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37 Cards in this Set
- Front
- Back
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What is the #1 causative organism in skin and soft tissue infection (SSTI)?
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Staph aureus
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What % of SSTI are caused by Staph aureus?
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45%
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What percent of SSTI are caused by MSSA?
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31%
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What percent of SSTI are caused by MRSA?
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15% (this may be higher, per more recent studies)
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What other organisms cause SSTI?
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Pseudomonas aeruginosa
Enterococci E. coli Enterobacter Klebsiella |
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What organisms cause cellulitis (2 most common)?
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beta-Haemolytic Strep (GABHS or S. pyogenes)
Staph aureus |
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What other organisms are implicated in cellulitis
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pseudomonas aeruginosa
CA-MRSA Aeromonas hydrophilia Vibrio Pasturella multocida |
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How do you get Pasturella multocida?
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cat scratch or bite
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When is someone at risk of Vibrio?
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bay exposure
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Who is at particularly high risk of vibrio
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Liver disease
Immunocompromised |
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Differentials for Skin infections
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contact dermatitis
insect bites parasites gout / pseudogout impetigo furuncles / carbuncles cellulitis thrombophlebitis systemic infection / sepsis / meningitis burn nevus necrotising fasciitis lymphedema |
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What tests do you do if an infection seems severe to assess if it may be a systemic infection
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CBC c/ diff
C & S creatinine creatinine phosphokinase CRP bicarb |
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When do you hospitalize someone with skin infection
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hypotension
increased creatinine / creatinine phosphokinase left shift on cbc increased CBC |
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What other markers indicate a severe skin infection
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disproportionate pain
violacceous bullae cutaneous hemmg skin sloughing skin anesthesia rapid progression gas in the tissue |
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If outpatient treatment of a skin infection, when do you f/u
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24-48 hrs to see if the infection is reacting and if it is improving.
If it is not reacting - culture and treat according to etiology. |
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what is a spider bite (really)
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mrsa
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how do you determine treatment for a severe case of skin infection
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based on C&S results
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When do you Always do wound cultures
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immunocompromised patient
clue of some other cause (that would lead potentially to an unusual etiology):activity, trauma, water exposure, bites, etc |
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What oral medications are used to empirically treat cellulitis
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Doxycycline
erythromycin Clindamycin Cephalexin |
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If a necrotising fasciitis is suspected, how do you manage it?
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Immediately to surgery
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What is the antibiotic of choice for bites?
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Augmentin (Amox clavulunate) PO
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With a surgical site, when is a temperature considered a problem (risk of infection)?
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after 48 hours post-surgery
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What do you do if patient has a fever 48hrs post surgery
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if <38.5 -- open wound
if > 38.5 -- open wound, give antibiotics |
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Define cellulitis
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spreading subcutaneous infection
it is a clinical diagnosis, no tests |
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What can you use to treat skin infections in the rare chance that there is NO concern for MRSA
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Keflex
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What is the PO med of choice for MRSA?
What is the second option? |
Bactrim
Clindamcin |
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Who gets CA-MRSA
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jails
athletic teams MSM daycare settings IVDU |
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What % of the population has MRSA colonization
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0.84%
Note that 23% of CA-MRSA is a/w invasive disease |
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5 C's of CA-MRSA
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Crowding
Contact Cleanliness (low) Contaminated Surfaces Compromised Skin |
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What class/type of abx is CA-MRSA resistant to
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beta-lactams
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what do you suspect if a skin infection is recurrent and spreading among members of a group
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CA-MRSA!!
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What is the differential for CA-MRSA
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necrotising fasciitis
cellulitis abscess (boil) impetigo |
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What do you do if a wound is fluctuant
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aspirate
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How long is the course of abx prescribed for CA-MRSA?
What antibiotics? |
7-10days
Bactrim Clindamycin Doxy Minocycline |
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What abx do you add if you're concerned there might be GABHS?
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add cephalexin
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What is the management plan for a CA-MRSA (or other) abscess
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1. aspirate (before I&D)
2. I&D 3. Give Abx 4. F/U in 24-48hrs |
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How do you prevent transmission of MRSA (by decolonization)?
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Identify carrier - nasal swab
Medicate with both 1. Mupiricin ointment 1% ointment - use intranasally BID x5days 2. Chlorhexadine gluconate showers - daily while using Mupiricin Determine need to treat family members (spread? boils on other family members?) |
