SSTI WITHOUT DIABETIC FOOT CAUSE WTF IS THAT
most appropriate duration of therapy for cellulitis
5 days
Signs of systemic infections
Febrile (>100.4 F) or hypothermic (<96.8 F) RR > 24 breaths/min HR > 90 bpm Leukocytosis (>12*10^3 cells/microL) or Leukopenic (<4*10^3 cells/microL)
Txt for large pustule under arm that is inflamed and indurated with systemic signs of infection I&D followed by piperacillin-tazobactam 3.375g IV Q6H I&D followed by cefepime 1g IV Q8H I&D followed by vancomycin 15mg/kg IV Q12H targeting an AUC of 400-600 I&D followed by SMX/TMP 1 DS tablet PO Q12H36
I&D followed by vancomycin 15mg/kg IV Q12H targeting an AUC of 400-600
Furuncles/carbuncle/abscess empiric txt no systemic signs of infection
I&D short course of PO abx that cover MRSA Doxy Bactrim linezolid 7-14 days FROM I&D
Furuncles/carbuncle/abscess txt
INCISION AND DRAINAGE Culture and streamline afterwards
Pyomyositis txt for all
INCISION AND DRAINAGE Culture and streamline afterwards
What to do for all purulent infections
INCISION AND DRAINAGE cultures
MRSA risk factor
Impaired skin integrity MRSA nasal colonization Hx of MRSA PWID purulent drainage
pyomysitis immunocomp/penetrating coverage
MRSA coverage PLUS broad gram negative coverage MRSA: Vanco, linzeolid, dapto GN: ceftriaxone, cefepime, zosyn 14-21 days FROM I&D
When to take cultures?
ONLY in purulent not useful in non-purulent
Nec fasc type III (Clostridium)
PCN PLUS Clinda
Impetigo milk, multiple lesions
PO abx with GAS and/or MSSA coverage PCN Augementin for MSSA 5-7 days
Ecthyma mild
PO abx with GAS and/or MSSA coverage PCN Augmentin for MSSA coverage 7 days
Animal/human bite txt
Pasturella Augmentin Zosyn 3-5 days unless pt developls SSTI
Question 1 Which of the following is not a common colonizer of the skin? Strept Mitis Pseudo Staph Epi Candida albicans
Pseudo
furuncles/carbuncles causative org
Purulent S. Aurues Sometimes CoNS
Cat scratch disease
Z-pack 3-5 days unless pt developls SSTI
Nec fasc type II (S. aureus)
antistaph DOC MSSA: Nafcillin or oxacillin or cefazolin MRSA: Vanco or linezolid
Nec fasc type II (S. pyogenes)
antistrept DOC plus antitoxin PCN plus Clinda
Nec fasc empiric
broad parenteral abx to cover GN, MRSA and anaerobes Vacno/linezolid PLUS zosyn/(cefepime PLUS metronidazole)
Pt has LLE pain, swelling and redness afeter scraping his leg, no signs of systemic infection, what does he have? impetigo ecthyma cellulitis
cellulitis
most appropraite txt for cellulitis
cephalexin
Impetigo extensive lesions and/or failed initiale therapy
consider PO MRSA coverage Bactrim or Doxy 5-7 days
Ecthyma extensive lesions and/or failed initial therapy
consider PO MRSA coverage Bactrim or Doxy 7 days
nec fasc DOT
continue for 48-72 hours AFTER clinical resolution may depend on additional factors
folliculitis severe
empiric therapy for Pseudo cefepime zosyn meropenem 5-7 days
why is clinda used in nec fasc?
high dose clinda is used to reduce toxin production of GAS, linezolid possible alt? but careful for long DOT and ADR
impetigo txt (for all)
local wound care (soaking crusts in soap and warm water)
Ecthyma causative org
non-purulent GAS
Impetigo causative org
non-purulent GAS (group A strept, S. pyogenes)
nec fasc clinical manifestations
pain out of proportion crepitus
pyomysitis empiric txt
parental MRSA coverage vanco linezolid dapto 14-21 days FROM I&D
folliculitis causative org
purulent skin flora = candida and lamassezia contaminated water = aeromonas, pseudomonas
pyomyositis Causative org
purulent S. aureus gram negative in immunocomp or hx or pen trauma
Nec fasc type III (Vibrio/Aeromonas)
Doxy PLUS ceftriax/cipro
Systemic signs of infections means?
Get Parenteral Abx
Furuncles/carbuncle/abscess empiric txt w/ systemic signs of infection
I&D plus empiric MRSA coverage vanco linezolid dapto 7-14 days FROM I&D
Most common bacteria in skin microbiome
Staph Corynebacterium Propionibacterium
Erysipelas/cellulitis w/ MRSA risk factors or critically ill
Strept PLUS MRSA Coverage MRSA linezolid Dapto 5 days
Erysipelas/cellulitis w/o systemic sx of infection
Strept coverage PCN Nafcillin/oxacillin for MSSA 5 days
Nec Fasc immediate txt
Surgical emergency IMMEDIATE TRIP TO OR PLUS I&D
Erysipelas/cellulitis causative agent
non-purulent GAS
Impetigo txt milkd/low risk of transmission
topical Abx mupirocin or retapamulin 5-7 days
folliculitis non-severe
topical antiinfectives +/- saline compress mupirocin or retapamulin topical antifungals 5-7 days
