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12 Cards in this Set
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Definir:
Cellulitis Erysipelas Folliculitis Skin abscesses Furuncles Carbuncles Methicillin-resistant Staphylococcus aureus (MRSA) |
Cellulitis is an infection of the deep dermis and subcutaneous fat of the skin. Erysipelas is a more superficial skin infection involving the upper dermis with prominent lymphatic involvement. Folliculitis is an infection of the hair follicle. Skin abscesses are collections of pus within the dermis and deeper skin tissues, potentially into the subcutaneous tissues. Furuncles are single, deep nodules involving the hair follicle that are often suppurative. Carbuncles are formed by multiple interconnecting furuncles that drain through several openings in the skin. Methicillin-resistant Staphylococcus aureus (MRSA) can cause any of the above disorders, and is discussed first because it is a common cause of soft tissue infections. |
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Proportion des infections reliées a MSRA (SARM) adultes et enfants ? |
Community-acquired MRSA (CA-MRSA) is epidemic across all populations, regardless of risk factors or geographic location
As much as 59% of purulent skin and soft tissue infections in patients >18 years old
and up to 75% of purulent skin abscesses in children are caused by MRSA. |
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Lequel est le plus dangereux ? SARM communautaire, SARM acquis hopital ou SASS |
Methicillin sensitive S. aureus, health care–associated MRSA, and CA-MRSA can all cause severe, invasive infections.
However, CA-MRSA tends to be a more aggressive organism and is associated with more frequent serious complications such as sepsis, bone and joint infections, and death
Despite its pathologic potential, however, most infections (~70%) caused by CA-MRSA are skin and soft tissue infections and, of these, the majority are furuncles, carbuncles, and abscesses. |
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Facteur de risque SARM communauté |
Community-acquired risk factors :
*= le plus à risque |
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Facteur de risque SARM |
Health care–associated risk factors
*= le plus à risque |
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Avec quoi sont classiquement confondues les infection SARM tissus mous? |
MRSA skin lesions are frequently confused with spider bites by both patients and clinicians, even in areas of the country where spiders capable of causing necrotic skin lesions are not endemic |
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Chez qui ont pourrait se passer d'antibiotique dans les cas d'abces 2nd à SARM? |
In general, antibiotics are optional for treatment of small abscesses (<5 cm), abscesses in immunocompetent hosts, and abscesses without accompanying cellulitis, as long as the abscess is properly drained. |
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Antibiothérapie infection MRSA légère suspectée ? |
Skin abscess: - after I & D = No antibiotics ou Clindamycin, 300 milligrams PO three to four times per day for 7–10 d. Clindamycin, 300 milligrams PO three to four times per day for 7–10 d.
Trimethoprim/sulfamethoxazole double strength one to two tablets twice per day PO ± cephalexin, 500 milligrams PO four times per day for 7–10 d.‡ |
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Antibiothérapie infection MRSA modérée suspectée ? |
Stable patient with cellulitis or abscess after I & D requiring hospital admission :
Clindamycin, 600–900 milligrams IV every 8 h or Vancomycin, 1 gram IV every 12 h. or Linezolid, 600 milligrams IV every 12 h
Worsening infection despite outpatient therapy Vancomycin, 1 gram IV every 12 h. or |
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Antibiothérapie infection MRSA sévère suspectée? |
SEPSIS ou NSTI = necrotizing soft tissue infection
Vancomycin, 1 gram IV every 12 h (or possibly linezolid, 600 milligrams IV every 12 h#).
Si comorbidités significatives : VANCO + Meropenem, 500–1000 milligrams every 8 h IV. or Piperacillin/tazobactam, 4.5 grams every 6 h, or imipenem-cilastatin, 500 milligrams every 6 h.
Consider also addition of clindamycin IV in cases of a NSTI to mitigate toxin production.
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Principe essentiel de la prescription d'antibio pour les cas de SARM ? |
Connaitre la flore locale et les antibiothérapie recommandée par les micro bio selon les résistences établies.
If local epidemiology supports MRSA as the likely cause of cellulitis, administer antibiotics likely to be effective against MRSA such as clindamycin (check local susceptibility), trimethoprim/sulfamethoxazole (MRSA is nearly 100% susceptible),5,20,21 or doxycycline (MRSA is 82% to 85% susceptible) |
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Que craindre avec Linezolide et quand l'employer? |
#Note complication of thrombocytopenia. Linezolid should be reserved for organisms with suspected vancomycin resistance or for patients with vancomycin allergy.
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