SSTI (3) Skin infections

Pregunta	Respuesta
Folliculitis signs and symptoms	superficial infection surrounding the hair follicles
Folliculitis RFs	1. shaving 2. wearing tight clothes 3. exposure to topical ointments, which may result in excessive skin moisture.
Folliculitis etiology	1. S. aureus (most common) 2. Pseudomonas aeruginosa (w/ exposure to pool)
Folliculitis treatment	1. local, warm compress to promote drainage 2. Topical agents such as i. clindamycin 1% (Cleocin T) BID, ii. erythromycin 2% BID, or iii. mupirocin 2% (Bactroban) BID for 7 days may be necessary for cases that are unresponsive to local measures
Furuncles signs and symptoms	1. is a boil or abscess originating from a hair follicle. 2. basically an extension of folliculitis = the inflammation extends from around the hair shaft deeper into the dermis layer of the skin. 3. Typically characterized by a painful, firm, tender, red nodule found on the neck, axillae (arm pit), groin, buttocks, or thighs. 4. If it is not firm (ie wavy), this indicates the presence of fluid inside.
Carbuncles signs and symptoms	1. is a network of furuncles that have coalesced and extend deeper beyond the dermis into the subcutaneous tissue 2. “car load of furuncles.” 3. systemic symptoms such as fever, chills, and malaise, and bacteremia (bacteria in the blood stream) may occur.
Furuncles and Carbuncles treatment ------- ?	1. Small = moist heat 2. Large = incision and drainage 3. Immunocompromised or severe or extensive disease or systemic symptoms such as fever or cellulitis = Bactrim, doxycycline, clindamycin, linezolid 4. Oral amoxicillin (added for empirical coverage)
Furuncles and Carbuncles treatment w/ no purulence but streptococci suspected, how do you treat the patient?	1. 5 to 10 day course of either a penicillinase-resistant penicillin (dicloxacillin 250 mg - 500 mg PO q6h) or first-generation cephalosporin (cephalexin (Keflex) 250 mg to 500 mg PO q6h). 2. For those with a pencillin allergy, clindamycin (Cleocin) 150 mg - 300 mg PO q6h may be used
In furuncles and carbuncles treatment, how do you eliminate staphylococcal carriage (decolonization)?	intranasal mupirocin (Bactroban) ointment bid for 5 to 10 days +/- a chlorhexidine bath for 5 to 14 days (only for nasal and topical decolonization)
Erysipelas (aka St. Anthony’s fire) sign and symptoms	1. red, edematous, painful lesions with sharply demarcated borders. 2. Affects lower extremity mostly (80%) and face (20%) 3. more common in infants, children, the elderly, and in those with areas of preexisting lymphatic obstruction or edema
Erysipelas (aka St. Anthony’s fire) etiology	1. S. pyogenes (B-hemolytic)** most common. 2. S. agalactiae (B-hemolytic) 3. S. aureu
Erysipelas (aka St. Anthony’s fire) treatment	1. Mild to moderate = 7 to 10 day of penicillin VK 250 mg - 500 mg PO q6h. clindamycin (Cleocin) 150 mg - 300 mg PO q6h or erythromycin (Ery-Tab) 250 mg - 500 mg PO q6h 2. severe = IV penicillin G 2 million units IV q4h
Impetigo sign and symptoms	1. small, clear fluid-filled vesicles, which later transform into pus-filled blisters that rupture 2. the purulent discharge may then dry to form a golden-yellow crust 3. common in children, especially during hot, humid weather, which is believed to facilitate microbial colonization of the skin 4. highly communicable and spreads easily through close contact
Impetigo etiology	1. Bullous = s. aureus 2. Non-bulluos = s. aureus and s. pyrogen
Impetigo treatment	1. mupirocin (Bactroban) ointment applied TID or 2. retapamulin (Altabax) applied BID for 5 days 3. Non responsive treatment = dicloxacillin, cephalexin or clindamycin (7 days)
Cellulitis sign and symptoms	1. an acute inflammation/infection of the dermis and subcutaneous fat tissue 2. induration, erythema, edema, and inflammation 3. hot and tender to the touch with poorly defined margins. 4. systemic symptoms such as fever, malaise, chills, and leukocytosis.
Cellulitis RFs include -------- ?	1. an IV drug use 2. diabetes mellitus (DM) 3. procedures that alter lymphatic drainage or compromise lymphatic circulation (such as post-mastectomy or post saphenous vein removal for a coronary artery bypass graft).
Cellulitis etiology	1. S. pyogenes 2. S. aureus
Cellulitis treatment	1. Mild: anti-staphylococcal penicillin = dicloxacillin, a first generation cephalosporin such as cephalexin (Keflex); clindamycin 2. Severe: Clindamycin, Bactrim, Doxycycline, vancomycin, ceftraroline (5th gen), Daptomycin and vancomycin
Necrotizing Infections signs and symptoms	1. results in progressive destruction of subcutaneous fat and fascia (separates subcutaneous fat from underlying muscle) 2. the affected area is often shiny, feels hardened like wood, and is also extremely painful. 3. appearance of bullae filled with clear fluid and the skin transitioning to a maroon or violet color after several days. 4. patients have systemic symptoms such as fever, elevated WBC, and possible delirium. 5. swelling and may show the presence of gas in soft tissues (if an anerobic organism is present)
Necrotizing Infections (Ni) etiology	1. Type 1 = polymicrobial = necrotizing fasciitis is a slower-progressing infection that usually occurs after trauma or surgery and is a polymicrobial infection (caused by at least 1 anaerobe and 1 aerobic organism) 2. Type II necrotizing fasciitis is caused by virulent strains of S. pyogenes = streptococcal gangrene or “flesh-eating bacteria.” 3. Clostridium perfringens is the most common microbial etiology of clostridial myonecrosis.
Necrotizing Infections (Ni) C, perfringens	1. most common microbial etiology of clostridial myonecrosis 2. is commonly called gas gangrene 3. it is an anaerobic organism that produces gases that are less water soluble and thus accumulate within tissue. 4. Most infections of myonecrosis occur after surgery or trauma.
Necrotizing Infections (Ni) treatment (Type I)	1. Broad spectrum (aerobic Gram+, Gram-, and anaerobes) therapy 2. vancomycin + an antipseudomonal carbapenem (imipenem/cilastatin, doripenem, meropenem) or vancomycin + piperacillin/tazobactam (Zosyn). 3. vancomycin + metronidazole + either an aminoglycoside OR a fluoroquinolone (#3 is for penicillin allergies)
Necrotizing Infections (Ni) treatment (Type II)	penicillin + clindamycin
What is the rational for adding clindamycin to Necrotizing Infections (Ni) treatment	The rationale for adding clindamycin comes from in vitro studies that show it has immunomodulatory properties by suppressing bacterial toxin synthesis and cytokine production.
Diabetic foot infections (DFIs) signs and symptoms	1. At least 2 signs of inflammation (redness, warmth, swelling, tenderness, or pain) or purulent secretions 2. discoloration 3. nonpurulent secretions, or 4. foul odor
Diabetic foot infections (DFIs) etiology	1. combination of aerobic Gram-positive cocci (S. aureus, streptococci, enterococci), aerobic Gram-negatives (including Pseudomonas spp.), and anaerobes, especially B. fragilis. 2. Gram-positive cocci (especially staphylococci)
Diabetic foot infections (DFIs) mild presentation and treatment	1. Presentation: local infection with no erythema or ≤ 2 cm of erythema around ulcer = dicloxacillin, clindamycin, cephalexin, or amoxicillin/ clavulanate (would cover MSSA and S. pyogenes). 2. Treatment: 7 - 14 day course of oral therapy (to target S. aureus and/or Streptococcus spp.)
Diabetic foot infections (DFIs) moderate presentation and treatment	1. Presentation: deeper infection or with erythema > 2 cm around ulcer 2. Treatment: Oral or IV (to target S. aureus, Streptococcus spp., Gram-negatives (sometimes Pseudomonas), B. fragilis = moxifloxacin or ciprofloxacin/levofloxacin + clindamycin ****Duration is 10-14 days if no osteomyelitis and 4-6 weeks if osteomyelitis
Diabetic foot infections (DFIs) severe presentation and treatment	1. Presentation: Signs of systemic infection or critical ischemia 2. Treatment: IV (to target S. aureus, Streptococcus spp., Gram negatives (sometimes Pseudomonas), B. fragilis = = piperacillin/tazobactam; ceftazidime, cefepime, or aztreonam + metronidazole; n antipseudomonal fluoroquinolone + metronidazole. *** Duration is 10-14 days if no osteomyelitis and 4-6 weeks if osteomyelitis
Bite Wounds Signs and symptoms	1. purulent discharge 2. erythema 3. swelling
Bite Wounds (Animal) etiology	1. Pasturella multocida (aerobic GNR) 2. streptococci 3. staphylococci 4. Moraxella spp (aerobic GNC) 5. Neisseria spp (aerobic GNC)
Bite Wounds (Animal) treatment	1. Amoxicillin/clavulanate x 5-7 days (most common agent) 2. Bite on the head, joint, or hand: IV ampicillin/sulbactam, cephamycin, cefotetan, or carbapenem x 7-14 days 3. Prophylaxis: 3-5 days of antibiotic treatment
Bite Wounds (Human) etiology	1. viridans streptococci 2. S. pyogenes 3. S. aureus 4. Eikenella corrodens 5. anaerobe
Bite Wounds (Human) treatment	1. Amoxicillin/clavulanate x 5-7 days (most common agent), Doxycycline = alternative 2. Serious injuries: IV ampicillin/sulbactam, cephamycin, cefotetan, or carbapenem x 7-14 days 3. Prophylaxis: 3-5 days of antibiotic treatment

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	Creado por Sam Adeyiga hace más de 4 años