___, ___ go up to the epidermis and dermal-epidermal junction.
Impetigo and ecthyma
What is the first line treatment for impetigo?
Mupirocin ointment BD 5d
What is the treatment for severe impetigo and ecthyma?
PO cephalexin/cloxacillin/clindamycin
IF culture: (S. pyogenes) penicillin VK, (MSSA) cephelaxin/cloxacillin
What are the 3 purulent infections?
Carbuncle, furuncle, cutaneous abscess
What is the standard treatment for purulent infections?
Incision & drainage
When should systemic antibiotics be used for purulent infections?
- Can’t drain properly
- Lack of response (erythema)
- Extensive infection w/ several sites
- very young/old
- Immunosuppressed or SIRS
What are the SIRS criteria?
- Temp <36C or >38C
- HR >90 bpm
- RR >24bpm
- WBC > 12x10^4 or <4x10^4
What is the duration of antibiotics for out/inpatient in purulent antibiotics?
Outpatient 5-7 days
Inpatient 7-14 days
What antibiotics are used for MSSA and MRSA in purulent infections?
MSSA: cloxacillin, cephalexin, cefazolin
MRSA: clindamycin, cotrimoxazole, doxycycline
Staphylococcus aureus commonly causes what kind of infections?
Purulent infections
What are the differences in presentation of erysipelas and cellulitis?
Erysipelas: sharply demarcated w/ raised border, non-purulent; up to superficial fascia and lymph
Cellulitis: poorly demarcated area; from epidermis to superficial fascia and lymph
What is the duration of antibiotics for cellulitis & erysipelas?
At least 5 days
Immunosuppressed 7-14days
What comorbidities make you more susceptible to what organisms?
- Immunosuppression: Strep. pneumoniae, E. coli, P. aeruginosa, Serratia marcescens
- Chronic liver/renal disease: Vibrio spp, E. coli, P. aeruginosa
When are cultures required?
- Impetigo and ecthyma: not needed
- Purulent infection: culture pus
- Cellulitis and erysipelas: only if purulent after I&D, immunosuppressed, SIRS -> preferred cutaneous aspirate/biopsy
- Moderate - severe DFI: deep tissue cultures after cleansing & before abx initiation
- Pressure ulcers: deep tissue cultures or biopsy
What are the common organisms in bite wounds cellulitis?
Staphylococcus aureus, Streptococcus spp
(animal) Pasteurella multocida
(human) Eikenella corrodens
(anaerobes) Prevotella spp., Peptostreptococcus spp.
What are the treatment options for bite wound cellulitis?
IV or PO depends on severity of infection
- Augmentin
- Clindamycin/metronidazole AND
- Ceftriaxone/cefuroxime OR ciprofloxacin/levofloxacin
Monitoring for cellulitis & erysipelas
- Clinical response: fever, pain, swelling, erythema, warmth
- Change to PO if initial IV: 48h afebrile, clinical improvement
- Otherwise consider resistant organisms and alternative causes
What are the treatment options for cellulitis & erysipelas (non-purulent)?
No SIRS: (strep only) Penicillin VK, cloxacillin, cephalexin, clindamycin
1-2 SIRS: (strep + SA) 2 SIRS or Tx failure - IV cefazolin, penicillin G, clindamycin
>2 SIRS: (strep + SA + P. aeruginosa + Gram -ve) IV piperacillin/tazobactam, cefepime, meropenem
(MRSA) IV vancomycin, daptomycin, linezolid
What is the difference in treatment options between purulent and non-purulent cellulitis & erysipelas?
No SIRS: (strep + SA) no penicillin VK, (MRSA) PO
1-2 SIRS: (strep + SA) 2 SIRS or Tx failure - no IV penicillin G, add IV cloxacillin
(MRSA) IV vancomycin, daptomycin, linezolid also for 1-2 SIRS
When are PO drugs used for MRSA?
PO cotrimoxazole, clindamycin, doxycycline Mild purulent cellulitis & erysipelas Mild DFI (no SIRS, skin & SC tissue, erythema <2cm)
Classification of DFI
Mild: no SIRS, skin & SC tissue, erythema <2cm
Moderate: no SIRS, deep tissue, erythema >2cm
Severe: SIRS
What is the classification for severe cellulitis & erysipelas?
> 2 SIRS + hypotension, rapid progression, immunosuppressed or comorbidities
What are the areas of DFIs?
Soft tissue or bone infections below the malleolus
– Skin ulceration (peripheral neuropathy)
– Wound (trauma)
What are the complications of DFIs?
Complications
– Hospitalization
– Osteomyelitis amputation
