month? (If so, include agents active against gram-negative bacilli)
  • Are there risk factors for Pseudomonas infection?(Local prevalence, Warm climate, Exposure of foot to water)
33
Q

What are possible pathogens for mild DFI?

A
  • Staphylococcus aureus (MSSA)
  • Streptococcus spp.
  • Methicillin-resistant S. aureus (MRSA)
34
Q

What are treatment for mild DFI?

A
  • Dicloxacillin
  • Clindamycin
  • Cephalexin
  • Levofloxacin
  • Amoxicillin-clavulanate
  • Doxycycline
  • SMX/TMP
35
Q

Duration of therapy for mild DFI

A

1-2 weeks

36
Q

What are possible pathogens for moderate DFI?

A
  • MSSA
  • Streptococcus spp.
  • Enterobacteriaceae
  • Obligate anaerobes
  • MRSA
  • Pseudomonas aeruginosa
37
Q

What are treatment for moderate DFI?

A
  • Levofloxacin
  • Cefoxitin
  • Ceftriaxone
  • Ampicillin-sulbactam
  • Moxifloxacin
  • Ertapenem
  • Tigecycline
  • Levofloxacin AND clindamycin
  • Ciprofloxacin AND clindamycin
  • Imipenem-cilastatin
  • Linezolid
  • Daptomycin
  • Vancomycin
  • Piperacillin / tazobactam
  • Ceftazidime
  • Cefepime
  • Aztreonam
  • Imipenem-cilastatin
  • Meropenem
  • Doripenem
38
Q

Duration of therapy for moderate DFI

A

1-3 weeks

39
Q

What are possible pathogens for severe DFI?

A
  • MRSA
  • Enterobacteriaceae
  • Pseudomonas
  • Anaerobes
40
Q

What are treatment for severe DFI?

A

Vancomycin (or daptomycin or linezolid) AND one of the following:

  • ZOSYN
  • IMIPENEM-CILASTATIN
  • Ceftazidime
  • Cefepime
  • Aztreonam
  • Meropenem
  • Doripenem
41
Q

Duration of therapy for severe DFI

A

2-4 weeks

42
Q

What are other factors that need to be taken into consideration when treating DFI?

A
  • Glycemic control
  • Duration of therapy
  • Surgical involvement
  • Wound care
  • Imaging for osteomyelitis: if there is residual, but viable infected bone treat 4-6 weeks (IV preferred) unless linezolid is an option (has excellent bioavailability)
43
Q

Microbiology of bone and joint infections: septic arthritis

A
  • Staphylococci
  • Streptococci
  • Enterococci
44
Q

What is the treatment and duration of therapy of bone and joint infections: septic arthritis?

A
  • Gram-positive directed therapy: Vancomycin, Daptomycin, Linezolid
  • Gram-negative bacilli: Vancomycin AND Ceftriaxone
  • Duration of therapy is 14-28 days
45
Q

Microbiology of bone and joint infections: Osteomyelitis

A
  • Staphylococcus aureus
  • Coagulase-negative Staphylococcus
  • Streptococci
  • Enterococci
  • Gram-negative organisms (secondary to DFI)
  • Anaerobes (secondary to DFI)
  • Mycobacterium and fungal—rarely
46
Q

What is the treatment and duration of therapy of bone and joint infections: osteomyelitis?

A
  • Wait for cultures before starting antibiotic therapy
  • Surgical debridement or bone biopsy
  • Therapy should be determined based on suspected organisms and modified based on culture and sensitivity results
  • Duration of therapy is at least 4-6 weeks (8 weeks for MRSA) and up to 3 months
  • Vertebral osteomyelitis should be treated for 6-12 weeks
47
Q

What is the treatment and duration of therapy of prosthetic joint infections: specific to Staphylococci?

A

• Debridement and retention of prosthesis:
- IV antibiotics AND rifampin followed by
- Oral antibiotics AND rifampin for 3 months (hip, elbow, or shoulder) or 6 months (knee)
- Oral antibiotics: fluoroquinolone, minocycline, doxycycline, SMX/TMP, cephalexin, or dicloxacillin
• Treatment after resection arthroplasty
- 4-6 weeks of IV or highly bioavailable oral therapy

48
Q

What are the possible organisms in Prosthetic Joint Infections?

A
  • Staphylococci (MSSA or MRSA)
  • Streptococci
  • Enterococci
49
Q

What is the treatment for Prosthetic Joint Infections: MSSA Staphylococci?

A
  • Nafcillin
  • Oxacillin
  • Cefazolin
50
Q

What is the treatment for Prosthetic Joint Infections: MRSA Staphylococci?

A

Vancomycin

51
Q

What is the treatment for Prosthetic Joint Infections: Streptococci?

A
  • Ampicillin

- Ceftriaxone

52
Q

What is the treatment for Prosthetic Joint Infections: Enterococci?

A

Ampicillin

53
Q

If a patient has a PCN allergy, which antibiotic can be used? (for Prosthetic Joint Infections)

A

vancomycin

OU Module ID Fall 2018 (18 decks)

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