Term
|
Definition
acute
infectious process
epidermis and dermis
may spread to superficial fascia
can lead to blood stream infection
erythema (redness) and edema
borders not well defined |
|
|
Term
Streptococcus pyogenes (Group A Beta hemolytic Strep)
Staphylococcus aureus |
|
Definition
| common cellulitis pathogens |
|
|
Term
anti-staph penicillins: Dicloxacillin PO, Nafcillin or Oxacillin IV
OR
1st generation cephalosporins: Cephalexin PO or Cefazolin IV
allergic patients: Clindamycin (lincosamide) |
|
Definition
|
|
Term
| short duration of therapy |
|
Definition
| duration of cellulitis therapy |
|
|
Term
|
Definition
traditionally health care acquired
now can be community associated
more toxin = more virulent
black necrotic center
looks like a spider bite |
|
|
Term
resistant to all beta-lactams and macrolides
sulfamethoxazole/trimethoprim, clindamycin, and doxycycline work |
|
Definition
treatment of community acquired MRSA
rising number of cellulitis cases
common in young athletes |
|
|
Term
Quinupristin/Dalfopristin IV
Linezolid IV/PO (KNOW that Linezolid is available PO)
Tigecycline
Telavancin (lipoglycopeptide)
Ceftaroline (5th generation cephalosporin) |
|
Definition
| new agents for skin and soft tissue infections that are effective against MRSA |
|
|
Term
Inducible Clindamycin Resistance in Staph and Strep
To find out more quickly (it may take days to become apparent in the patient) if there is cross resistance with erythromycin and clarithromycin
inducible clarithromycin resistance may be present if there is erythromycin resistance
[image] |
|
Definition
| What is the D test used to test for? |
|
|
Term
|
Definition
primarily occurs during hot, humid weather
small, fluid filled vesicles
puss blisters
characteristic yellow crusts when dry
most common in children
highly contagious to close contact
spreads quickly through day care centers, siblings
scratching can spread
pruritis (itching) common |
|
|
Term
Streptococcus pyogenes (Group A Strep)
Staphylococcus aureus - still MSSA |
|
Definition
|
|
Term
anti staph penicillins: Dicloxacillin PO, Nafcillin or Oxacillin IV
OR
1st generation Cephalosporins: Cephalexin PO or Cefazolin IV
alternative treatments: Clindamycin for the penicillin allergic |
|
Definition
|
|
Term
| short duration of therapy |
|
Definition
| duration of impetigo treatment |
|
|
Term
|
Definition
type of superficial cellulitis with extensive lymphatic involvement
borders WELL DEFINED by elevation
lower extremities most common, face and ears also possible |
|
|
Term
| Streptococcus pyogenes (Group A Strep) |
|
Definition
|
|
Term
| Drug of Choice = Penicillin (any will work) |
|
Definition
|
|
Term
| short duration of therapy |
|
Definition
| duration of erysipelas therapy |
|
|
Term
Found in Group A Strep, S. aureus, and Clostridium
can produce deadly toxins
for serious infections combine:
beta-lactam or cell wall agent
PLUS
Clindamycin (protein synthesis inhibitor): not affected by size of inoculum nor stage of bacteria's growth phase, MAY PREVENT TOXIN RELEASE
possible with linezolid (for MRSA) too |
|
Definition
| What is the Eagle Effect? |
|
|
Term
| necrotizing soft tissue infections |
|
Definition
rare, but very serious
progressive destruction of fascia, subcutaneous fat and even muscle
most frequently occurs below the diaphragm: abdomen, perineum, lower extremities
predisposing conditions: diabetes, surgery/local trauma, and recent infections are all risk factors |
|
|
Term
1) anaerobes plus facultative bacteria: act synergistically to destroy fat and fascia, progresses slowly, skin can be spared
2) STREPTOCOCCUS PYOGENES (Group A Strep): virulent strain known as "strep gangrene"; flesh eating bacteria can affect the young and healthy; progresses very rapidly; can kill within 12 hours; early onset of shock; organ failure common; treat as emergency; staph can also cause it
3) Clostridium Myonecrosis: causes by the anaerobe CLOSTRIDIUM PERFRINGENS; "gas gangrene"; advances rapidly; shows little inflammation; risk factors are recent surgery or trauma |
|
Definition
| what are the 3 types of necrotizing soft tissue infections? |
|
|
Term
broad spectrum antibiotic coverage
Penicillin/beta lactamase inhibitor
+ Vancomycin
+/- Clindamycin (for the toxin effect) |
|
Definition
| Emperic treatment of necrotizing soft tissue infections |
|
|
Term
neuropathy, ischemia, and immune defects
osteomyelitis is possible
goal of treatment: preserve life, limb, and function |
|
Definition
| why are people with diabetes more prone to foot infections? |
|
|
Term
often polymicrobial (~5/culture)
Staph and Strep are most common: bacteria from the skin enter the wound first
gram - and anaerobes
remember your feet and shoes are dirty places (gram -) and people with diabetes have poor blood flow (anaerobe) |
|
Definition
| causes of diabetic foot infections |
|
|
Term
mild cases:
amoxicillin/clavulanate PO, ampicillin/sulbactam IV, ertapenem IV
severe/life threatening infections: Vancomycin if MRSA suspected |
|
Definition
| treatment of diabetic foot infections |
|
|
Term
| duration longer than ordinary cellulitis |
|
Definition
| duration of treatment of diabetic foot infections |
|
|
Term
prevention!
relieve pressure/friction
debridement
wound cleansing
dressing
antibiotics only if infected |
|
Definition
|
|
Term
topical for minor sores: Silver sulfadiazine (metal can be antimicrobial), triple antibiotic ointment (neomycin, bacitracin, polymyxin)
systemic for severe sores: same as for polymicrobial infections, Gram + Gram - and anaerobes = amoxicillin/clavulanate PO, ampicillin/sulbactam IV, ertamenem IV |
|
Definition
| antibiotics for pressure sore wounds |
|
|
Term
Staph and Strep
consider skin and oral flora resonsible |
|
Definition
| causes of infected bite wounds |
|
|
Term
|
Definition
| treatment of infected bite wounds |
|
|
Term
|
Definition
infection and inflammation of the bone (and even marrow)
signs and symptoms: pain and tenderness at site, erythema (redness) and swelling, fever, chills, and malaise |
|
|
Term
biopsy
culture from surgery
elevated WBC, ESR (erythrocyte sedimentation rate), and CRP (C reactive protein) - better for monitoring response to therapy than diagnosis |
|
Definition
| diagnosis and follow up testing for osteomyelitis |
|
|
Term
| hematogenous osteomyelitis |
|
Definition
| osteomyelitis infection that spread through the bloodstream |
|
|
Term
most cases occur in patients younger than 16 yo (usually in long bones in children)
vertebral infections are more common in patients older than 50 yo |
|
Definition
| in what patient population does hematogenous osteomyelitis most often occur? |
|
|
Term
infection spread from adjoining tissue
penetrating trauma and pressure ulcers may cause contiguous infections |
|
Definition
| how are contiguous infections spread and what are likely causes? |
|
|
Term
|
Definition
| common pathogen of hematogenous osteomyelitis in children |
|
|
Term
|
Definition
| Common pathogens of hematogenous osteomyelitis in adults |
|
|
Term
S. aureus most common
Gram negatives more prevalent with this (E. coli, Proteus, Pseudomonas aeruginosa (rare) from soles of shoes)
whenever soles of shoes are penetrated, Pseudomonas is a possible cause of osteomyelitis of the feet, but not too common. |
|
Definition
| common pathogens of contiguous osteomyelitis |
|
|
Term
nafcillin, oxacillin, cefazolin, or clindamycin alone in children for MSSA
Vancomycin in adult b/c MRSA likely
If Pseudomonas aeruginosa suspected (IV drug abuse, shoe/foot penetration, hospital acquired following surgery): antipseudomonal beta lactam - pipericillin/tazobactam
if vascular insufficiency there is an increased likelihood of anaerobes: add clindamycin or metronidazole
LENGTH OF TREATMENT is 4-6 weeks |
|
Definition
| treatment of osteomyelitis |
|
|
Term
there is confirmed osteomyelitis
completing a parenteral regimen in children who have had a good clinical response to IV antibiotics
adults without DM or peripheral vascular disease (vascular insufficiency prevents adequate drug concentration from reaching site of infection)
the organism is susceptible to the oral antimicrobial
a suitable oral agent is available
compliance is ensured |
|
Definition
| when can oral step down therapy be considered for patients with osteomyelitis? |
|
|
Term
joint disease (OA, RA)
arthrocentesis can introduce
corticosteroids, injected or systemic
replacement surgery
DM
trauma |
|
Definition
| risk factors for joint infections |
|
|
Term
children younger than 16 yo
adults older than 50 yo |
|
Definition
| what populations are most likely to get infectious arthritis? |
|
|
Term
|
Definition
| most common pathogen to cause infectious arthritis |
|
|
Term
APPROPRIATE ANTIBIOTICS, SURGICAL DRAINAGE, JOINT REST
nafcillin, oxacillin, cefazolin, or clindamycin alone in children for MSSA
Vancomycin in adult b/c MRSA likely
if Pseudomonas aeruginosa suspected: antipseudomonal beta lactams = piperacillin/ticarcillin
patients with established vascular insufficiency: increased likelihood of anaerobes - add clindamycin or metronidazole
ceftriaxone for 7-10 days in the young (infection due to Neisseria gonorrheae is common)
LENGTH OF TREATMENT is 2-3 weeks |
|
Definition
| treatment of infectious arthritis |
|
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