Skin and Soft Tissue Infections

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giddyupp
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63872
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Skin and Soft Tissue Infections
Updated:
2011-02-04 11:46:13
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Skin Soft Tissue Infections PHPR523 Test2
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Skin and Soft Tissue Infections
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  1. What are the uncomplicated skin and soft tissue infections (SSTIs)?
    • impetigo
    • furuncles
    • carbuncles
    • erysipelas
    • simple cellulitis
  2. What are the complicated SSTIs?
    • necrotizing fasciitis
    • severe cellulitis
    • severe animal/human bites
  3. What are the SSTIs of the epidermis?
    • impetigo
    • folliculitis
    • furunculosis
    • carbunculosis
    • erysipelas
  4. What are the SSTIs of the dermis?
    cellulitis
  5. What are the SSTIs of subcutaneous tissue?
    necrotizing fasciitis
  6. What pathogens are common in animal bites?
    • Pasturella multocida
    • S. aureus
  7. What pathogens are common in human bites?
    • Eikenella corrodens
    • S. aureus
    • oral anaerobes
  8. What is the most common pathogen found in animal bites?
    Pasteurella multocida
  9. What is the most common skin infection in children?
    impetigo
  10. What pathogens cause impetigo?
    • S. pyogenes
    • S. aureus including MRSA
  11. What are the clinical manifestations of impetigo?
    • pustules
    • honey-crusts
  12. What is the treatment for impetigo?
    • cleansing with soap and water
    • removal of crusts
    • warm water soaks
    • Mupirocin
    • Retapamulin
    • Dicloxacillin (penicillinase-resistant pen)
    • Cephalexin (1st gen ceph)
    • Bactrim
    • Doxycycline (suspected MRSA)
    • Minocycline (suspected MRSA)
  13. When is topical treatment for impetigo appropriate?
    when lesions are limited in number
  14. What antibiotics are used in topical treatment of impetigo?
    • Mupirocin
    • Retapamulin
  15. What antibiotics are used in oral treatment of impetigo?
    • Penicillinase-resistant pens (Dicloxacillin)
    • 1st gen cephs (Cephalexin)
  16. What antibiotics are used to treat impetigo when MRSA is suspected?
    • Bactrim
    • Doxycycline
    • Minocycline
  17. What is the duration of oral treatment for impetigo even with MRSA?
    5-10d
  18. What are the clinical manifestations of furuncles?
    • a "boil" is an acute inflammation of subcutaneous layers of skin and hair follicles
    • occurs in skin areas containing hair follicles subject to friction and sweat
  19. What are the clinical manifestations of carbuncles?
    • more extensive than furuncles, extending into subcutaneous fat and developing into multiple abscesses
    • larger, deeper, indurated lesion typcially at the nape of the neck, on back, or on thighs
    • can be associated with fever and malaise
    • commonly repeated attacks (nasal carriage)
  20. What pathogens cause furuncles and carbuncles?
    S aureus (inclucing CA-MRSA)
  21. What is the treatment for furuncles and carbuncles with lesions < 5cm?
    incision and drainage alone MAY be effective
  22. What is the treatment for furuncles and carbuncles with lesions > 5cm?
    • incision and drainage
    • antibiotics
  23. What antibiotics are used for oral treatment of furuncles and carbuncles?
    • Bactrim
    • TCAs
    • Clindamycin (if D test negative)
    • Rifampin (not monotherapy)
    • Linezolid
  24. What antibiotics are used for parenteral treatment of furuncles and carbuncles?
    • Vancomycin DOC
    • Clindamycin (if D test negative)
    • Daptomycin
    • Llinezolid
    • Tigecycline (probably not for much longer)
    • Quinupristin/Dalfopristin
    • Telavancin
    • Ceftaroline (reserved for complicated infections)
  25. What is erysipelas?
    • distinct type of superficial cellulitis of the skin with prominent lymphatic involvement
    • usually lower extremities, but can be on the face
    • usually occurs in 60s and 70s
  26. What are the clinical manifestations of erysipelas?
    • pain
    • swelling
    • bright red indurated lesion
    • advanced raised border sharply demarcated shiny erythematous plaque
    • bulla formation - considered relatively severe
    • fever
    • leukocytosis
  27. What pathogens cause erysipelas?
    • S. pyogenes
    • S. aureus (rare)
    • S. agalactiae (newborns)
  28. What is the treatment for erysipelas?
    • Mild-moderate:
    • Pen VK
    • Suspected CA-MRSA:
    • Bactrim
    • Doxycycline or Minocycline
    • Severe:
    • Pen G potassium
    • Severe with suspected MSSA:
    • penicillinase-resistant pen (dicloxacillin)
    • 1st gen ceph (Cephalexin)
    • Severe with suspected MRSA or pen allergy:
    • Clindamycin (if D test negative)
    • Vancomycin
  29. What is cellulitis?
    • acute inflammation of the epidermis and dermis and may spead within the superficial fascia, extending deeper than erysipelas
    • previous trauma or underlying condition predisposes development of cellulitis
    • may progress to a serious condition since bacteria can spread via blood stream or lymphatics
  30. What are the symptoms of cellulitis?
    • local tenderness/pain
    • erythema
    • hot
    • swollen
  31. What pathogens cause cellulitis?
    • S. aureus (including MRSA)
    • S. pyogenes
    • Pseudomonas
    • Candida
  32. What is the oral treatment for cellulitis?
    • penicillinase-resistant pen (Dicloxacillin)
    • 1st gen ceph (Cephalexin)
  33. What is the parenteral treatment for cellulitis?
    • penicillinase-resistant pen (Nafcillin)
    • 1st gen ceph (Cefazolin)
  34. What is the treatment for cellulitis in pts with pen allergy?
    • Clindamycin
    • Vancomycin
  35. What is the treatment for cellulitis if MRSA is suspected?
    • Vancomycin IV - DOC
    • Linezolid IV/PO
    • Daptomycin
    • Tigecycline
    • Telavancin
    • Ceftaroline
    • Doxycycline (less severe cases only)
    • Bactrim (less severe cases only)
  36. What is the empiric treatment for cellulitis with purulent discharge or abscess?
    Clindamycin + Vancomycin
  37. What is the treatment for mixed infection cellulitis?
    • Parenteral tx:
    • penicillinase-resistant pen + AG
    • AG + Clindamycin
  38. What are the symptoms of an animal bite infection?
    • pain
    • erythema
    • purulent discharge (often gray and malodorous)
  39. What is the treatment for animal bites?
    • tear and puncture wounds require copious irrigation, immobilization/elevation, and surgical debridement if indicated
    • tetanus toxoid
    • rabies vaccine/immune globulin
  40. What is the treatment for human bites?
    • aggressive irrigation, surgical debridement, immobilization
    • tetanus toxoid
    • prophylaxis of non-infected wound is recommended
    • IV antibiotics required for severe infections and clenched-fist injury
  41. What is the duration of antibiotics for treatment of bites?
    • treatment: 5-10d
    • prophylaxis: 3-5d
  42. What oral antibiotics are used for treatment of bites?
    • Amoxicillin clavulanate
    • Clindamycin + Bactrim or Doxycycline
  43. What are the parenteral antibiotics used for treatment of bites?
    • Ampicillin sulbactam
    • Ampicillin + Clindamycin
    • Clindamycin + Bacrim or Doxycycline
  44. What is necrotizing fasciitis?
    • uncommon, highly lethal, soft tissue infection characterized by:
    • rapid spreading inflammation
    • necrosis of the muscle, fascia,a nd overlying skin
    • extensive inflammation of subcutaneous tissue
    • progressively destroys fascia and fat
  45. What are the symptoms of necrotizing fasciitis?
    • Early signs (much like cellulitis):
    • hot, severe pain, swollen, shiny, tender, and erythematous
    • Suggestive of necrotizing infection:
    • diffuse swelling followed by bullae
    • severe, constant pain
    • skin necrosis
    • gas in the soft tissue
    • edema extending beyond the margin of erythema
    • Systemic symptoms:
    • fever, chills, leukocytosis
    • shock and organ failure
  46. What are the types of necrotizing fasciitis?
    • Type I:
    • skin may be spared and speed of spread is somewhat slower
    • polymicrobial, mixed anaerobic/aerobic (Bacteroides, Peptostreptococcus, facultative bacteria, MSSA/MRSA)
    • Type II:
    • true "flesh-eating" disease
    • rapidly extending necrosis of subcutaneous tissues and skin, gangrene, severe local pain, and systemic toxicity
    • mortality rate 20-50%, virtually 100% without surgical interventions
    • death may occur within hours of diagnosis
    • S. pyogenes
  47. What is the treatment for necrotizing fasciitis?
    • immediate and aggressive surgical debridement (multiple surgical procedures over several weeks if the patient survives)
    • Critical care unit support (rapid fluid replacement, mechanical ventilation)
    • Empiric broad spectrum parenteral antibiotics
  48. What antibiotics are used to treat necrotizing fasciitis empirically?
    • Ampicillin sulbactam or Piperacillin tazobactam
    • + Ciprofloxacin or Gentamicin
    • + Clindamycin
    • + Vancomycin
  49. What antibiotics are used to treat necrotizing fasciitis when S. pyogenes is identified?
    • Pen G potassium + Clindamycin
    • both at high doses
    • Clindamycin suppresses toxin synthesis (antitoxin activity)
  50. What is the adjunctive therapy used in necrotizing fasciitis?
    • Vacuum-assisted wound closure therapy (VAC dressing)
    • Hyperbaric oxygen (HBO)
    • Intravenous immunoglobulin
    • Recombinant activated protein C (Drotrecogin Alpha)

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