E2: SSTI and bite wounds

mechanisms of skin resistance

mechanical barrier

dry

slight ACIDIC pH

colonizing bacteria

frequent desquamation

sweat

which of the following is NOT a mechanism of defense by the skin?

a. dryness

b. colonizing bacteria

c. sweat

d. slight basic pH

d

what can lead to a skin infection

high bacterial load

excessive moisture

low blood supply

availability of nutrients

damage to the corneal layer

impetigo

highly contagious bacterial skin infection that causes red, itchy sores or blisters that typically break open and ooze fluid

what type of infection is impetigo

superficial

which two bacteria are the main cause of impetigo

staphylococcus aureus and streptococcus pyogenes

impetigo mainly affects

kids

impetigo is limited in its….

infectious capabilites

where are impetigo infections located on the body usually

face and extremeties

how does impetigo present

thin walled blisters that rupture and create a dry yellow crust on the area of infection, may be painful, itchy

is impetigo itchy?

yuh

can impetigo be treated OTC

no

drugs of choice for impetigo

dicloxacillin (anti-staph-penicillin)

cephalexin (1st gen)

alternative medications for impetigo

clindamycin, bactrim, and doxycycline

which administration route for impetigo infection treatment is preference

po

impetigo treatment alternative route of administration

topical

what is the duration of therapy for oral impetigo treatment

7 days

what is the doc for topical impetigo treatment

mupirocin ointment and retapamulin

topical impetigo treatment is usually reserved for when it is infecting which part of the body

extremities (no face)

what is the duration of topical impetigo treatment

5 days

eryspielas

a bacterial skin infection that causes a raised, well-defined, red rash with raised borders

what layers of the skin does erysipelas effect

superficial and upper dermis

cellulitis

infection of the epidermis, dermis, super fascia, and mostly occurs on the lower extremities

which bacteria are the most common cause of cellulitis

s. pyogenes and s.aureus

how does cellulitis and erysipelas present

pain, tender, burning, warmth

what are some complications that could occur from cellulitis and erysipelas

lymphedema

spread to deep layers

sepsis

recurrence

_________ can be due to spider bites

cellulitis

treatment of uncomplicated cellulitis and erysipelas infections in outpatient settings

penicillins, cephalexin, clindamycin

treatment of uncomplicated cellulitis and erysipelas infections in outpatient settings if MRSA is suspected

bactrim or doxycycline

treatment of uncomplicated cellulitis and erysipelas infections in outpatient settings (regardless of if MRSA is suspected) should last for…

5 days

treatment of complicated cellulitis and erysipelas infections in outpatient settings if MRSA is suspected

vancomycin, daptomycin, linezolid, or ceftaroline (these are the drugs of choice for HA MRSA)

most patients with cellulitis or erysipelas will not have _____ so cultures might not be beneficial

systemic symptoms

necrotizing fasciitis

rare but life-threatening bacterial infection that destroys the skin, muscle, and tissue beneath it (fascia) and subcutaneous fat.

which layers of the skin does necrotizing fasciitis infect

superficial fascia and subq fat

who is at high risk for necrotizing fasciitis

diabetic pts

illicit drug users

vascular diseases

what are the bacteria most commonly associated with necrotizing fasciitis

s. pyogenes and s. aureus

which other bacteria can cause necrotizing fasciitis (besides strep and staph)

vibrio/ aeromonase, peptostreptococci,

pt presentation of necrotizing fasciitis

severe pain

numb

warm

gangrene

crepitis

red

blisters

complications that could occur due to untreated necrotizing fasciitis

myconecrosis

septic shock

toxic shock

death

amputation

non pharmacological treatment of necro. f.

surgery

treatment of necro. f

broad spectrum IV antibiotic + clindamycin or linezolid

duration of clindamycin and linezolid add on therapy for necro f

72 hours

duration of IV antibiotic for necro

until symptoms are gone

s. pyogenes caused necro treatment

clindamycin + penicillin

clindamycin + penicillin for necro treament should last until

pt is okay for 48-72 hours

diabetic foot infections (DFI)

common and potentially serious complication of diabetes mellitus. It occurs when an open wound or ulcer on the foot becomes infected. 

DFI can occur when an_____ on the foot becomes infected

open wound or ulcer

risk of getting an ulcer on the foot for a diabetic pt

25%

DFI’s are more common in what type of diabetes

mellitus

DFI causative organisms

usually polymicrobial

most strep and staph

gram - bacilli

gram - anaerobes

p. aeruoginosa

which are the main bacteria that cause DFI

strep and staph

a more serious DFI could be caused by which bactreia

p. aeruginosa

local symptoms and presentation of DFI

pain, redness, edema

maybe purulent drainage

delayed healing

bad smell

tissue friability

increased bleeding

new color

ability to probe

systemic symptoms with DFI

fever

increased HR

increased respiratory rate

DFI is more common in diabetic pts who have

neuropathy

angiopathy

ischemia

immunologic effects

grade 1 DFI

not infected

grade 2 DFI

mild infection, local symptoms only

treatment for grade 2 DFI (mild) not caused by MRSA

dicloxacillin

clindamycin

cephalexin

levofloxacin

amoxicillin + clavulanic acid

treatment for DFI grade 2 caused by MRSA

doxycycline, linezolid, Bactrim, clindamycin

grade 3 DFI

no systemic symptoms, infection is deeper than subq

treatment for grade 3 DFI

levofloxacin

ceftriaxone

ampicillin + sulbactam

cefuroxime

carbapenems

piperacillin + tazobactam

treatment for grade 3 DFI caused by MRSA

linezolid

vancomycin

daptomyin

grade 4 DFI

severe, ONLY ONE WITH SYSTEMIC SIGNS

treatment for grade 4 DFI

anti-MRSA agents

anti-pseudomonal agents

anti-pseudomonal agents

Carbapenems
Ceftazidime
Cefepime
Ciprofloxacin
Levofloxacin
Aztreonam
Amikacin
Piperacillin + tazobactam
Polymyxin
Tobramycin

anti MRSA agents

linezolid

daptomycin

vancomycin

clindamycin

minocycline

moxifloxacin

ceftaroline

tigecylcine

-vancins

bactrim

duration of therapy for all DFI treatments

7-14 days

examples of pressure injuries

decubitus ulcer

bed sores

pressure sores

who is at risk for pressure injuries

old people

spinal cord or orthopedic injury

pressure injury

chronic wound form continuous pressure

pressure injures are often (uni-microbial or polymicrobial0

poly

presentation of pressure injuries

stages 1-4

maybe in patin

red

drainage

stinky

delayed healing

complications of untreated pressure injuries

osteomyelitis

necrotizing fasciitis

clostridial myonecrosis

sepsis

non rx preventative measures for pressure injuries

pressure relief, increase protein in diet, debridement

rx therapy for pressure injuries

broad spectrum IV antibiotic that covers both pseudomonas and MRSA for 10-14 days

dog or cat bites can infect a person with which bacteria

Pasteurella multocida

Staphylocci

Streptococci

Moraxella

Capnocytophaga canimorsus

Actinomyces

Prevotella

human bites can infection people with which bacteria

VGS

S. aureus

Haemophilus

Eikenella corrodens

anaerobic bacteria

signs and symptoms of an infection from a bite show up in

12 - 24 hours

signs and symptoms of a bite infection

red, pain, edema, drainage, decreased range of motion

complications of bite infections

lymphangitis, abscess, septic arthritis, osteomyelitis

non rx treatment for bite infections

irrigation, elevation, immobilization

rx treatment for bite infections

amoxicillin + clavulanate

cefuroxime + clindamycin or + metronidazole

prophylactic treatment for human bites should last for

3-5 days

tx for biteinfection should last for

7-10 days