thera SSTI

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thera SSTI
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2013-09-10 20:10:32
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thera SSTI
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  1. 3 most common skin flora
    • staphylococcus epidermidis
    • staphylococcus aureus
    • streptococcus spp
  2. example of direct infection
    diabetic foot infection
  3. examples of hematogenous spread
    • meningitis petechiae
    • measles
    • chickenpox
  4. 4 classifications for uncomplicated skin infections
    • mostly gram positive
    • superficial = impetigo
    • extends into dermis and subcutaneous fat - erysipelas
    • hair follicle associated
    •   folliculitis
    •   furuncles
    •   carbuncles
  5. 5 classifications of complicated skin infections
    • gram positive and negative,polymicrobial
    • involve deep tissue & subcutaneous fat
    • need for surgical intervention
    • involvement of perianal are
    • presence of coexisting diseases
  6. coexisting diseases that affect complicated skin infections
    • DM
    • immunocompromised
    • obesity
  7. examples of complicated skin infections
    • diabetic foot infections
    • decubitus ulcers
    • surgical site infections
    • necrotizing fasciitis
  8. examples of acute skin infections
    • break in intact skin
    •   cuts
    •   burns
    •   bites
    •   trauma
    •   surgery
  9. examples of chronic skin infections
    • underlying mechanism that cause infection
    •   diabetic foot infection
    •   venous stasis ulcers
    •   pressure sores
  10. examples of local skin infections
    • impetigo
    • abscesses
  11. examples of diffuse skin infections
    • cellulitis
    • necrotizing fasciitis
  12. 3 ways to classify skin infections
    • complicated vs uncomplicated
    • acuity - acute vs chronic
    • area of infection - local vs diffuse
  13. differentiate between staph and strep uncomplicated skin infections
    • staph - local, pus producing(boils,abscess)
    • strep - diffuse (erysipelas,lymphangitis,cellulitis)
  14. 2 bacterial causes of impetigo
    • staph aureus
    • strep pyogenes
  15. Tx considerations of impetigo
    • number of lesions
    • location of lesions
    • limiting spread to others
  16. first line Tx for impetigo
    mupirocin ointment - 1 application TID
  17. oral antibiotics for impetigo and when to use
    • dicloxacillin
    • cephalexin
    • clindamycin
    • augmentin
    • if many lesion or not respinding to topical therapy
  18. common bacterial cause of erysipelas and Tx of choice
    • S. pyogenes
    • IV/PO penicillin
    •   nafcillin/oxacillin or cefazolin
    • affects dermis of face and lower extremities
  19. common organism causing furuncle and Tx
    • S. aureus
    • small - moist heat to promote drainage
    • large - incision and drainage
    • antibiotics usually unnecessary
  20. S&S of cellulitis
    • tachycardia
    • confusion
    • hypotension
    • fever
    • leukocytosis
  21. Tx of cellulitis
    • elevate affected area to promote gravity drainage of edema and inflammatory mediators
    • 1st line (unless staph/strep resistance high)
    •   nafcillin/oxacillin
    •   cefazolin
    •   PCN allergy - clindamyacin, vanco
    • duration of Tx 5-10 days
  22. drug of choice IV for MSSA SSTI
    nafcillin/oxacillin
  23. drug of choice PO for MSSA SSTI
    dicloxacillin
  24. drug of choice IV for MRSA SSTI
    • vanco - trough goal > 10 mcg/mL
    • 15-20 mcg/mL for severs diabetic foot
  25. S&S of necrotizing fasciitis
    • subcutaneous tissues will feel hard
    • broad erythematous tract along skin
    • probing edges of wound will allow viewing down to fascia
  26. common organisms causing necrotizing fasciitis
    • s. pyogenes
    • vibrio vulnificus
    • aeromonas hydrophila
  27. risk factors for polymicrobial NF
    • postoperative infections
    • peripheral vascular disease/DM
    • decubitus ulcers
  28. Tx of NF caused by
    streptococcus
    s. aureus
    clostridium
    mixed infections
    • penicillin + clindamycin
    • nafcillin/oxacillin
    • clindamyacin
    • amp-sulbactam or pip/tazo + clinda + cipro
  29. most common organism in cat/dog bites and Tx
    pending identification of organism what do we empirically treat with
    • pasturella - augmentin
    • doxycycline or cipro
  30. when do most surgical site infections present and signs to watch to determine to treat
    • after 48 postoperatively
    • if temp < 38.5 or HR > 110 bpm = observe
    • if temp >38.5 or HR > 110 bpm = usually require antibiotics
  31. 4 criteria for a surgical site infection where only 1 needs to be present
    • purulent incisional drainage
    • positive wound culture results
    • pain, tenderness, swelling, erythema at site
    • diagnosis by attending surgeon or physician
  32. intestinal/genital tract Tx of surgical site infections : single agents
    • cefoxitin
    • ampicillin/sulbactam, piperacilin/tazobactam
    • carbapenem's
  33. intestinal/genital tract Tx combination products
    • cipro,levo
    • ceftriaxone, ceftazidime
    • aztreonam
    • aminoglycosides
  34. intestinal/genital tract surgical site infection Tx for anaerobic activity
    clindamycin, metronidazole
  35. when treating surgical site infections of the intestinal/genital tract what organism groups are we suspecting
    anaerobes and gram (-)
  36. nonintestinal Tx of surgical site infections for the trunk and extremities
    • oxacillin
    • cefazolin
  37. nonintestinal surgical site infection Tx of axillary or perineum
    • ceftoxitin
    • unasyn, zosyn
  38. infected diabetic foot classification
    • 2 of these
    • local swelling/induration
    • erythema
    • local tenderness/pain
    • local warmth
    • purulent discharge
  39. mild classification of diabetic foot
    • only involves skin and SC tissue
    • erythema < 2 cm around ulcer
    • exclude other causes of inflammation
  40. moderate classification of diabetic foot
    • erythema > 2 cm or involvement of structures deeper than SC
    • no SIRS
  41. severe classification of diabetic foot
    • local infection + SIRS
    • temp > 38 or < 36
    • HR > 90 bpm
    • RR > 20
    • WBC > 12,000 or < 4000
  42. bacteria commonly responsible for diabetic foot infection
    • staphylococcus spp
    • s. aureus
    • coagulase-negative spp
  43. when would you consider MRSA for diabetic foot infection
    • history of MRSA in last year
    • prevalence is high (30-50%)
    • severe infections
  44. when would you consider P. aeruginosa for diabetic foot infections
    • only if risk factors of
    • warm climates
    • soaking feet/ frequent water exposure
    • failed nonpseudomonal agents
    • severe infection
  45. when would you consider ESBL pathogens for diabetic foot infections
    • primarily in warm southern climates (india)
    • associated w/ neuropathy, osteomyelitis, ulcer > 4 cm2. poor glycemic control, need for surgery

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