Term
| Staph. aureus, Strep. pyogenes |
|
Definition
| most common organisms found in SSTIs (Skin & Soft Tissue Infections) |
|
|
Term
|
Definition
involves healthy skin & caused by a single bacterial pathogen;
erysipelas, impetigo, lymphangitis, cellulitis, necrotizing fasciitis |
|
|
Term
|
Definition
involves areas of previously damaged skin & typically polymicrobial;
diabetic foot infections, pressure sores, bite wounds (animal or human), burn wounds |
|
|
Term
|
Definition
|
|
Term
|
Definition
involves deeper skin structure (fascia, muscle); requires surgical intervention;
occurs in immunocompromised pts (DM, HIV) |
|
|
Term
|
Definition
Gram-Pos:
CN Staphylocci, Corynebacterium species (diphtheroids);
Gram-Neg:
Acinetobacter spp. |
|
|
Term
|
Definition
Gram-Pos:
S. aureus, S. pyogenes, Enterococci;
Gram-Neg:
Pseudomonas aeruginosa, E. coli |
|
|
Term
| Risk Factors for Developing SSTIs |
|
Definition
high conc. of bacteria;
excessive moisture of skin;
inadequate blood supply;
availability of bacterial nutrients;
damage to corneal layer allowing bacterial presentation; |
|
|
Term
|
Definition
primary SSTI of more superficial layers of skin & cutaneous lymphatics;
Pathogen: Grp A Strep (S. pyogenes)
Most common in lower extremities;
Signs: bright red, edematous lesion, mildly elevated temperature, CLEAR, DEMARCATED RAISED MARGIONS;
Sx: flu-like prior to lesion, painful or BURNING sensation |
|
|
Term
|
Definition
Mild-Moderate:
PCN G IM q12 hr or PCN VK (Veetids) PO q6 hrs
If PCN Allergic:
clindamycin (Cleocin) PO q6-8 hrs
erythromycin PO q6 hrs
Severe:
PCN G IV daily
Duration: 7-10 days (IM is a single dose)
Outcomes: improvement in 48-72 hrs |
|
|
Term
|
Definition
primary SSTI - superficial skin infection most commonly seen in children, common during hot & humid weather;
minor trauma (scratches or insect bites) but HIGHLY contagious;
Common Pathogens: Staph. aureus, Grp A Strep.;
Sx: pruritus, scratching causes further spread, minimal systemic signs, fever, diarrhea, weakness;
Signs: Nonbullous - small,fluid-filled vesicles; Bullous - vesicles turn into bullae containing clear yellow liquid |
|
|
Term
|
Definition
dicloxacillin PO q6 hr (penicillinase-resistant)
cephalexin PO q6 hr
cefadroxil PO q12 hr
clindamycin PO q6-8 hr (if PCN allergic)
mupirocin ointment TOP q8 hr
- Staph & Strep coverage ONLY, no PCN b/c it does not cover Staph.
Duration: 7-10 days
Outcomes: improvement within 7 days |
|
|
Term
|
Definition
primary SSTI; inflammation involving SubQ lymphatic channels, occurs 2ndary to puncture wound, infected, blister, or other skin lesion;
Pathogens: Grp A strep (S. pyogenes mainly);
Acute or chronic inflammation of lymph nodes;
Sx: systemic (fever, chills, malaise), more profound;
Signs: peripheral lesion w/ proximal red streaks toward lymph nodes, lymph nodes are enlarged & tender, DO NOT confuse w/ thrombophlebitis; |
|
|
Term
|
Definition
PCN G IV q4-6 hrs
Clindamycin PO q6-8 hrs (if PCN allergic);
Duration: 10 days;
Outcomes: Improvement in 24 hrs |
|
|
Term
|
Definition
primary SSTI; acute, spreading infectious process initially affecting epidermis/dermis & spread to superficial fascia;
Hx of previous wound from minor trauma, abrasion, ulcer, or surgery;
Systemic: hypotension, dehydration, altered mental status;
More serious;
Pathogeng: Grp A Strep, S. aureus, occasionally other Gram-Pos cocci, Gram-Neg bacilli, &/or anaerobes;
Sx: systemic (fever, chills, malaise), affected area feels hot, painful;
Signs: erythema & edema of skin, extensive lesions w/ no clearly defined margins that are warm to touch, inflammation is common;
Tests: CULTURES (site & blood) |
|
|
Term
| Tx of Cellulitis caused by Staph. or unknown Gram-Pos infection |
|
Definition
Mild:
dicloxacillin PO q6 hrs
cephalexin PO q6 hrs
Moderate-severe:
nafcillin or oxacillin IV q4-6 hrs |
|
|
Term
| Tx of Cellulitis caused by Strep. (documented) |
|
Definition
Mild:
PCN VK PO q6 hrs
PCN G 600,000 units IM q8-12 hrs
Moderate-Severe:
PCN G 1-2 million units IV q4-6 hrs
Duration: usually 5-10 days, 7-14 days if Gram-Neg or polymicrobial
Outcome: improvement in 24-48 hrs |
|
|
Term
| Tx of Cellulitis caused by Gram-Neg bacilli |
|
Definition
Mild:
cefaclor PO q8 hr
cefuroxime PO q12 hr
Moderate-Severe:
AMG (gentamicin or tobramycin) or
IV cephalosporin (1st or 2nd gen)
Duration: usually 5-10 days, 7-14 days if Gram-Neg or polymicrobial
Outcome: improvement in 24-48 hrs |
|
|
Term
| Tx of Cellulitis caused by Polymicrobial infection (no Anaerobes) |
|
Definition
AMG + PCN G IV or nafcillin IV
Duration: usually 5-10 days, 7-14 days if Gram-Neg or polymicrobial
Outcome: improvement in 24-48 hrs |
|
|
Term
| Tx of MILD Cellulitis caused by Polymicrobial infection (WITH Anaerobes) |
|
Definition
Option 1 - amoxicillin/clavulanic acid PO q12 hr
OR
Option 2 - ciprofloxacin or levofloxacin PO q12 hr
PLUS
clindamycin PO q8 hr OR metronidazole PO q8 hr
Duration: usually 5-10 days, 7-14 days if Gram-Neg or polymicrobial
Outcome: improvement in 24-48 hrs |
|
|
Term
| Tx of MODERATE-SEVERE Cellulitis caused by Polymicrobial infection (WITH Anaerobes) |
|
Definition
Option 1 - AMG + clindamycin OR metronidazole;
OR
Option 2 - Monotherapy w/ 2nd or 3rd gen. cephalosporin (cefoxitin IV q6 hr or ceftizoxime IV q8 hr)
OR
Option 3 - Monotherapy with imipenem IV q6-8 hrs, meropenem IV q8hr, ertapenem IV q24 hr, piperacillin/tazobactam IV q6 hrs, OR tigecycline IV (LD & MD)
Duration: usually 5-10 days, 7-14 days if Gram-Neg or polymicrobial
Outcome: improvement in 24-48 hrs |
|
|
Term
| Necrotizing Soft-Tissue Infections - necrotizing fasciitis, clostridial myonecrosis (gas gangrene) |
|
Definition
Group of rare, life-threatening infections requiring early & aggressive surgical debridement along with antibiotics;
Pathogengs:
Type 1 (trauma & surgery) - polymicrobial (anaerobes, faculatative bacteria)
Type II (Strep. gangrene - "flesh-eating bacteria") - Grp A Strep. (Strep. pyogenes);
Clostridial myonecrosis: C. perfringens (anaerobe);
Frequently involves abdomen, perineum, & lower extremities;
Predisposing factors: DM, local trauma or infection, recent surgery;
Sx: marked systemic manifestations (chills, fever, leukocytosis), shock, organ failure;
Signs: difficult to differentiate from cellulitis; shiny, exquisitely tender, painful; prgoresses rapidly --> skin turns maroon; without intervention, gangrene develops; |
|
|
Term
| Tx of Necrotizing Soft-Tissue Infections |
|
Definition
Option 1 - AMG + clindamycin OR metronidazole;
OR
Option 2 - Monotherapy w/ 2nd or 3rd gen. cephalosporin (cefoxitin IV q6 hr or ceftizoxime IV q8 hr)
OR
Option 3 - Monotherapy with imipenem IV q6-8 hrs, meropenem IV q8hr, ertapenem IV q24 hr, piperacillin/tazobactam IV q6 hrs, OR tigecycline IV (LD & MD)
OPTIMAL CHOICE:
- ampicillin/sulbactam + clindamycin + ciprofloxacin;
ADD: vancomycin, linezolid, or daptomycin if MRSA is suspected;
For clostridial myonecrosis: PCN + clindamycin
Duration: varies
Outcomes: high mortality, needs rapid & complete debridement, w/ appropriate Abx therapy & supportive measures |
|
|
Term
|
Definition
foot infections in DM pts due to minor penetrating trauma or nail or toe web space infection;
Most serious complication: osteomyelitis;
3 Key Factors: neuropathy, ischemia, immunologic defects;
Pathogens: S. aureus, Enterobacteriaceia, Bacteroides spp., Peptostreptococcus spp., Pseudomonas aeruginosa;
Sx: peripheral neuropathy will not feel pain but will seek tx for swelling or erythema of foot;
Signs: varies (erythema, edema, warmth), foul-smelling odor (anaerobic organisms);
Tests: cultures, radiograph &/or bone scan if osteomyelitis suspected; |
|
|
Term
| Tx of Mild Diabetic Foot Infections |
|
Definition
Goal: Preserve Limb Function
amoxicillin/clavulanate PO q12 hr
OR
a fluoroquinolone (cipro PO q12 hr) + clindamycin PO q6-8 hr OR metronidazole PO q8 hr;
Duration of Therapy:
1-2 wks
Outcomes:
Improvement within 72 hrs, change therapy if no improvemenet seen |
|
|
Term
| Tx of Moderate Diabetic Foot Ulcer |
|
Definition
Goal: Preserve Limb Function
Monotherapy w/ 2nd or 3rd Gen. Cephalosporin (cefoxitin IV q6 hr or ceftizoxime IV q8 hr)
Duration of Therapy:
2-4 wks
Outcomes:
improvement in 72 hrs, change therapy if no improvemenet seen |
|
|
Term
| Tx of Severe Diabetic Foot Infections |
|
Definition
Goal: Preserve limb function;
Monotherapy with imipenem IV q6-8 hr, meropenem IV q8 hr, or ESBL/beta-lactamase inhibitor (piperacillin/tazobactam IV q6 hr);
Pts w/ MRSA: Vancomycin;
PCN-Allergy:
clindamycin or metronidazole PLUS either a FQ, aztreonam, or 3rd Gen. Cephalosporin
Duration of Therapy:
2-4 wks, 6-12 wks if osteomyelitis
Outcomes:
See improvement in 72 hrs; change therapy if no improvement seen |
|
|
Term
|
Definition
Stage 4 --> penetrates into deep fascia involving both muscle & bone;
Risk Factors: paralysis, immobilization, malnutrition, infection, elderly;
Pathogens: polymicrobial;
May occur anywhere on body, but majority on lower part of body;
Sx: commonly have other med problems that mask typical S/Sx of infection;
Signs: redness, heat, pain; purulent discharge, foul odor, systemic signs (fever, leukocytosis);
Tests: cultures, radiograph/bone scan; |
|
|
Term
| Tx of Infected Pressure Ulcers |
|
Definition
Clean & decontaminate wound & relieve pressure;
Non-infected: mechanical or chemical debridement;
Infected:
Mild - amoxicillin/clavulanic acid or cipro or levofloxacin PLUS clindamycin or metronidazole;
Moderate/Severe:
- AMG + clindamycin or metronidazole
OR
Monotherapy w/ 2nd or 3rd gen. cephalosporin (cefoxitin, ceftizoxime);
OR
monotherapy w/ imipenem, meropenem, ertapenem, piperacillin/tazobactam, or tigecycline
Duration: 7-14 days
Outcomes:
Reduction in erythema, warmth, & pain improves in 48-72 hrs |
|
|
Term
|
Definition
Wound irrigation w/ normal saline;
Amoxicillin/clavulanate (Augmentin) PO q12 hr
PCN Allergic: doxycycline PO q12 hr
If IV necessary: use beta-lactam/beta-lactamase inhibitor
Duration:
Non-infected: 3-5 days
Infected: 7-10 days
Outcomes: improvement within 24 hrs |
|
|
Term
|
Definition
Aggressive wound irrigation w/ normal saline & topical wound cleansing;
Amoxicillin/clavulanate (Augmentin) PO q12 hr
PCN Allergic: doxycycline PO q12 hr
If IV necessary: use beta-lactam/beta-lactamase inhibitor
Duration:
Non-infected: 3-5 days
Infected: 7-14 days
Outcomes: improvement within 24 hrs |
|
|
Term
|
Definition
infections predominantly from dogs & cats;
Pathogens:
Dogs - polymicrobial (Pasturella spp.)
Cats - Pasteurella multocida
Dog: greatest risk if puncture wound & no med attention w/in 12 hrs of injury & >50 yrs old;
Cat: 30-50% become infected;
Sx: pain, purulent discharge, swelling;
Signs: cellulitis spreads proximally from intitial site of injury, fever is uncommon; |
|
|
Term
|
Definition
Infections that occur from bites from teeth or from blows to mouth;
Pathogens: Eikenella corrodens, S. aureus, Streptococci, Corynebacterium spp., Bacteroides spp., Peptostreptococcus spp.;
More serious than animal bites;
Sx: painful, throbbing, swollen extremity, decreased range of motion;
Signs: erythema, swelling, clear or purulent discharge; |
|
|
Term
|
Definition
infection of the bone;
Pathogen: S. aureus is predominant; If polymicrobial: S. aureus, Enterococcus, Enterobacteriaceae, Pseudomonas aeruginosa, Anaerobes;
S/Sx:
Systemic - fever, chills, malaise;
Localized - pain or tenderness, edema, erythema, inflammation, decresed range of motion of infected area;
Diagnosis:
bone biopsy (GOLD STANDARD)
Lab tests (WBC, ESR, CRP)
Imaging (MRI [most accurate], CT scan [monitor clinical improvement]) |
|
|
Term
| Risk Factors for Osteomeylitis |
|
Definition
trauma or surgery;
artificial joints;
IV drug abuse;
DM;
peripheral vascular disease;
immunocompromised pts; |
|
|
Term
| Tx of Osteomyelitis caused by MSSA |
|
Definition
nafcillin/oxacillin IV q4-6 hrs
If PCN Allergic: cefazolin IV q8 hr
Duration of Therapy:
6-12 wks |
|
|
Term
| Tx of Osteomyelitis caused by MRSA |
|
Definition
If Vanco MIC <= 1 mcg/mL:
vancomycin 15-20 mg/kg per dose q8-12 hr;
If Vanco MIC >1 mcg/mL:
linezolid 600 mg IV/PO q12 hr
OR
daptomycin 6 mg/kg IV q24 hr
Duration:
6-12 hrs |
|
|
Term
| Tx of Osteomyelitis caused by Enterococcus spp. |
|
Definition
Ampicillin-Sensitive:
ampicillin 2 g IV q4-6 hr
Ampicillin-Resistant:
vancomycin |
|
|
Term
| Tx of Osteomyelitis caused by Streptococcus spp. |
|
Definition
| PCN G 2-4 million units IV q4-6 hrs |
|
|
Term
| Tx of Osteomyelitis caused by Enterobacteriaceae (**including P. aeruginosa) |
|
Definition
ceftriaxone 2 g IV q24 hr
cefotaxime 2 g IV q8 hr
ceftazidime 2 g IV q8 hr**
cefepime 2 g IV q8-12 hr **
piperacillin/tazobactam 3.375-4.75 g IV q4-8 hr**
ciprofloxacin 400 mg IV q12hr, 500-750 mg PO q12 hr**
levofloxacin 500-750 mg IV/PO daily
moxifloxacin 400 mg IV/PO daily |
|
|
Term
| Tx of Osteomyelitis caused by Anaerobes |
|
Definition
Clindamycin 600-900 mg IV q8 hr, 300-450 mg PO q6-8 hrs;
Metronidazole 500 mg IV/PO q8 hr |
|
|
