SSTI Fong

Which SSTI should you obtain cultures for

purulent

When would you swab an SSTI

collected during surgery

When would you recommend imaging for SSTI

deep infections

Which SSTI should you get culture and sensitivity for

purulent

Empiric therapy for moderate purulent infections

doxycycline, bactrim

Definitive therapy for moderate purulent infection with MRSA

Bactrim

Definitive therapy for moderate purulent infection with MSSA

cephalexin

Empiric therapy for severe purulent infections

vanco, dapto, linezolid, ceftaroline

Definitive therapy for severe purulent infection with MSSA

nafcillin or cefazolin or clindamycin

Definitive therapy for severe purulent infection with MRSA

vanco, dapto, linezolid, ceftaroline (same as empiric)

What is the goal of therapy for moderate purulent infections

decrease recurrence

Cellulitis is non-purulent or purulent

non-purulent

Erysipelas is non-purulent or purulent

non-purulent

Furuncle is non-purulent or purulent

purulent

Carbuncle is non-purulent or purulent

purulent

Empiric therapy for mild purulent infection

no antibiotics

What qualifies as a moderate purulent SSTI

some SRIS

SIRS Temp

38

SIRs HR

90

SIRS RR

24

SIRS WBC

12k or <4k

What qualifies as severe SSTI

most SIRS with hypotension, failed oral antibiotics, immunocompromised

What bugs should you cover for purulent SSTI

staph. Aureus, GNR if immunocomp.

How long should you treat purulent SSTI

5-10 days

Empiric treatment for moderate nonpurulent SSTI

IV penicillin or ceftriaxone or cefazolin or clindamycin

What bugs are you covering for nonpurulent infections

strep and staph

Empiric treatment for mild nonpurulent SSTI

oral penicillin VK, cephalexin or clindamycin

When should you cover MRSA in non purulent

penetrating trauma, MRSA infection, IV drug use, SIRS

Cephalexin dose for SSTI and precautions

500-1000 mg po q6h, safe

Clindamycin dose for SSTI

300 po TID, c diff risk for elderly and sick

Doxycycline dose for SSTI and precautions

100 mg BID, not for pregnant, photosensitivity, esophageal irritation and teeth straining

Bactrim dose and precautions

1 DS BID, renal injury, hyperkalemia, warfarin use

Linezolid for SSTI

too broad

Vancomycin PO for SSTI

no bioavailability

Empiric therapy for necrotizing infection

vancomycin/linezolid + zosyn or carbapenem or ceftriaxone + metronidazole +/- clindamycin

Why is clindamycin used in necrotizing fasciitis

inhibits toxin production

Definitive therapy for monomicrobial strep pyogenes (GAS) necrotizing infection

penicillin + clindamycin

Definitive therapy for polymicrobial necrotizing infection

vanc + zosyn

Type 1 necrotizing fasciitis

polymicrobial

Type 2 necrotizing fasciitis

monomicrobial (group a strep > MRSA)

How long is therapy for GAS necrotizing fasciitis

10-14 days

Treatment for bite wounds

augmentin or ampicillin-sulbactam, only treat if needed