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15 Cards in this Set

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  • Back

What are uncomplicated skin and soft tissue infections in immunocompromised patients most commonly caused by?

Staphylococcus aureus, Streptococcus pyogenes, or other beta-hemolytic streptococci

Complicated infections, such as those that occur in patients with burns, diabetes mellitus, infected pressure ulcers, and traumatic or surgical wound infections, are more commonly ____________ and often include __________ and ___________ bacilli, such as ____________ and ___________.

Polymicrobial


Anaerobes


Gram-negative


Escherichia coli and Pseudomonas aeruginosa

What bugs can cause fulminant soft tissue infections and necrosis, particularly in patients with diabetes mellitus?

Group A streptococci


S. aureus


Clostridium spp., with or without anaerobes

What is the predominant cause of suppurative skin infection in many parts of the US?

MRSA

What does community acquired MRSA (CA-MRSA) cause?

Furunculosis, cellulitis, and abscesses = > necrotizing fasciitis and sepsis can occur

What are CA-MRSA strains usually susceptible to?



Are nosocominal strains also susceptible?

Trimethoprim/sulfamethoxazole


Clindamycin


Tetracyclines

What is the treatment for simple abscesses and less serious CA-MRSA skin and soft tissue infections? What does you use when these techniques are not effective?



What drug should NEVER be used to treat MRSA because resistance if common and is increasing in both nosocomial and community settings?

Incision and drainage



Oral trimethoprim/sulfamethoxazole, minocyclines, doxycycline, clindamycin, or linezolid



Fluoroquinolones

If patients have more serious skin and soft tissue infections suspected to be caused by MRSA, what should they be empirically treated with?

Vancomycin, linezolid, or daptomycin

For complicated polymicrobial infections that could include MRSA, the drugs in the previous card (vancomycin, linezolid, daptomycin) could be added to what?

Broad-spectrum parenteral antibiotic:



Piperacillin/tazobactam or a carbapenem

What drug may be effective against MRSA as monotherapy if infection with P. aeruginosa and anaerobic bacteria is unlikely?

Ceftaroline fosamil



A new IV cephalosporin

For uncomplicated skin and soft tissue infections unlikely to be caused by MRSA (no recent hospitalizations or antibiotic use, not known to be colonized, and not in a geographic area with a high prevalence), what are reasonable drug choices?

Dicloxacillin (oral antistaphylococcal penicillin)


Cephalexin (first generation cephalosporin)

If a non-MRSA patient with skin/soft tissue infections requires hospitalization, what should you give?



What if the patient is allergic to beta-lactam?

IV nafcillin, oxacillin, or cefazolin



Allergic to B-lactam = vancomycin or clindamycin

What could you give empirically to COMPLICATED infections that could be microbial and are unlikely to involve MRSA?

Ampicillin/sulbactam


Piperacillin/tazobactam


Ticarcillin/clavulanate


or


Carbopenem

COMPLICATED infection that could be polymicrobial and unlikely to involve MRSA:



What would you give if group A streptococcus or clostridium spp. is suspected?

Combination of clindamycin and penicillin

What if the patient (with complicated polymicrobial infection unlikely to involve MRSA) is severely ill?



What is essential to the management of necrotizing skin and soft tissue infections?

Vancomycin, linezolid, or daptomycin until MRSA is ruled out.



Surgical debridement