DPT III Exam 2 (tran)

which types of SSTIs are typically associated with purulence?

folliculitis, furuncles

carbuncles

± impetigo

abscess

± diabetic foot infection

± human or animal bites

which types of SSTIs are not typically associated with purulence?

erysipelas

cellulitis

necrotizing fasciitis

which two gram-positive organisms are typically associated with SSTIs?

Streptococcus spp. and Staphylococcus spp.

which gram-positive organism is typically associated with purulence?

Staphylococcus spp.

an infection with which organism classically presents as "streaking, nonpurulent cellulitis"?

Streptococcus spp

mild SSTI

description:

treatment:

P: I&D

NP: oral abx

moderate SSTI

description:

systemic signs of infection

treatment:

P: I&D + oral abx

NP: IV abx

severe SSTI

description:

P: failed I&D + oral abx OR systemic signs of infection OR immunocompromised patients

NP: failed oral abx OR systemic signs of infection OR immunocompromised patients OR clinical signs of deeper infection OR evidence of organ dysfunction

treatment:

P: I&D + IV abx

NP: IV abx (broad-spectrum)

mild diabetic food infection

description:

local infection (involves only the skin and subcutaneous tissue) AND no systemic signs; if erythema present must be > 0.5 cm to ≤ 2 cm around the ulcer

treatment:

oral abx

probable pathogens: Staphylococcus aureus, Streptococcus spp.

moderate diabetic food infection

description:

no systemic signs AND local infection + erythema > 2 cm OR involvement of deeper structures

treatment:

oral OR IV abx

probable pathogens: polymicrobial**

severe diabetic food infection

description:

local infection AND ≥ 2 signs of SIRS*

treatment:

oral OR IV abx

probable pathogens: polymicrobial**

what are the MRSA risk factors for SSTIs?

-purulence

-history of previous MRSA infection

-high local prevalence of MRSA

-use of antibiotics in last month

-hospitalization in the past year

-history or previous MRSA colonization

-MRSA nares swab

what are the Psuedomonas risk factors for SSTIs?

-warm climate

-frequent exposure of foot to water

-high prevalence of Pseudomonas

-severe infection

true or false: Cephalosporins should always be avoided in the setting of a penicillin allergy.

false

in assessing susceptibility patterns in an antibiogram, what percentage cutoff would warrant AVOIDANCE of

that antibiotic for empiric coverage?

80

are there renal dose adjustments for dicloxacillin, nafcillin, and oxacillin?

no

what do penicillin G and penicillin VK have a DDI against?

probenecid

should you use higher or lower doses if piperacillin-tazobactam for more severe infections?

higher

does piperacillin-tazobactam have Pseudomonas coverage?

yes

cefepime adverse effect

neurotoxicity

does ceftriaxone need renal dose adjustments?

no

tedizolid adverse effect

myelosuppression, peripheral neuropathy, serotonin syndrome, thrombocytopenia

common adverse effect of the tetracyclines

photosensitivity

DDI with the tetracyclines

oral cations

do doxycline or omadacycline need renal dose adjustment?

no

adverse effects of the oxazolidinones

myelosuppression, peripheral neuropathy, serotonin syndrome, thrombocytopenia

do the oxazolidinones need renal dose adjustment?

no

DDI of the oxazolidinones

serotonergic agents

adverse effect of dalbavancin and oritavancin

infusion reaction

DDI of oritavancin

warfarin, heparin, coagulation tests

adverse effect of telavancin

foamy urine, nephrotoxicity, infusion-related reaction, taste disturbance,

DDI of telavancin

heparin, coagulation tests

adverse effect of vancomycin

nephrotoxicity, infusion-related reaction

DDI of vancomycin

nephrotoxic agents

adverse effects of fluoroquinolones

CNS effects, peripheral neuropathy, photosensitivity, QT prolongation, tendinitis, tendon rupture

DDI of fluoroquinolones

oral cations

which fluoroquinolone does not have an adverse effect of QT prolongation or photosensitivity?

delafloxacin

does moxifloxacin need renal dose adjustment?

no

adverse effect of clindamycin

C.diff diarrhea

does clindamycin need renal dose adjustment?

no

adverse effect of daptomycin

increased creatinine phosphokinase, eosinophilic pneumonia

does daptomycin need higher or lower doses for more severe infections (bacteremia, osteomyelitis, vancomycin-resistant)?

higher

DDI of daptomycin

statins

adverse effect of metronidazole

metallic taste, peripheral neuropathy

what should you avoid taking metronidazole with?

alcohol

DDI of metronidazole

warfarin

adverse effect of mupirocin

skin irritation

adverse effects of trimethoprim-sulfamethoxazole

bone marrow suppression, increased potassium, increased serum creatinine

should you use higher or lower doses of trimethoprim-sulfamethoxazole for diabetic foot infections?

higher

DDI for trimethoprim-sulfamethoxazole

warfarin, renin-angiotensin-aldosterone system inhibitors

which organism should be empirically treated for with the presence of purulence in the setting of an SSTI?

MRSA

which organisms should be empirically treated for with the absence of purulence in the setting of an SSTI?

MSSA, Streptococcus spp., and gram negative bacilli

when can NO antibiotics potentially be a treatment option for SSTIs?

in mild purulent infections

when are oral antibiotics for SSTI treatment recommended?

SSTI

mild non-purulent infections

moderate purulent infections

diabetic foot infections

mild diabetic foot infections

moderate diabetic foot infections

severe diabetic foot infections

when are intravenous antibiotics for SSTI treatment

recommended?

SSTI

moderate non-purulent infections

severe purulent and non-purulent infections

diabetic foot infections

moderate diabetic foot infections

severe diabetic foot infections

which antibiotics commonly used for the treatment of SSTIs come in an oral formulation?

amoxicillin-clavulanate

dicloxacillin

penicillin VK

cefuroxime

cephalexin

doxycyline

minocycline

omadacycline

linezolid

tedizolid

ciprofloxacin

delafloxacin

levofloxacin

moxifloxacin

clindamycin

metronidazole

trimethoprim-sulfamethoxazole

which antibiotics commonly used for the treatment of SSTIs come in an intravenous formulation?

ampicillin-sulbactam

nafcillin

oxacillin

penicillin VK

penicillin G

piperacillin-tazobactam

cefazolin

cefepime

cefoxitin

ceftraoline

ceftazidime

ceftriaxone

doripenem

ertapenem

imipenem-cilastatin

meropenem

doxycyline

minocycline

omadacycline

linezolid

tedizolid

oritavancin

telavancin

vancomycin

ciprofloxacin

delafloxacin

levofloxacin

moxifloxacin

aztreonam

clindamycin

daptomycin

metronidazole

trimethoprim/sulfamethoxazole

which antibiotics commonly used for the treatment of SSTIs cover MRSA?

clindamycin PO

doxycycline

TMP-SMX

ceftraoline

dalbavancin

daptomycin

linezolid

oritavancin

tedizolid

vancomycin

which antibiotics commonly used for the treatment of SSTIs cover Pseudomonas?

aztreonam

carbapenem

cefepime

ciprofloxacin

levofloxacin

piperacillin-tazobactam

which antibiotics commonly used for the treatment of SSTIs cover anaerobes?

ampicillin-sulbactam

clindamycin

piperacillin-tazobactam

metronidazole

what is the place in therapy of dalbavancin, oritavancin?

one time infusion

what is the place in therapy of delafloxacin?

-broad coverage (MRSA, P. aeruginosa)

-no known QT prolongation or phototoxicity

what is the place in therapy of omadacycline?

activity against tetracycline-resistant pathogens

what is the place in therapy of tedizolid?

-less frequent dosing

-less risk of serotonin syndome

-less potential for thrombocytopenia compared with linezolid

when would a patient be "eligible" to switch from an intravenous antibiotic to an oral antibiotic?

-intravenous antibiotics > 24 hours

-stable infection

-clinical improvement

-afebrile

-WBC trending down

-hemodynamically stable

-ability to tolerate oral

-bacteria susceptibility to oral treatment

how long should a SSTI typically be treated?

SSTI

individualized to patient response, but typically 5 to 14 days

diabetic foot infection

1 to 4 weeks

organism that causes streaking, nonpurulent cellulitis

streptococcus spp.

organism that causes purulence and erythema

staphylococcus spp.

organism that causes pain out of proportion to exam

necrotizing facitis

comorbidities of SSTIs

-diabetes

-peripheral artery disease

-poor nutritional status

-concomitant osteomyelitis

treatment for mild purulent SSTIs

empiric MRSA coverage

no antibiotics

treatment for moderate purulent SSTIs

empiric MRSA coverage

clindamycin PO

doxycycline

tmp-smx

treatment for severe purulent SSTIs

empiric MRSA coverage

ceftraoline

dalbavancin

daptomycin

linezolid

oritavancin

tedizolid

vanocmycin

treatment for mild non-purulent SSTIs with no MRSA risk factors (empiric MSSA, sttreptococcus spp., empiric GMB coverage)

cephalexin

clindamycin PO

dicloxacillin

penicillin VK

treatment for moderate non-purulent SSTIs with no MRSA risk factors (empiric MSSA, sttreptococcus spp., empiric GMB coverage)

cefazolin

ceftriaxone

clindamycin IV

penicillin

treatment for severe non-purulent SSTIs with no MRSA risk factors (empiric MSSA, sttreptococcus spp., empiric GMB coverage)

vancomycin AND piperacillin-tazobactam

imipenem-cilastatin

meropenem

treatment for mild non-purulent SSTIs with MRSA risk factors (empiric MSSA, sttreptococcus spp., empiric GMB coverage)

doxycycline

tmp-smx

AND

penicillin

amoxicillin

cephalexin

treatment for moderate non-purulent SSTIs with MRSA risk factors (empiric MSSA, sttreptococcus spp., empiric GMB coverage)

ceftraoline

dalbavancin

daptomycin

linezolid

oritavancin

tedizolid

vancomycin

treatment for severe non-purulent SSTIs with MRSA risk factors (empiric MSSA, sttreptococcus spp., empiric GMB coverage)

vancomycin

AND

piperacillin-tazobactam

imipenem-cilastatin

meropenem

treatment for mild foot infections based on Staphylococcus spp., Streptococcus infections

amoxicillin-clavulanate

cephalexin

clindamycin

dicloxacillin

levofloxacin

moxifloxacin

treatment for moderate/severe diabetic foot infections based on susceptible MSSA, Streptococcus spp., and Enterobacteriaceae infections

ampicillin-sulbactam

cefoxitin

ertapenem

imipenem-cilastatin

levofloxacin

moxifloxacin

treatment for moderate/severe diabetic foot infections based on susceptible MRSA infections

daptomycin

linezolid

vancomycin

treatment for moderate/severe diabetic foot infections based on anaerobes infections

ampicillin-sulbactam

clindamycin

piperacillin-tazobactam

metronidazole

treatment for moderate/severe diabetic foot infections based on Pseudomonas infections

aztreonam

carbapenem

cefepime

ciprofloxacin

levofloxacin

piperacillin-tazobactam

treatment for human or animal bites via *empiric Staphylococcus spp.; Streptococcus spp.; Pasteurella multocida (cat or dog bites); Eikenella corrodens (human bites); anaerobic coverage"

amoxicillin-clavulante

doxycycline

moxifloxacin

when do incision and drainage function need antibiotic therapy?

if:

-inability to drain completely

-lack of response

-associated septic phlebitis

-severe or extensive disease

-systemic illness

-extremes of age

-associated comorbidities or immunosuppression