MRSA

- Methicillin-resistant Staphylococcus Aureus (MRSA) infections
- community acquired or health-care acquired (CA-MRSA more common)
- CA-MRSA begins as a localized infection from a break in the skin among healthy individuals who have not been hospitalized
- Both transmitted through direct contact with colonized skin or surface of a shared item where MRSA is present
- Postop MRSA infections can occur as surgical site infections, chest infections, or bloodstream infections (BSIs; bactremia)
- the risk of MRSA infection after surgery is generally low but affects up to 33% of patients after certain types of surgery

bacterial skin infections

- Highly contagious
- Affects infants and children
- MRSA, group A strep
Children will be told to stay home from school
At least 24 hours after antibiotics
- Can be very contagious - do not touch the sores and then touch someone else
- Given through close contact, warm and humid weather, broken cut, any other type of dermatitis
- Older adults - with diabetes or weakened immune system
- Can also have it

impetigo

- treatment for impetigo
- topical _______________.

mupirocin

impetigo
- wounds are result in cellulitis, ___________ problems, scarring
- make sure nails are trimmed to prevent ______________ which can lead to scarring.

kidney
scratching

- impetigo
- red sores that will burst and show as ____________ ___________.

honey like

- Prevention of impetigo
- Skin ___________
- Wash _________ or scrapes
- Prevent spread by washing affected area with mild soap and water and cover lightly with _____________
- Wash clothing and linen every day with _________ water
- Wear ___________ when applying ointment and wash hands after
- Cut ___________
- Encourage frequent hand washing
- Keep child home

clean
cuts
gauze
hot
gloves
nails

- Folliculitis
Treatment:
- Moist __________
- Topical ______________
- ________________ lotion or gel
- _____________ _____________ wash when showering for 5-7 days to increase healing
- If caused by MRSA, they normally do _____ antibiotics

heat
mupirocin
clindamycin
benzoyl peroxide
2

- Furuncle
- Occurs deep in _______________.
- Caused by MRSA
- Tx:
- Small - moist ________
- Large - incision and _______________ and antibiotics
- Furunculosis - ________________.

follicles
heat
drainage
mupirocin

- Can cause infection in healthy and young people
- Associated with poor hygiene, overcrowded living, sharing contaminated objects, previous infection with MRSA, trauma
- Spreads easily
- Tx:
- Vancomycin
- Linezolid, clindamycin
- Ceftaroline fosamil
- Can lead to sepsis, organ damage, or death
- Can cause recurrent infections and exposure to other people

community acquired MRSA

- Microorganisms find entry through skin breaches
- Gram-positive bacteria such as methicillin-sensitive Staphylococcus aureus (MSSA) and S pyogenes are isolated about 50% of the time.
- Typically streptococcal and staphylococcal
- Presentation
- Erythema
- Warmth
- Edema
- Localized pain

non-necrotizing cellulitis

- Identified by rapidly spreading erythema, warmth, localized pain, and edema with possible inflammation of the regional lymph nodes.
- Acute phase with intense erythema
- Treatment - antibiotics
- Symptoms:
- Swelling
- Tenderness
- Pain
- Warmth
- Fever
- Blisters
- Swollen lymph nodes

cellulitis

- Spread rapidly and destroy a significant amount of tissue
- Usually polymicrobial
- Very serious, possibly life-threatening
- Penetrate and spread throughout the dermis, subcutaneous tissues, fascia, and muscles.
- Necrotizing infections- involving the fascia are more common because of the fascia's poor blood supply and limited immune function, which allows pathogens to spread rapidly along the fascial plane.
- Presentations
- Mild at first
- Left untreated:
- Fever
- Tachycardia
- Pain that is disproportionate to physical findings
- Disorientation
- Lethargy
- Hypotension
- Necrotizing fascitis
- Erythematous skin with firmness in underlying tissues
- Edema
- Vascular occlusion
- Ischemia
- Tissue necrosis with resulting anesthesia of necrotizing infections
- Sepsis
- Most common sites
- Abdomen
- Lower extremities
- Perineum
- Fournier's gangrene is the descriptive name given for a necrotizing fasciitis fo the genital or perineal area
- MRSA typically colonizes in the anterior nares of the patient

necrotizing infections (potentially life threatening)

necrotizing infections potentially life-threatening:
- Presentations
- Mild at first
- Left untreated:
- Fever
- Tachycardia
- _________ that is disproportionate to physical findings
- Disorientation
- Lethargy
- _________tension
- Necrotizing fascitis
- ________________ skin with firmness in underlying tissues
- Edema
- ______________ occlusion
- Ischemia
- Tissue _____________ with resulting anesthesia of necrotizing infections
- Sepsis
- Most common sites
- Abdomen
- ____________ extremities
- _______________: Fournier's gangrene is the descriptive name given for a necrotizing fasciitis fo the genital or perineal area

pain
hypo
erythematous
vascular
necrosis
lower
perineum

- prevention of bacterial infections
- _____________ ointment alone or in combination with ________________ gluconate baths.

mupirocin
chlorohexidine

- susceptibility to bacterial infections:
- Acute or chronic skin __________________
- _____________ infections
- Venous ____________ disease
- Alterations in _______________ drainage
- Obesity
- _____________ compromise to the skin
- ____________ node resection
- Immunocompromised state

ulcerations
fungal
stasis
venous
arterial
lymph

- MRSA infections are frequently associated with:
- _________ hygiene
- __________________ living conditions
- Skin-to-skin contact
- Sharing of _______________ objects
- Previous ___________ infections
- Trauma
- Demographic group:
- Children
-_________ adults
- Minorities
- Low-socioeconomic groups
- _______________ males
- Athletes
- Prisoners
- Day-care workers
- ________________ recipients

poor
overcrowded
contaminated
MRSA
young
homosexual
tattoo

- management of bacterial infections:
- __________ ___________ therapy for uncomplicated infection
- ______________ treatment duration for complicated infection

short course
variable

DX testing for bacterial skin infections
- ___________ ____________ and sensitivity
- _________ with differential
- Serum lytes
- _____ ____________ protein
- Monitors inflammation
- CT
- Surgical exploration and ______________
- Followed by broad-spectrum antibiotics
- __________ swab
- Testing for colonization of MRSA
- Quantitative tissue ______________
- An invasive test in which a piece of tissue below the surface of the wound is obtained and sent for quantitative gram stain and culture
- Considered gold standard for finding wound pathogens

blood culture
CBC
C reactive
debridement
nasal
biopsy

- Complications of bacterial skin infections.
- Overuse and misuse of ____________
- Incorrect wound _____________ techniques
- Leads to the misidentification of the virulent bacteria, worsening infection, and bacteremia
-__________ loss
- Multitude of future surgeries
- Possible death

antibiotics
culturing
tissue

- TX for cellulitis and MRSA
- Systemic ________________
- For MRSA-antibiotics that are known not to have resistance
- Wound ____________________.

antibiotics
debridement

Worried if it can become ______ (signs of sepsis) _______ (early sign), fever, ______ (later sign); need fluids

systemic

Tachycardia

Hypotension (Low BP)