SSTI/OSTEO Flashcards
Abscess Bugs
-S. aureus (and MRSA)
-Gram - bacilli
Cellulitis Bugs
-Purulent: S. aureus, MRSA
-Non-purulent: Streptococci pyogenes
Surgical Sites Bugs
-S. aureus (MRSA)
-Enterococcus spp
-E. coli
-Staph coag neg
IDSA Guidelines, Diagnosis
Moderate
-SSTI with systemic signs/sx
Severe
-Purulent: > 38 fever, HR > 90, RR > 24, WBC > 12, immunocomp
-Non: same ^ plus failed oral therapy or skin sloughing
Impetigo/Ecthyma Bugs
Bullous Impetigo
-Staph aureus (MRSA/MSSA)
Non-bullous Impetigo
-Staph aureus
-Strep pyogenes
Ecthyma
-Staph aureus
-Strep pyogenes
Impetigo/Ecthyma TX
*Empiric tx should cover both MSSA and streptococci
-Dicloxacillin
-Cephalexin
-Clindamycin (pcn allergy)
-Doxycycline (pcn allergy)
-Sulf/TMX (pcn allergy)
DCDCS
Furuncles/Carbuncles TX
-S. aureus
Large: incision, drainage
Systemic abx not needed unless systemic sx
Chlorhexidine soap (hibiclens)
Cutaneous Abscess TX
Polymicrobial
-S. aureus (MRSA)
Incision and drainage
Culture to see if systemic abx are needed
Cellulitis TX
-Penicillin (if strep susceptible)
-Cephalexin (strep/mssa)
-Clinda (strep/mssa/mrsa)
-Cefazolin (strep/mssa)
-Dicloxacillin (strep/mssa)
-Amox/Clav (strep/mssa)
CCC PDA
TX is 5-10 days
Necrotizing Fasciitis Bugs
Polymicrobial
-Aerobic + anaerobi
Monmicrobial
-S. pyogenes (most common)
-S. aureus
-Clos. spp.
-Vibrio vuln
-Aeromonas hydro
Necrotizing Fasciitis TX
Empiric tx should be broad
-MRSA coverage
= Vanco, dapto, linezolid
-Gram neg, anaerobic coverage
= pip/tazo, carb, cetriaxone with metronidazole
-Add clindamycin
Fournier Gangrene Bugs
-S. aureus
-P. aeruginosa
-E.coli, Klebisiella
-Anaerobes
Pyomyositis TX
Infection within a muscle
BROAD empiric tx
-MRSA, Gram -, anaerobe
= Vanco, dapto, linezolid
= pip/tazo, carb, cetriaxone with metronidazole
S. aureus, S. pyogenes, S. pneumonia, Gram -
Bite Wounds TX
For P. mult, Eikenella
-Amox/Clav
-Doxycycline
P. mult only
-Levofloxacin
P. mult, anaerobes
-Moxifloxacin
CEFAZOLIN/CEPHALEXIN DO NOT COVER PASTEURELLA
Purulent MRSA/MSSA vs Non beta-hemolytic strep
Purulent MRSA/MSSA
= doxy, clinda, bactrim
Non
= cephalexin, clinda
Diabetic Foot Infections Bugs
-MSSA/MRSA
-Gram neg bacilli (P. aeru rarely)
-Anaerobes
Most common are Staphylococcus aureus and Streptococcus spp.
MILD DFI TX
Oral agents
-Clindamycin
-Cephalexin
-Levofloxacin
-Amoxicillin-clavulanate
-Doxycycline
-Trimethoprim-sulfamethoxazole
MODERATE DFI TX
Broader, covering Gram neg
Oral or IV
-Levofloxacin
-Moxifloxacin
-Clindamycin + ciprofloxacin
-Ceftriaxone
-Cefoxitin
-Ampicillin-sulbactam
MRSA coverage based on risk factors
SEVERE DFI TX
-Ertapenem
-Imipenem-cilastatin
-Meropenem
-Pip/tazo
-Ceftazidime
-Aztreonam
-Cefepime
-Vancomycin
-Daptomycin
-Linezolid
EXAMPLE
-VDL + cefepime/ceftazidime/aztreonam + metro
*pip/tazo avoid with Vanco = AKI
*ertapenem for P. aeru RF
RF for P. aeru in DFI
-High local prevalence of P. aeruginosa infections
-Infection occurs in a warm climate
-Frequent exposure of infected foot to water
-PRIOR ANTIBIOTIC EXPOSURE
DFI Duration of TX
1-4 weeks
Mild 1-2
Mod 1-3
Sev 2-4
Osteomyelitis Bugs/Duration
S. aureus (MSSA/MRA)
S. epidermidis
E. coli
K. pneumonia
Proteus spp
P. aeruginosa
Acute: 6 wks parenteral
Chronic: 4-6 weeks antibiotics (po vs iv)
CRP > 3.2
ESR > 60
Ceftaroline
AE: myelosuppression
Covers strep, staph (MRSA), entero
Tedizolid
Covers strep, staph (MRSA), entero (VRE)
200 mg, no adjustments
Oritavancin
Gram-positive pathogens (including MRSA)
1200 mg IV once
No renal adj over > 30
Dalbavancin
Gram-positive pathogens (including MRSA)
1 g then 500 mg
