7 pyoderma abx stewardship and

how do you evaluate depth of pyoderma

Surface & superficial: erythema, exudate, pruritus • Deep: pain, haemorrhage, swelling

Seborrhoeic pyodermas

bacterial overgrowth syndrom— surface

• Diffuse erythema, scales and a greasy, keratoseborrhoeic exudate; often pruritic and malodouress

• folds, chronic inflammation

add intertrigo?

Skin fold infection; moist, greasy & erythematous,
with or without a malodorous exudat

Papules, pustules, epidermal collarettes & scaling, focal alopecia

• name 3 type

• name thei clinical presentation

non haemprrhagic as no bv in epidermis

Superficial bacterial folliculitis

• Non-follicular pustules; often large and flaccid or
  tense (bullous impetigo)

Impetigo

• Small, follicular pustules, papules, erythematous
  macules, epidermal collarettes, and patchy tufting
  of the coat with multi-focal alopecia

Superficial spreading pyoderma

• Large, spreading and coalescing epidermal
  collarettes, erythema and exfoliation

• staph, folliculitis, papules

  • multifollicularl: pemphicus folliacous

  • focal: staph

add specific above

Erosions and ulcers

Pyotraumatic dermatitis (self traumatise, strich strat corneum)

Intertrigo (body fold)

AD, steroid + antiseptic

add

add see notes

Deep pyoderma dermis or deeper tissue (rupture of hair follicle),

• A superficial, exudative, highly pruritic and painful
  infection caused by repeated self-trauma; well-
  defined moist erosions, with or without folliculitis
  or furunculosis in the surrounding haired skin

furunculosis— deep (2dry

Nodules or regional swelling

Abscess— deep

Diffuse and poorly-circumscribed infection and inflammation; painful and may have a bloody
serous to purulent exudate

Celllulitis— deep

Discrete, swollen, walled off accumulations of pus; often drain purulent fluid and form crusts

us eof cytology in Diagnosis of pyoderma (2)

• cytology to confirm diagnosis

• use C+C. to ID sensititvity

descripte how to collect representative samples

epidermal collarete: leading edge of sace

pustule: pus in fresh leisinofuruncuosis: deeper— fresh subcut dermal material

cat skin erosion moist—> staph in subcut

name this infection

Staphylococcal pyoderma

staph form a. pair: 2 axis. form bunch

rods— gram -ve (pseudo, endo etc)

wanna do more culture, less susceptible

bacterial overgrowth syndrom

• nede torecognise staph, malassezia, rods

empitical choice of anitbiotic

1. what rules

Not life-threatening – 1 st infection within 3 months – Surface or superficial infection – Predictable antibiotic susceptibility – Antibiotic resistance not likely

appropriate for topical

approapriate for immmediate theapy of life-threa

Bacterial culture & sensitivity indication

Life-threatening infections • Deep or complex infections • Clinical signs and cytology not consistent • Rod or unusual bacteria on cytology • Empirical antibiotics not effective • Antibiotic resistance likely

risk factor of AMR infection

Multiple broad-spectrum antibiotic courses • Antibiotic treatment within 3 months • Non-healing wounds • Post-operative infections • Nosocomial infections • Treatment failure

when to start treametn?

• start immediately only if clinically necessary – Look at cytology and likely sensitivity • Escalate treatment to a higher antibiotic tier if resistance present • De-escalate to a lower tier drug or stop treatment if possible

• mino staph, staph funniculitis persistant, post op cellulitis, whole limb

Kirby-Bauer discs

MIC

re-visit the breakpoint

highest effective conc of tissue at site of infecct

define breakpoints: sensitive, ressitant, intermediate

Breakpoint:MIC index/ratio

always go fr the higher breakpoint mic ration as most susceptible

MIC = lowest concentration of antibiotic that prevented bacterial growth • The tissue concentration needs to match or exceed the MIC • Tissue concentrations < MIC are sub-therapeutic

Culture results and topical therapy

DO NOT USE CULTURES TO SELECT TOPICAL ANTIBIOTICS

• then what do we use????

when is systemic treatment not required

what do you do then?

mild, non-life threatening, focal surface or superficial infections

• Manage the primary disease – Consider topical antimicrobials – Consider topical antibiotics

MRSA pesistant infection

• biofilm cleaning

• reisstant fusidic acid for gram +ve bacteria HIGH CONC

name some topical you can use antiseptic

Hypochlorous acid MICs & MBCs

Other topical antimicrobials

chloorhexidine

CHlorhexidine

efficayr and availability is good

first line sntiseptive.

As effective as systemic amoxicillin-clavulanate – Effective against AMR bacteria – Effective against biofilms – Residual activity on skin & hairs • Can be drying and sensitising

• switch to other product that are not drying

works less on super pseudomona (0 effect) and ESL

Hypochlorous acid MICs & MBCs

tissue safe but efficay to clean wound

No residual activity – use at least once daily

Other topical antimicrobials

Polihexanide, hydrogen peroxide, povidone iodine & sodium hypochlorite • Micronised silver • Manuka honey • Essential fatty acids & plant oils • Antimicrobial peptides

ask about ingredient

topical antibiotic used in

focal lesions • Can be effective against AMR bacteria • Silver sulfadiazine – Additive with aminoglycosides & fluoroquinolones • Fusidic acid (goof for gram +ve mrsa) • Mupirocin (check if reserved fro human)

give adveantaege of first line 4

Well established and well tolerated – Good evidence of efficacy – Good evidence of safety • Anti-staphylococcal activity • No less potent than 2nd & 3rd line drugs • Appropriate for empirical treatment

give example of first line

Second line antibiotics

• Broad spectrum drugs important for animals and humans – Resistance of greater concern • Should only be used when there is culture or clinical evidence that first line drugs will not be effective

give example

Cefovecin, cefpodoxime • Enrofloxacin, marbofloxacin, orbifloxacin, difloxacin, pradofloxacin

third line indication

Culture evidence of sensitivity • No 2nd line antibiotics are effective • Topical antimicrobial therapy is not effective or feasible. multidrug resistant organism

• Aminoglycosides, chloramphenicols, 3rd and 4th generation cephalosporins, anti-Pseudomonas penicillins, rifampin

fluo aminnoglycovide dose dedpendatn

cephosporin time dependace

tertramycine, ___,___ are untder curve

tissue penetration

use of steroid:

• describe clincal cure

• surface and superficial pryoderma: how long dows it need

• deep pyoderma oftern inproved in ___, full resolution _____

Resolution of lesions and normal cytology • Surface & superficial pyodermas usually 1-3 weeks • Deep pyodermas often improved in 2 weeks – Full resolution may take 4-6 weeks or longer