603 Therapeutics > SSTI > Flashcards

SSTI Flashcards

(45 cards)

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1
Q

IV Antibiotics for S. aureus MRSA cover empirically

A

Vancomycin
Daptomycin
Ceftaroline
Dalbavancin/ Oritavanvin

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2
Q

Oral antibiotics for S. aureus MRSA cover empirically

A

TMP/SMX (Bactrim)
Doxycycline
Linezolid

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3
Q

IV Antibiotics for S. aureus MSSA de-escalate

A

Ampicillin/ Sulbactam
Nafcillin/ Oxacillin
Cefazolin
Clindamycin

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4
Q

Oral antibiotics for S. aureus MSSA de-escalate

A

Amoxicillin/ clavulanate
Dicloxacillin
Cephalexin
Clindamycin (also IV)

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5
Q

Cutaneous Abscess

A

collection of pus within the dermis and deeper skin tissues
-painful, fluctuant red nodules, often topped with pustule, rim of erythematous swelling

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6
Q

Furuncle (“boils”)

A

Infection of single hair follicle

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7
Q

Carbuncle

A

collection of infected follicles

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8
Q

Majority of Purulent SSTIs are caused by:

A
  • **Staphylcoccus aureus
    -MSSA
    -MRSA
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9
Q

Purulent STTIs Treatment

A

INCISION & DRAINAGE
- furuncles may spontaneously rupture and drain
-cutaneous abscesses, large furuncles and carbuncles require incision and drainage
-gram stain & culture of pus is recommended if I&D performed (except cysts)
+ Antibiotics if patient has systemic signs of infection, immunocompromised, has multiple abscess, or doesn’t respond to I&D
DURATION
5-10 days

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10
Q

Purulent SSTIs Classifications

A

Mild: purulent infection w/o systemic signs of infection
Moderate: purulent infection with systemic infection
Sever: patients who have failed I&D plus oral antibiotics, septic, immunocompromised patients

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11
Q

SIRS criteria

A

Systemic inflammatory response syndrome
-temp >38C or <36C
-tachypnea
-tachycardia
-WBC > 12,000 or < 4,000 cells/uL

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12
Q

Vancomycin IV

A

1st line, empiric antibiotic for SEVERE purulent SSTIs
-Dose: 15mg/kg q12h (interval based on CrCl). round dose to 250mg increments
-Monitor:
–trough levels with goal of 10-15 mcg/ml
ADEs: red man syndrome, renal dysfunction

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13
Q

Cellulitis/ Erysipelas

A

(non-purulent)
classic signs: red, warm, swollen, painful
erysipelas
-limited more to upper dermis( more clear delineated borders)
-cellulitis of face only
-synonym to cellulitis

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14
Q

Non-purulent SSTIs risk factors

A

dry skin, fragile skin, obesity, previous skin trauma, previous cellulitis, edema from venous insufficiency, tinea pedia (athlete’s foot)
-occurs when bacteria invade deeper skin tissues

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15
Q

Majority of Cellulitis is cause by

A

Streptococcus species**
Group A (‘flesh eating bacteria’)
Groups B C F G
-subset caused by S. aureus (rare but severe)

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16
Q

Cellulitis Treatment

A

ANTIBIOTICS
-drainage and cultures NOT recommended for typical case (except immunodeficiency, cancer/ chemotherapy
-blood cultures are recommended even though rarely grow but when they do, it can be significant

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17
Q

Non Purulent Classification

A

Mild: non-pur. without systemic infection
Moderate: non-pur. with systemic infection
Severe:
-deep tissue involvement/ penetrating trauma
-failed prior treatment
-septic
-immunosuppressed
-IVDA
-MRSA colonization (nasal, other sites)

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18
Q

Mild non purulent treatment

A

Oral Rx
-penicillin VK
-Cephalosporin
-dicloxazillin
-clindamycin

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19
Q

Moderate non purulent treatment

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A

IV Rx
-penicillin
-ceftriaxone
-cefazolin
-clindamycin

20
Q

Severe non-purulent treatment

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A

Emergent Surgical Inspection/ Debridement
-rule out necrotizing process
Empiric Rx
-Vacomycin plus Piperacillin/ Tazobactam

21
Q

Oral options for Streptococcus

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A

Penicillin VK
Amoxicillin
Amoxicillin/ Clavulanate
Cephalexin
Clindamycin (for B-lacam allergic) (no renal adjust)
*not reliable for strep doxycycline, SMX/TMP (Bactrim)

22
Q

IV options for Streptococcus

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A

Penicillin G
Cefazolin
Ceftriaxone
Clindamycin (for B-lactam allergic)
**options for severe penicillin allergy: clindamycin, vancomycin, linezolid, daptomycin

23
Q

Mild Cellulitis treatment duration

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A

5 days as long as patient responds

24
Q

Moderate to severe cellulitis treatment duration

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A

10 to 14 days, possibly longer in difficult to treat cases

25
Necrotizing Fasciitis
Deep infection involving the superficial fascia comprising all tissue between skin and muscles
26
Fournier's Gangrene
Necrotizing infection of genitalia Involves the scrotum and penis or vulva Diabetes strong risk factor
27
Necrotizing Fasciitis Clinical Presentation
Starts like a cellulitis OBJECTIVE -severe systemic symptoms- fever, altered mental status -fast temporal progression SUBJECTIVE -pain out of proportion PHYSICAL EXAM -edema and tenderness beyond the redness -"wooden-hard induration of subcutaneous tissue -crepitus -skin necrosis IMAGING- CT scan or MRI -may show gas in soft tissues, edema along fascia ****SURGICAL EMERGENCY
28
Nec. Fasc. Microbiology
Streptococcus pyogenes (group A "flesh eating strep) Staphylococcus aureus Clostridium spp.
29
Nec. Fasc. Polymicrobial
Mixed aerobic/ anaerobic flora Four clinical settings most often associated: 1. abdominal trauma or surgery 2. decubitus ulcers 3. IVDU- injection sites 4. Spread from genital site
30
Nec. Fasc. Treatment
SURGERYYY -Blood cultures should be sent as well as deep tissue cultures take at the time of surgery -Broad spectrum antibiotics are empirically started and can be de-escalated based on culture results -Multiple surgical interventions often required
31
Nec. Fasc. Treatment duration
Continue antibiotics until: -debridement is no longer needed -patient clinically improved -afebrile for 48 to 72 hrs duration of therapy tends to be more conservative as this is an aggressive infection
32
DFI Clinical presentation
arise from an ucler or from wound caused by trauma Classical findings- redness, warmth, swelling, tenderness, pain, purulent drainage ->2 are necessary to call a wound infected Secondary findings: -non purulent secretions -discolored granulation tissue -foul odor
33
Assessment of foot DFI
Hammer toes, bunions, calluses, charcot foot
34
Assessment of Wound DFI
-depth and tissues involved -requires debridement of necrotic tissue -looking for abscesses, sinus tracts, foreign bodies, probe to bone X-ray recommended for all If bone involvement suspected, MRI is study of choice
35
DFI classifications
Mild: Erythema > 0.5 cm but < 2 cm Moderate: Erythema >2 cm or involving structures deeper than the skin Severe: Local infection with > 2 SIRS criteria
36
Work-up DFI
Do NOT culture a clinically uninfected wound -cultures may not be necessary in mild infections In moderate and severe infections multiple organisms likely and multi-drug resistant organisms may be possible therefore cultures essential superficial swabs much less helpful than deeper tissue cultures or aspirates or purulent secretions
37
DFI Microbiology
Aerobic gram-positive cocci -staphylococcus and streptococcus most common (sometimes MRSA( Aerobic gram-negative bacilli -sometimes can be pseudomonas Anaerobes -play more of a role in moderate to severe infections -may not need to cover if wound has been adequately debrided
38
DFI risk factors
MRSA -history of MRSA infection or colonization -high local prevalence -severe infection Pseudomonas -warm climate -frequent exposure to water -high local prevalence
39
Empiric Mild DFI therapy
MSSA; Strep sp likely -cephalexin -amoxicillin/ clavulanate -clindamycin MRSA likely -TMP/SMX -doxycycline
40
Moderate/ severe empiric therapy (MSSA, Strep spp, gram negative anaerobes)
- ampicillin/sulbactam (has anaerobic activity) -cefoxitin (anaerobic activity) -ceftriaxone+ metronidazole (metronidazole added for anaerobes) -ciprofloxacin + clindamycin (clinda added for staph and anaerobes) -moxifloxacin (anaerobes) -ertapenem (broad spectrum but doesn't cover Pseud, anaerobic activity)
41
Moderate/ severe empiric therapy (MRSA)
-vancomycin (generally treatment of choice) -linezolid ($, serotonin syndx) -daptomycin ( $, monitor CK)
42
Moderate/ severe empiric therapy (Pseudomonas)
-piperacillin/ tazobactam (covers anaerobes) -cefepime (no anaerobes add metronidazole)
43
Duration of therapy mild
oral 1-2 weeks
44
Duration of therapy Moderate
ora or IV transition to oral 1-3 weeks
45
duration of therapy severe
IV transition to oral 2-4 weeks
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