Term
| Factors that predispose to skin & soft tissue infections |
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Definition
High bacterial concentration
Increased skin moisture
Occluded or decreased skin perfusion
Bacterial food supply
Damage to the skin allowing entry or penetration of the organism |
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Term
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Definition
| Involvement of the superficial skin layers (epidermis, dermis, subcutaneous fat) |
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Term
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Definition
Infections that involve deeper skin structures (facia, muscle)
Require significant surgical intervention
Infections occurring in patients with impaired immune function
Perianal skin infections |
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Term
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Definition
Mild- no fever or systemic manifestations
Moderate-severe- Presence of fever and/or systemic manifestations |
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Term
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Definition
Acute purulent superficial cellulitis (most commonly on the face)
-Initially, fluid filled vesicles
-Secondly form pus-filled blisters that rupture easily
-Form golden-yellow dried crusts
HIGHLY contagious
Seen in the summer months |
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Term
| Impetigo: Common pathogens |
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Definition
Group A strep. (GAS)
Staph aureus (10%)- usually MSSA |
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Term
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Definition
Can resolve spontaneously
Locally: soap & water + topical mupirocin
Antibiotics: used to decrease symptoms,prevent new vesicle formation, transition to the crusted phase.
Dicloxacillin 250-500mg po q6hrs
Cephalexin 500mg po q6-8hrs
PCN allergic:
-Erythromycin
-Clindamycin
Duration of therapy: 7-10 days |
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Term
| Erysipelas (St. Anthony's Fire) |
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Definition
Superficial skin lesion,extends into other areas. Sharply marginated
Extensive lymphadenopathy
Presents on face and lower extremities
Deep red color & burning pain
Fever (mild)
Increase WBC count |
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Term
| Erysipelas: common pathogens |
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Definition
Streptococcus sp. (S. pyogenes most common)
Staph. aureus |
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Term
| Erysipelas: Treatment (Severe-systemic cases) |
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Definition
Penicillin aqueous 1-2 million units IV q6 hrs
Nafcillin or Oxacillin 1-2gm IV q 4-6hrs
Cefazolin 1-2 gms IV q8hrs
PCN allergic:
-clindamycin
-vancomycin |
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Term
| Erysipelas treatment: Less severe cases |
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Definition
PenicillinVK 500 mg po QID
Cephalexin 500 mg po TID/Cicloxacillin 500mg QID
PCN allergic
-Clindamycin 300-450mg TID-QID
Duration of treatment (PO or IV or combo): 7-10 days |
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Term
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Definition
Acute spreading infection of the skin that progresses to other soft tissues
Red erythematous skin, warm, painful, non-elevated, poorly defined margins, edematous, tender lymphadenopathy, fever (chills/malaise) |
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Term
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Definition
Group A strep
Staph aureus
Less common:
-E. coli
-Pseudomonas aeruginosa
-Klebsiella sp
-Bacteroides |
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Term
| Cellulitis: non-pharm treatment |
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Definition
Local care: elevation, immobilization, cool sterile saline dresses, moist heat
Progressive, fluid collections and or gas production: surgical debridement/incision and drainage
-No fluid: treatment is empiric |
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Term
| Cellulitis: Mild- treatment |
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Definition
-No systemic symptoms
No abscess formation or necrosis:
-Dicloxacillin 250-500mg po QID
-Cephalexin 250-500mg po QID-TID
Abscess formation:
-I & D
-TMP-SMX 2 DS tabs po BID
-Doxycycline 100mg po BID
-+/- clindamycin 300-450mg po TID-QID |
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Term
| Cellulitis: Moderate/Severe Treatment |
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Definition
Empiric:
-Nafcillinor Oxacillin 1-2gm IV q4-6hrs/Cefazolin 1-2 gm IV q8hrs (Strep/MSSA)
-Penicillin G 1-2 million units IV q4-6hrs (GA/BS)
-Nafcillin or Oxacillin 1-2 gm IV q4-6hrs (MSSA)
-Vancomycin (MRSA) |
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Term
| Cellulitis: Gram (-) Organism Treatment |
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Definition
Mild:
-Cefdinir 300mg po BID
-Cefuroxime 500mg po TID
-Amoxicillin/clavulanate 875mg po BID
Moderate/Severe:
-Cefriaxone 2 gm IV daily +/- metronidazole
-Ampicillin/sulbactam
-Piperacillin/tazobactam (pseudomonas)
-Aztreoname (PCN allergic) |
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Term
| Necrotizing Soft Tissue Infections: Treatment |
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Definition
Always surgery first!!!
Empiric therapy chosen based on presentation
-Ampicillin sulbactam
Piperacillin/tazobactam
Meropenem
Imipenem/cilistatin
(May need MRSA coverage as well)
All +/- Penicillin |
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Term
| Necrotizing Soft Tissue Infections: Clinical Presentation |
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Definition
-Starts like cellulitis
-Doesn't respond to typical antibiotics
-Aggressively spreading lesions
-Edema beyond erythema
-Skin blisters or bulla
-Localized pallor or discoloration
-Can progress into muscle
-Gas in the SQ tissue (crepitus) |
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Term
| Two types of necrotizing fasciitis |
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Definition
Type I: Polymicrobic (Diabetic foot)
Type II: Single organism (GAS or clostridium perfringens) |
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Term
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Definition
-Increase beta-lactam doses and get decreasing effect
-Bugs in various stages of growth, become stationary faster and beta-lactams have a slower less efficient kill |
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Term
| Diabetic Foot Infections: General Information |
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Definition
-Common diabetes complication
-Accounts for 20% of all diabetic hospital admissions
-25% of patients will have a deep penetrating soft tissue infection
-Accounts for ~55,000 lower extremity amputations |
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Term
| Diabetic foot infections: Pathophysiology |
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Definition
Factors that predispose patients to infections:
-Neuropathy
-Angiopathy and ischemia
-Defective immune defense
-Healthcare failures |
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Term
| Diabetic foot infection: Presentation |
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Definition
-Paronychia: infection of the tissue adjacent to the nail
-Middle foot infections: secondary to trauma
-Toe web space infections
-Mal perforans puncture wounds: sole of the foot
-Osteomyelitis or necrotizing fasciitis |
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Term
| Diabetic Foot Infections: Pathogens |
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Definition
-Strep. pyogenes (Group A, C, G)
-Staph. aureus (CA-MRSA, or HA-MRSA)
-Staph. epi (MRSE)
-Enterococcus faecalis (VRE)
-Pseudomonas aeruginosa
-Enterobacter sp
-Gram (-) rods
-Anaerobes |
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Term
| Diabetic Foot Infections: Treatment |
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Definition
-Surgical debridement (I & D)
-Non-limb threatening mild (oral tx)
-Non-limb threatening moderate/severe (IV tx)
-Limb-threatening (agressive treatment)
Non-pharm tx:
-Wound care, off-loading, surgical debridement, glycemic control, orthopedic shoes, daily foot exams, twice yearly podiatry exams |
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Term
| Diabetic Foot Infections: Pharm tx |
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Definition
-Ampicillin sulbactam 3gms IV q6hrs
-Piperacillin/tazobactam 3.375mg IV q 6hrs
-Meropenem 1000mg IV q8hrs or 500mg IV q6hrs
-ALL +/- clindamycin 900mg IV q8hrs
OR
-Imipenem/cilistatin 500mg IV q6hrs
-Ciprofloxacin 750mg IV/po BID/levofloxacin 750 IV/po daily + metronidazole IV/po q 8hrs
-Moxifloxacin 400mg IV/po +/- metronidazole 500mg IV/po q8hrs
Also coverage for MRSA: vancomycin, daptomycin, linezolid, tigecycline |
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Term
| Osteomyelitis: Presentation |
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Definition
-Inflammation/infection of the bone & marrow
-Types: hematogenous, contiguous, associated with vascular insufficiency
-Acute: days-week
-Chronic: Fever, swelling, erythema/hot joint or area, local tenderness, decreased range of motion, malaise
-Labs: increased WBC count with left shift, increased ESR, increased CRP |
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Term
| Hematogenous Osteomyelitis |
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Definition
-Infection spread from the bloodstream: secondary to trauma
-Bimodal distribution: children under 20 yrs, adults over 50 yrs
-Involves the rapidly growing long bones of the lower extremities
-Single organism
-Blood cultures are often (+) |
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Term
| Hematogenous Osteomyelitis: Pathogens |
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Definition
-Neonates: GBS, S. aureas, E. coli
-Children: S. aureus, H. influenzae (B), Pseudomonas aeruginosa, GAS
-Adults: Staph. spp, E. coli, gram (-) organisms,Mycobacterium tuberculosis
-IV drug abusers: Pseudomonas, S. aureus
-Sickle cell anemia: Salmonella spp |
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Term
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Definition
-Infection from outside source or adjacent soft tissue or fractures/trauma
-Common in patients >50 yrs
-Bones and tissues involved: long bones of lower extremities, hip, teeth and mandibular infections (secondary to sinus infections)
-POLYMICROBIAL |
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Term
| Osteomyelitis with vascular insufficiency |
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Definition
-Most common in pts 50-70 yrs: diabetics, atherosclerosis, previous fractures
-Generally contiguous
-Bones involved: small bones of hands and feet. Adjacent to soft tissue infections
-Polymicrobial infections
-Usually not cured by antibiotics alone |
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Term
| Osteomyelitis with vascular insufficiency: Presentation |
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Definition
| Local symptoms, areas of previously traumatized skin or limited blood supply, minimal cellulitis, severe pain, upper portions of lower extremities |
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Term
| Osteomyelitis: Empiric therapy (general guidelines) |
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Definition
Basic principles:
-Start IV antibiotics early
-Cover S. aureus
-Bactericidal antibiotics only
-Bone or tissue penetration
-High (MAX) doses
-Long duration (4-6 weeks) minimum
-Consider the need for surgical debridement: bone cultures |
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Term
| Osteomyelitis: Empiric antibiotic therapy: Children |
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Definition
-Nafciillin/Cefazolin or vancomycin
-PCN allergic: Clindamycin |
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Term
| Osteomyelitis: Empiric Therapy: Adults |
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Definition
-Nafcillin or oxacillin 2 gms IV q4-6 hrs
-Cefazolin 2 gms IV q8hrs
-Vancomycin 17-19 mg/kg ABW IV q12hrs
-Linezolid 600 mg IV/po
Gram (-) coverage
-3rd generation cephalosporins
-Ciprofloxacin 750mg BID
-+/- Rifampin 600mg/d |
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Term
| Osteomyelitis with vascular insufficiency: Empiric therapy |
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Definition
-Nafcillin or Oxacillin 2gm IV q4-6hrs + ceftazidime 2 gm IV q 8hrs
-Vancomycin/linezolid + others (MRSA coverage)
-Clindamycin 600-900mg IV q 8hrs or metronidazole 500mg IV q 8-12hrs |
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Term
| Oral antibiotic therapy for Osteomyelitis |
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Definition
Populations that benefit:
-Children responding to initial modalities
-Adults with organism sensitive to FQ's (Gm - infections) Great bone penetration datat
-Organism identified, sensitivities determined, good oral agent available w/ good bone penetration, compliance assured |
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Term
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Definition
-Involves dead or sclerotic bone that serves as a focus/source for persistent infection
-Treatment: surgery + antimicrobials
-Culture & sensitivity required
-IV agents for 6-8 weeks followe dby PO agents for several months. Off-loading if possible |
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Term
| Pressure Sores: General info |
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Definition
Localized necrotic areas of skin due to unrelieved pressure
-Usually in people who are bed-ridden
-Common locations: ischial/sacrum/pelvis areas
Risk factors: paralysis, paresis, immobilization, elderly, debilitated, malnutrition, anemia, infection, increased weight |
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Term
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Definition
Stage 1:
-Reversible
-Limited to epidermis
-Resembles abrasion
Stage 2:
-Maybe reversible
-Extends to SQ fat
Stage 3:
-Extends further into SQ fat
-Extensive undermining
Stage 4:
-Penetration into the deep fascia
-Involves both muscle and bone |
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Term
| Pressure sores: Treatment |
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Definition
-Relieve pressure
-Debridement
-Disinfection
-Dressing and wound care (change frequently)
-Stimulation granulation of the tissue (adequate tissue nutrition) |
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Term
| Animal bites: Common pathogens |
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Definition
Dogs: Pasturella multocida, S. aureus, alpha-hemolytic Strep., Fusobacterium, Bacteroides
Cats: Pasturella multocida, S. aureus
Human: alpha hemolytic Strep., S. aureus, Eikenelia corrodens, Haemophilus parainfluenzae, corynebacterium, bacteroides, fusobacterium, peptostreptococcus |
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Term
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Definition
Empiric therapy:
-Amoxicillin/clavulanate
-Penicillin + dicloxacillin
-Cefuroxime axetil
-PCN allergic: Clindamycin + FQ's, or metronidazole + doxycycline |
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Term
| Surgical site infection Classification |
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Definition
-Supercicial incisional: only skin and SQ tissue
-Deep incisional: deep soft tissues
-Organ/space: any part of the anatomy other than incision |
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Term
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Definition
-Operations that involve entry into a hollow viscous area under controlled conditions
-Inserting prosthetic material
-Operations that could create catastrophic risk (cardiac, neuro)
Goals:
-Prevent post-op infection
-Exceed MIC's for the most frequent organisms |
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Term
| Timing of surgical prophylaxis |
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Definition
-Infusion of 1st AB should begin within 1 hr before the surgical incision
-Vancomycin infusion should begin within 120 minutes before the incision
Duration:
-D/C antibiotic within 24 hours of operation
-Cardiothoracic surgeries should d/c prophylaxis w/in 24-48 hrs |
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