Unit 5: SSTIs

RFs for SSTI

decreased skin integrity, increased moisture, decreased blood supply, increased bacterial load, availability of bacterial nutrients

Mild SSTI staging

no systemic infection signs

Moderate SSTI staging

systemic signs (fever, chills, increased WBCs), involvement of face, hands, and genitalia

Severe SSTI staging

Failed antibiotics, I&D, SIRs presence, immunocompromised, end organ dysfunction, altered mental status

folliculitis

inflammation of a single hair follicle

Clinical presentation of folliculitis

localized around follicle, may have pustule, typically in areas of friction/sweating, systemic signs uncommon, epidermis only

Definition of furuncle

also known as a boil

Clinical presentation of furuncle

firm, tender, red nodule around follicle, painful and fluctuant, systemic signs are uncommon, may looks like spider bite, affects epidermis and dermis

Definition of carbuncle

multiple boils in skin that cover larger area

Clinical presentation of carbuncle

broad, swollen, deep, red, painful, systemic signs are common, affects epidermis and dermis, can spread

What usually causes folliculitis, carbuncles, and furuncles?

S. aureus (MRSA)

Classification of folliculitis, furuncles, and carbuncles by severity

Folliculitis < sm furuncle (less than 1 cm) < large furuncle (greater than 1 cm) < carbuncle

Erysipelas causative agent

Group a strep (S. pyogenes)

Erysipelas Clinical Presentation

common on lower extremities and face, burning pain, intensely red and edematous, raised from normal skin with sharp demarcation, non-purulent, systemic S/Sx common, affects epidermis and cutaneous lymphatic system

Classification of erysipelas

done using routine staging (mild, moderate, severe)

Impetigo causative agent

S. pyogenes and S. aureus (bullous)

Nonbullous impetigo clinical presentation

systemic signs uncommon, small, clear fluid-filled vesicles, then turn to pustules that rupture and form yellow crust, significant pruritis

Bullous impetigo clinical presentation

systemic signs uncommon, small clear fluid-filled vesicles, turn to bullae, and burst to form thin brown crust

Impetigo classification

Mild or Extensive, facial, large outbreaks

What skin layers does impetigo affect?

epidermis only

Cellulitis definition

acute infection in epidermis that can go down and reach blood and lymphatics, two types: non-purulent and purulent

NPC Causative agent

S. pyogenes

NPC skin layers affected

Epidermis, dermis, and SQ fat

NPC clinical presentation

erythema, warm, painful, swollen, poorly defined margins, non-raised border, systemic symptoms common

Classification of NPC

routine staging (mild, moderate, severe)

PC causative agent

S. aureus including MRSA

PC skin layers affected

epidermis, dermis, SQ fat

PC clinical presentation

Same presentation as NPC with addition of drainage/pus, systemic Sx common

Folliculitis treatments

moist heat compress, topical agents BID- QID 7 days (clinda, erythro, mupirocin, benzoyl peroxide)

Small furuncle treatment

moist heat compress

Large furuncle/carbuncle treatment

I&D, Bactrim or tetracycline if systemic Sx

Erysipelas treatement

Mild- Pen V or PenG, or Clindamycin if PCN allergic

Impetigo treatment

topicals if mild, severe- ASPs, FGCs, Clindamycin, doxycycline, bactrim

NPC non-pharm

elevation/immobilization, cold compress 1st then warm moist compress

NPC mild treatment

PO PCN, Cephalexin, Dicloxacillin, Clindamycin

NPC moderate treatment

IV PCNs, CSPs, Clindamycin

NPC severe treatment

Vanco

PC mild treatment

I&D only

PC moderate treatment

I&D plus oral Bactrim or Doxycycline

PC severe treatment

address in Future ILEs