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PR3151 Finals > SSTIs > Flashcards

SSTIs Flashcards

1
Q

Pathogens causing impetigo?

A

Staph
Strep
Bullous form -> toxin-producing strains of S. aureus

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2
Q

Tx for impetigo?

  1. Mild, limited lesions
A
  1. Mild, limited lesions
    Topical mupirocin BD x 5d
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3
Q

Tx for impetigo?

  1. Multiple lesions
A
  1. Multiple lesions (same as Tx for ecthyma)

Treat for 5-7 days

Empiric: PO cloxacilin, PO cephalexin, PO cefuroxime (mild penicillin allergy), or clindamycin (severe penicillin allergy)

Culture directed:
Strep pyogenes- PO Pen V, PO amoxiciilin
MSSA- PO cephalexin, PO cloxacillin

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4
Q

Pathogens causing nonpurulent Cellulitis and Erysipelas?

A
  • Mainly beta-hemolytic strep (usually strep A pyogenes)
  • S. aureus (less frequent)
  • Less common, based on risk factors: Aeromonas, Vibrio vulnificus, Pseudomonas
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5
Q

What pathogens must you cover for MILD nonpurulent Cellulitis and Erysipelas?

What does mild mean?

What type of abx must you use (route)?

A

Cover S. pyogenes

Mild: without systemic s/sx

Use PO abx

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6
Q

Tx for MILD nonpurulent Cellulitis and Erysipelas?

A

Treat for 5-10 days, 14 days if immunocompromised

  • PO Pen V
  • PO Cephalexin
  • PO Cloxacillin
  • Penicillin allergy: PO clindamycin
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7
Q

What pathogens must you cover for MODERATE nonpurulent Cellulitis and Erysipelas?

What does moderate mean?

What type of abx must you use (route)?

A

Cover MSSA

Moderate: Systemic s/sx with some purulence

May use IV abx (depends on clinical judgement)

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8
Q

Tx for MODERATE nonpurulent Cellulitis and Erysipelas?

A

Treat for 5-10 days, 14 days if immunocompromised

  • IV cefazolin
  • PO/IV cloxacillin
  • Penicillin allergy: PO/IV clindamycin

If water exposure: Add PO/IV ciprofloxacin

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9
Q

What pathogens must you cover for SEVERE nonpurulent Cellulitis and Erysipelas?

What does severe mean?

What type of abx must you use (route)?

A

Broader coverage*, consider possibility of necrotising infections (more gram -ve)

Severe means systemic s/sx, failed PO Tx or immunocompromised

IV abx

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10
Q

Tx for SEVERE nonpurulent Cellulitis and Erysipelas?

If MRSA risk factors?

A

Treat for 5-10 days, 14 days if immunocompromised

  • IV piperacillin-tazobactam
  • IV cefepime
  • IV meropenem

IF MRSA risk factors: add IV vancomycin, daptomycin, linezolid

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11
Q

What are some non-pharmacological Tx for SEVERE nonpurulent Cellulitis and Erysipelas?

A
  • Ensure rest, limb elevation
  • Treat underlying conditions
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12
Q

What pathogens must you cover for purulent (furuncles, carbuncles, skin abscesses, cellulitis)?

What about pts with skin abscess involving perioral, perirectal and vulvovaginal areas?

A

S. aureus (main)
Some Beta-hemolytic strep

If skin abscess involving perioral, perirectal and vulvovaginal areas: cover Gram -ve AND anaerobes

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13
Q

What is the mainstay treatment of purulent SSTI?

A

Incision and drainage (I&D)

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14
Q

When do you add on systemic abx for purulent SSTI? (6 points)

A

Add if:
- Unable to drain completely
- No response to I&D
- Extensive disease involving several sites
- Extreme age
- Immunosuppressed (chemoTx, transplant)
- Systemic s/sx (at least 2 of SIRS Criteria)

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15
Q

Name the SIRS Criterias (4)

A
  1. Temp > 38°C or < 36°C
  2. HR > 90 bpm
  3. RR > 24 bpm
  4. WBC > 12 x 10^9/L or < 4 x 10^9/L
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16
Q

Tx for MILD purulent SSTI?

A

I&D or warm compress to promote drainage

17
Q

Tx for MODERATE purulent SSTI?

A

I&D + PO abx

  • PO Cloxacillin
  • PO Cephalexin
  • PO Clindamycin if penicillin allergy
18
Q

Tx for SEVERE purulent SSTI?

A

I&D + IV abx

  • IV Cloxacillin
  • IV Cefazolin
  • IV Clindamycin
  • IV Vancomycin (MRSA cover)
19
Q

If a patient with purulent SSTI has MRSA risk factors, what is the empiric Tx for MRSA?

A
  • PO co-trimoxazole
  • PO doxycycline
  • PO clindamycin
  • IV vancomycin (FIRST-LINE)
  • IV daptomycin ($$)
  • IV linezolid ($$)
20
Q

If a patient has purulent SSTI with skin abscess involving perioral, perirectal and vulvovaginal areas, we need to cover gram- ve and anaerobes, so what is the empiric Tx?

A

Amoxicillin-clavulanate

21
Q

What are the risk factors for CA-MRSA? (7 points)

A

Risk factors:
- Contact sports
- Military personnel
- IV drug abusers
- Prison inmates
- Overcrowded facilities
- Close contact
- Lack of sanitation

22
Q

How do you define HA-MRSA and what are the risk factors? (7 points)

A

HA-MRSA is MRSA that occurs
- > 48h after hospitalisation
- Outside of hospital within 12m of exposure to healthcare

Risk factors:
- Abx use
- Recent hospitalisation/ surgery
- Prolonged hospitalisation
- ICU
- Hemodialysis
- MRSA colonization
- Proximity to others with MRSA colonisation/ infection

23
Q

How do you classify DFI as an infection?

A

Purulent discharge OR at least 2 s/sx of inflammation:

  • Erythema
  • Warmth
  • Tenderness
  • Pain
  • Induration
24
Q

What are the likely pathogens for DFI?

Name the gram +ve, gram -ve and anaerobes.

When do you see gram -ve and anaerobic pathogens?

A

Gram +ve:
- S. aureus
- Beta hemolytic strep

Gram -ve:
Particularly in chronic wounds/ wounds previously treated with abx
- E coli., Klebsiella, Proteus spp

Anaerobes:
Particularly in ischemic/ necrotic wounds
- Peptostreptococcus spp
- Veillonella spp
- Bacteroides spp

25
Q

For DFI empiric Tx, when do you need to cover for P. aeruginosa?

A

When severe infection and/ or failure of abx (that was not active against P. aeruginosa)

26
Q

Describe how you would classify a MILD DFI?

A
  • Infection of skin and SC tissue and
  • Erythema ≤ 2cm around ulcer
  • NO systemic s/sx of infection
27
Q

What are the organisms to cover for MILD DFI?

A

Strep spp, S. aureus

28
Q

Tx for MILD DFI?

If need MRSA coverage, what to use?

A
  • PO cephalexin
  • PO cloxacillin
  • PO clindamycin

If MRSA coverage needed, use:
- PO co-trimoxazole
- PO clindamycin
- PO doxycycline

29
Q

Describe how you would classify a MODERATE DFI?

A
  • Infection of deeper tissue (eg bone, joints) OR
  • Erythema > 2cm around ulcer
  • NO systemic s/sx of infection
30
Q

What are the organisms to cover for MODERATE DFI?

A

Strep spp, S. aureus

Gram -ve (+/- P. aeruginosa) - depends on risk factors for P. aeru

Anaerobes

31
Q

Tx for MODERATE DFI?

If need MRSA coverage, what to use?

A

IV abx (if no need P. aeruginosa cover):
- IV amoxicillin-clavulanate
- IV cefazolin/ ceftriaxone + metronidazole

If MRSA coverage needed, add:
- IV vancomycin
- IV daptomycin
- IV linezolid

32
Q

Describe how you would classify a SEVERE DFI?

A
  • Infection of deeper tissue (eg bone, joints) OR
  • Erythema > 2cm around ulcer AND
  • Systemic s/sx
33
Q

What are the organisms to cover for SEVERE DFI?

A

Strep spp, S. aureus

Gram -ve (P. aeruginosa)

Anaerobes

34
Q

Tx for SEVERE DFI?

If need MRSA coverage, what to use?

A

IV abx:
- IV piperacillin-tazobactam
- IV cefepime + metronidazole
- IV meropenem
- IV ciprofloxacin + clindamycin

If MRSA coverage needed, add:
- IV vancomycin
- IV daptomycin
- IV linezolid

35
Q

If no bone is involved, what is the recommended Tx duration for mild, moderate and severe each?

A

NO bone involved:
Mild- 1-2w
Moderate- 1-3w
Severe- 2-4w

36
Q

If the bone is involved, what is the recommended Tx duration for:

  1. Surgery (amputation- ALL removed)
  2. Surgery- residual infected soft tissue
  3. Surgery- residual viable bone
  4. No surgery/ surgery- residual dead bone
A
  1. Surgery (amputation- ALL removed)
    2-5 days
  2. Surgery- residual infected soft tissue
    1-3w
  3. Surgery- residual viable bone
    4-6w
  4. No surgery/ surgery- residual dead bone
    ≥ 3m

PR3151 Finals (11 decks)

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