Podcast
Questions and Answers
What does the acronym SSTI stand for?
What does the acronym SSTI stand for?
- Systemic Skin Toxic Inflamation
- Serious Skin Trauma Infection (correct)
- Superficial Skin and Tissue Irritation
- Skin and Soft Tissue Infection
Which type of SSTI is characterized by collections of pus?
Which type of SSTI is characterized by collections of pus?
- Furuncles
- Cellulitis (correct)
- Erysipelas
- Cutaneous abscesses
What is a common initial clinical sign of impetigo?
What is a common initial clinical sign of impetigo?
- Systemic signs of infection
- Deep, aggressive infection (correct)
- Erythematous papules
- Hard, wooden feeling of tissue
Which of the following is a typical characteristic of cellulitis?
Which of the following is a typical characteristic of cellulitis?
What is the primary treatment for cutaneous abscesses?
What is the primary treatment for cutaneous abscesses?
Which of the following infections is often referred to as a 'flesh-eating infection'?
Which of the following infections is often referred to as a 'flesh-eating infection'?
What is a common causative organism for impetigo?
What is a common causative organism for impetigo?
What is the recommended duration of treatment with topical mupirocin for impetigo?
What is the recommended duration of treatment with topical mupirocin for impetigo?
What is a key characteristic of severe purulent SSTIs?
What is a key characteristic of severe purulent SSTIs?
What is the term for several adjacent furuncles?
What is the term for several adjacent furuncles?
In recurrent skin abscesses, what is typically included in the decolonization regimen?
In recurrent skin abscesses, what is typically included in the decolonization regimen?
Which antibiotic is commonly used to treat MSSA infections?
Which antibiotic is commonly used to treat MSSA infections?
What is the most common cause of cellulitis?
What is the most common cause of cellulitis?
What is a typical duration of antibiotic treatment for cellulitis?
What is a typical duration of antibiotic treatment for cellulitis?
What is a finding specific to necrotizing fasciitis?
What is a finding specific to necrotizing fasciitis?
What is the recommended management for carbuncles?
What is the recommended management for carbuncles?
Which term describes a superficial infection of the hair follicle?
Which term describes a superficial infection of the hair follicle?
Which of these is part of the decolonization process for recurrent skin abscesses?
Which of these is part of the decolonization process for recurrent skin abscesses?
What is a factor that may predispose someone to recurrent cellulitis?
What is a factor that may predispose someone to recurrent cellulitis?
In the context of SSTIs, what does 'I&D' stand for?
In the context of SSTIs, what does 'I&D' stand for?
What is the first-line management for furuncles?
What is the first-line management for furuncles?
Which of the following describes the appearance of impetigo?
Which of the following describes the appearance of impetigo?
In necrotizing fasciitis, what does the term 'crepitus' refer to?
In necrotizing fasciitis, what does the term 'crepitus' refer to?
Which group of individuals may require systemic antibiotics for mild cutaneous abscesses?
Which group of individuals may require systemic antibiotics for mild cutaneous abscesses?
What is a key componenet in the treatment of cellulitis?
What is a key componenet in the treatment of cellulitis?
What is the main difference between furuncles and carbuncles?
What is the main difference between furuncles and carbuncles?
What is the typical duration of treatment of S.aureus infections with oral agents?
What is the typical duration of treatment of S.aureus infections with oral agents?
Which part of the body is most commonly affected by cellulitis?
Which part of the body is most commonly affected by cellulitis?
What is the first step in treating nonpurulent cellulitis?
What is the first step in treating nonpurulent cellulitis?
Which of the following signs would classify a purulent SSTI as severe?
Which of the following signs would classify a purulent SSTI as severe?
Which of the following is used in decolonization regimen?
Which of the following is used in decolonization regimen?
Is staphylococcus aureus gram negative or gram positive?
Is staphylococcus aureus gram negative or gram positive?
What is 'BID' an abbreviation of?
What is 'BID' an abbreviation of?
True or False: Gram staining is necessary for diagnosis of impetigo.
True or False: Gram staining is necessary for diagnosis of impetigo.
What is the first-line treatment for a carbuncle?
What is the first-line treatment for a carbuncle?
What is the main sign of severe cellulitis?
What is the main sign of severe cellulitis?
What is the main component of treating recurrent skin infections?
What is the main component of treating recurrent skin infections?
What is the main characteristic found in cellulitis?
What is the main characteristic found in cellulitis?
The initial presentation of necrotizing fasciitis is similar to what other infection?
The initial presentation of necrotizing fasciitis is similar to what other infection?
Which of the following is typically the first-line treatment for cutaneous abscesses?
Which of the following is typically the first-line treatment for cutaneous abscesses?
What is a key characteristic of furuncles?
What is a key characteristic of furuncles?
What is a typical feature of a carbuncle?
What is a typical feature of a carbuncle?
For recurrent skin abscesses, what is a common step in the management process after draining and culturing early?
For recurrent skin abscesses, what is a common step in the management process after draining and culturing early?
What does decolonization typically involve for recurrent skin infections?
What does decolonization typically involve for recurrent skin infections?
What is a common causative organism for purulent SSTIs?
What is a common causative organism for purulent SSTIs?
What is generally considered the first-line management for purulent SSTIs?
What is generally considered the first-line management for purulent SSTIs?
Which of the following is a possible oral antibiotic option for treating MSSA infections?
Which of the following is a possible oral antibiotic option for treating MSSA infections?
What is a typical treatment duration with antibiotics for cellulitis?
What is a typical treatment duration with antibiotics for cellulitis?
What is the annual recurrence rate percentage for cellulitis?
What is the annual recurrence rate percentage for cellulitis?
In the context of skin infections, what does 'I&D' stand for?
In the context of skin infections, what does 'I&D' stand for?
What clinical finding strongly suggests necrotizing fasciitis?
What clinical finding strongly suggests necrotizing fasciitis?
Which of the following bacteria is a causative organism in necrotizing fasciitis?
Which of the following bacteria is a causative organism in necrotizing fasciitis?
What is an important early treatment for necrotizing fasciitis?
What is an important early treatment for necrotizing fasciitis?
What layers of the body can SSTIs involve?
What layers of the body can SSTIs involve?
In most cases, what is the typical cause of SSTIs?
In most cases, what is the typical cause of SSTIs?
Which of the following refers to small, raised skin lesions?
Which of the following refers to small, raised skin lesions?
What is the typical appearance of fluid-filled or pus-filled bumps?
What is the typical appearance of fluid-filled or pus-filled bumps?
What is often the appearance of the discharge seen in impetigo?
What is often the appearance of the discharge seen in impetigo?
In typical cases of impetigo, what is necessary for diagnosis?
In typical cases of impetigo, what is necessary for diagnosis?
The majority of SSTIs are caused by organisms:
The majority of SSTIs are caused by organisms:
What provides the first line of defense against skin infections?
What provides the first line of defense against skin infections?
In relation to severity, what classifies mild purulent SSTIs?
In relation to severity, what classifies mild purulent SSTIs?
In relation to severity, what classifies moderate purulent SSTIs?
In relation to severity, what classifies moderate purulent SSTIs?
What is the first-line management for cutaneous abscesses?
What is the first-line management for cutaneous abscesses?
What is the appearance of cutaneous abscesses?
What is the appearance of cutaneous abscesses?
What usually proceeds I&D in the management of recurrent skin abscesses?
What usually proceeds I&D in the management of recurrent skin abscesses?
What is the first step in treating furuncles?
What is the first step in treating furuncles?
What type of infection is a furuncle?
What type of infection is a furuncle?
What does management of carbuncles typically include?
What does management of carbuncles typically include?
What is the main sign of severe non-purulent SSTIs?
What is the main sign of severe non-purulent SSTIs?
What is a common symptom of moderate non-purulent SSTIs?
What is a common symptom of moderate non-purulent SSTIs?
What is a common causative organism in cellulitis?
What is a common causative organism in cellulitis?
Commonly, where on the body does cellulitis manifest?
Commonly, where on the body does cellulitis manifest?
In cases of cellulitis, it is important to:
In cases of cellulitis, it is important to:
What is the typical duration of treatment of cellulitis with antibiotics?
What is the typical duration of treatment of cellulitis with antibiotics?
When gynecologic cancer patients w/ surgery/radiation present with moderate infection cellulitis, which bacteria should be considered?
When gynecologic cancer patients w/ surgery/radiation present with moderate infection cellulitis, which bacteria should be considered?
What is considered a predisposing factor for cellulitis?
What is considered a predisposing factor for cellulitis?
What is a long-term solution to prevent against recurrent cellulitis?
What is a long-term solution to prevent against recurrent cellulitis?
What is a potential effect of bacterial toxins related to necrotizing fasciitis?
What is a potential effect of bacterial toxins related to necrotizing fasciitis?
What symptom is typically associated with necrotizing fasciitis?
What symptom is typically associated with necrotizing fasciitis?
What is a treatment component to suppress toxin and cytokine production?
What is a treatment component to suppress toxin and cytokine production?
What is one sign of necrotizing fasciitis?
What is one sign of necrotizing fasciitis?
What is a synonym for necrotizing fasciitis?
What is a synonym for necrotizing fasciitis?
What type of tissue infection is Fournier Gangrene?
What type of tissue infection is Fournier Gangrene?
What areas of the body does Fournier Gangrene affect?
What areas of the body does Fournier Gangrene affect?
What is a factor associated with the development of Fournier Gangrene?
What is a factor associated with the development of Fournier Gangrene?
In most cases, what are the infection characteristics of Fournier Gangrene?
In most cases, what are the infection characteristics of Fournier Gangrene?
What annual physician's office visit number can be contributed to SSTIs?
What annual physician's office visit number can be contributed to SSTIs?
In the adult dosage, what should Piperacillin-tazobactam be PLUS in combination with for first-line antimicrobial agents?
In the adult dosage, what should Piperacillin-tazobactam be PLUS in combination with for first-line antimicrobial agents?
What amount is the daily dosage of Ertapenem?
What amount is the daily dosage of Ertapenem?
A Cefotaxime of 2g q6h should be combined with what OR clindamycin?
A Cefotaxime of 2g q6h should be combined with what OR clindamycin?
How low must blood cultures test positive as to be considered an unnecessary culture?
How low must blood cultures test positive as to be considered an unnecessary culture?
What needs to be ruled out in an emergent surgical inspection for SSTIs?
What needs to be ruled out in an emergent surgical inspection for SSTIs?
What is the typical duration of topical mupirocin treatment for impetigo?
What is the typical duration of topical mupirocin treatment for impetigo?
What is a common symptom associated with moderate non-purulent SSTIs?
What is a common symptom associated with moderate non-purulent SSTIs?
What is a significant potential consequence of necrotizing fasciitis?
What is a significant potential consequence of necrotizing fasciitis?
How are most cases of impetigo diagnosed?
How are most cases of impetigo diagnosed?
What is a common first-line treatment for cutaneous abscesses?
What is a common first-line treatment for cutaneous abscesses?
What is often involved in the decolonization process for recurrent skin infections?
What is often involved in the decolonization process for recurrent skin infections?
Which bacteria is most commonly associated with causing cutaneous abscesses?
Which bacteria is most commonly associated with causing cutaneous abscesses?
What is the primary treatment for carbuncles?
What is the primary treatment for carbuncles?
What is a typical feature of cellulitis?
What is a typical feature of cellulitis?
What is considered first-line management for purulent SSTIs like cutaneous abscesses?
What is considered first-line management for purulent SSTIs like cutaneous abscesses?
What is a potential agent used in decolonization for recurrent skin infections?
What is a potential agent used in decolonization for recurrent skin infections?
What is generally the treatment duration for cellulitis with antibiotics?
What is generally the treatment duration for cellulitis with antibiotics?
What type of infection should be suspected if a patient has disproportionate pain relative to the clinical findings?
What type of infection should be suspected if a patient has disproportionate pain relative to the clinical findings?
What is the recommendation if a patient with infection has blood cultures with positive tests results of <5%?
What is the recommendation if a patient with infection has blood cultures with positive tests results of <5%?
In which scenario would systemic antibiotics likely be considered in addition to incision and drainage (I&D) for a cutaneous abscess?
In which scenario would systemic antibiotics likely be considered in addition to incision and drainage (I&D) for a cutaneous abscess?
What distinguishes a carbuncle from a furuncle in terms of their structural characteristics?
What distinguishes a carbuncle from a furuncle in terms of their structural characteristics?
Which of the following is the primary approach for managing furuncles, assuming there are no signs of systemic involvement?
Which of the following is the primary approach for managing furuncles, assuming there are no signs of systemic involvement?
What is the most appropriate next step in managing recurrent skin abscesses after initial drainage and culture?
What is the most appropriate next step in managing recurrent skin abscesses after initial drainage and culture?
What is a key component of decolonization for patients with recurrent skin abscesses?
What is a key component of decolonization for patients with recurrent skin abscesses?
What is the recommended approach to managing most purulent SSTIs?
What is the recommended approach to managing most purulent SSTIs?
According to the content, which oral antibiotic option is suitable for treating MSSA infections?
According to the content, which oral antibiotic option is suitable for treating MSSA infections?
In a patient with cellulitis, what factor necessitates consideration of MRSA as a possible causative organism?
In a patient with cellulitis, what factor necessitates consideration of MRSA as a possible causative organism?
What is the standard duration of antibiotic treatment for cellulitis, according to the guidelines presented?
What is the standard duration of antibiotic treatment for cellulitis, according to the guidelines presented?
What is the typical annual recurrence rate for cellulitis, even with appropriate management?
What is the typical annual recurrence rate for cellulitis, even with appropriate management?
What underlying condition is MOST associated with leading to cellulitis?
What underlying condition is MOST associated with leading to cellulitis?
What is the general recommendation for managing cellulitis in a patient with positive blood cultures of <5%?
What is the general recommendation for managing cellulitis in a patient with positive blood cultures of <5%?
A patient presents with a skin infection displaying pain that seems disproportionately severe compared to the visible signs. Which condition should be suspected?
A patient presents with a skin infection displaying pain that seems disproportionately severe compared to the visible signs. Which condition should be suspected?
When examining a patient suspected to have necrotizing fasciitis, which of these physical exam findings would be most indicative of the infection?
When examining a patient suspected to have necrotizing fasciitis, which of these physical exam findings would be most indicative of the infection?
What is the MOST immediate and critical step in the management of necrotizing fasciitis?
What is the MOST immediate and critical step in the management of necrotizing fasciitis?
In the context of necrotizing fasciitis, why is clindamycin often used as an adjunct to other antibiotics?
In the context of necrotizing fasciitis, why is clindamycin often used as an adjunct to other antibiotics?
A patient is diagnosed with Fournier gangrene. What is the primary characteristic that defines this condition?
A patient is diagnosed with Fournier gangrene. What is the primary characteristic that defines this condition?
What is a frequent characteristic related to Fournier Gangrene?
What is a frequent characteristic related to Fournier Gangrene?
What is a primary consideration for diagnosing impetigo?
What is a primary consideration for diagnosing impetigo?
Which antibiotic is identified as a possible first-line antimicrobial agent for treating necrotizing infections caused by Streptococcus species or Clostridium species?
Which antibiotic is identified as a possible first-line antimicrobial agent for treating necrotizing infections caused by Streptococcus species or Clostridium species?
Which type of SSTI is characterized by eryhtematous papules that turn into vesicles or pustules that rupture, eventually leading to a honey-colored discharge?
Which type of SSTI is characterized by eryhtematous papules that turn into vesicles or pustules that rupture, eventually leading to a honey-colored discharge?
An immunocompromised patient presents with a suspected non-purulent SSTI. Which of the following characteristics would classify the infection as 'severe'?
An immunocompromised patient presents with a suspected non-purulent SSTI. Which of the following characteristics would classify the infection as 'severe'?
A patient is diagnosed with erysipelas. What is the main difference between erysipelas and cellulitis?
A patient is diagnosed with erysipelas. What is the main difference between erysipelas and cellulitis?
What is the most common causative agent for cellulitis?
What is the most common causative agent for cellulitis?
A patient with a history of gynecologic cancer who recently underwent surgery and radiation presents with cellulitis. Which specific bacterial etiology should be of heightened concern in this case?
A patient with a history of gynecologic cancer who recently underwent surgery and radiation presents with cellulitis. Which specific bacterial etiology should be of heightened concern in this case?
Which factor is LEAST likely to be a predisposing condition for cellulitis?
Which factor is LEAST likely to be a predisposing condition for cellulitis?
A patient with cellulitis is being considered for oral antibiotic therapy. Which of the following medications, if used, illustrates an appropriate choice based on common causative organisms?
A patient with cellulitis is being considered for oral antibiotic therapy. Which of the following medications, if used, illustrates an appropriate choice based on common causative organisms?
A 62-year-old male presents with a painful, rapidly spreading skin infection. Examination reveals crepitus and a 'wooden' induration of the subcutaneous tissues. Which diagnostic method would be most useful in confirming the suspected diagnosis?
A 62-year-old male presents with a painful, rapidly spreading skin infection. Examination reveals crepitus and a 'wooden' induration of the subcutaneous tissues. Which diagnostic method would be most useful in confirming the suspected diagnosis?
What is the most common causative organism for cellulitis in an otherwise healthy adult patient?
What is the most common causative organism for cellulitis in an otherwise healthy adult patient?
According to the materials, what is the primary goal of emergent surgical inspection/debridement when examining SSTIs?
According to the materials, what is the primary goal of emergent surgical inspection/debridement when examining SSTIs?
Which of the following is NOT a potential treatment strategy?
Which of the following is NOT a potential treatment strategy?
A patient with Fournier gangrene MOST commonly has which comorbidity?
A patient with Fournier gangrene MOST commonly has which comorbidity?
What are the age ranges typically associated with Fournier Gangrene?
What are the age ranges typically associated with Fournier Gangrene?
What is the first component to treating a carbuncle?
What is the first component to treating a carbuncle?
What is the best way to treat against S. Aureus infections?
What is the best way to treat against S. Aureus infections?
Is it necessary to send off gram stain for diagnosis of impetigo?
Is it necessary to send off gram stain for diagnosis of impetigo?
What is a treatment that must always be a part of Necrotizing Fasciitis and not optional?
What is a treatment that must always be a part of Necrotizing Fasciitis and not optional?
What is the symptom that is paired with Necrotizing Fasciitis, compared to cellulitis, that makes it different?
What is the symptom that is paired with Necrotizing Fasciitis, compared to cellulitis, that makes it different?
Impetigo is often caused by...
Impetigo is often caused by...
You are treating a case of cellulitis that is spreading. Which of these antibiotic options is the BEST choice for IV treatment?
You are treating a case of cellulitis that is spreading. Which of these antibiotic options is the BEST choice for IV treatment?
Which of the following refers to the location of cellulitis?
Which of the following refers to the location of cellulitis?
Which of the following is an appropriate treatment duration for oral antibiotics prescribed for impetigo caused by S. aureus?
Which of the following is an appropriate treatment duration for oral antibiotics prescribed for impetigo caused by S. aureus?
In managing recurrent skin abscesses, what is the next step after initial drainage and culturing is performed?
In managing recurrent skin abscesses, what is the next step after initial drainage and culturing is performed?
A patient has a furuncle with signs of systemic involvement. What management strategy is most appropriate?
A patient has a furuncle with signs of systemic involvement. What management strategy is most appropriate?
What is a key difference between cellulitis and necrotizing fasciitis in terms of clinical presentation?
What is a key difference between cellulitis and necrotizing fasciitis in terms of clinical presentation?
In the treatment of necrotizing fasciitis, why is clindamycin often included in the antibiotic regimen?
In the treatment of necrotizing fasciitis, why is clindamycin often included in the antibiotic regimen?
A patient with a skin infection is diagnosed with Fournier gangrene. What area of the body is affected?
A patient with a skin infection is diagnosed with Fournier gangrene. What area of the body is affected?
In necrotizing fasciitis, which of the following imaging findings would support the diagnosis?
In necrotizing fasciitis, which of the following imaging findings would support the diagnosis?
A 55-year-old patient is diagnosed with Fournier gangrene. Which comorbidity is MOST commonly associated with this condition?
A 55-year-old patient is diagnosed with Fournier gangrene. Which comorbidity is MOST commonly associated with this condition?
What is the most appropriate initial step in the management of a carbuncle?
What is the most appropriate initial step in the management of a carbuncle?
A patient presents with a non-purulent skin infection. Which of the following findings would classify the infection as 'severe'?
A patient presents with a non-purulent skin infection. Which of the following findings would classify the infection as 'severe'?
Which organism is a less common cause of cellulitis and should be considered in specific patient populations, such as those who have undergone gynecologic surgery/radiation therapy?
Which organism is a less common cause of cellulitis and should be considered in specific patient populations, such as those who have undergone gynecologic surgery/radiation therapy?
A patient with cellulitis is being treated with intravenous antibiotics. After a few days, blood cultures show minimal growth (<5%). What is the MOST appropriate course of action?
A patient with cellulitis is being treated with intravenous antibiotics. After a few days, blood cultures show minimal growth (<5%). What is the MOST appropriate course of action?
Which of the following is included as part of the decolonization process used in patients with recurrent skin infections?
Which of the following is included as part of the decolonization process used in patients with recurrent skin infections?
What is a common causative organism for cutaneous abscesses?
What is a common causative organism for cutaneous abscesses?
A patient presents with a skin infection involving the deep dermis and subcutaneous tissues, but without systemic signs. Which of the following best classifies this infection, considering both purulence and severity?
A patient presents with a skin infection involving the deep dermis and subcutaneous tissues, but without systemic signs. Which of the following best classifies this infection, considering both purulence and severity?
What is a crucial element in the initial assessment of a suspected necrotizing fasciitis case that guides immediate management?
What is a crucial element in the initial assessment of a suspected necrotizing fasciitis case that guides immediate management?
In managing a patient with a large carbuncle, what additional factor would most strongly influence the decision to include systemic antibiotics in addition to incision and drainage?
In managing a patient with a large carbuncle, what additional factor would most strongly influence the decision to include systemic antibiotics in addition to incision and drainage?
A patient with recurrent furunculosis is undergoing decolonization. Besides intranasal mupirocin, which of the following is a critical recommendation to prevent the spread of infection to others?
A patient with recurrent furunculosis is undergoing decolonization. Besides intranasal mupirocin, which of the following is a critical recommendation to prevent the spread of infection to others?
A patient with diabetes develops a rapidly progressing skin infection. What characteristic suggests progression to necrotizing fasciitis rather than severe cellulitis?
A patient with diabetes develops a rapidly progressing skin infection. What characteristic suggests progression to necrotizing fasciitis rather than severe cellulitis?
When deciding between antibiotic options for a patient with cellulitis, which factor should MOST strongly influence the decision to empirically cover for MRSA?
When deciding between antibiotic options for a patient with cellulitis, which factor should MOST strongly influence the decision to empirically cover for MRSA?
A patient with necrotizing fasciitis requires empiric antibiotic therapy. In addition to Vancomycin or Linezolid, what would be the MOST appropriate choice?
A patient with necrotizing fasciitis requires empiric antibiotic therapy. In addition to Vancomycin or Linezolid, what would be the MOST appropriate choice?
What is the primary rationale for including clindamycin in the treatment regimen for necrotizing fasciitis, beyond its antibacterial activity?
What is the primary rationale for including clindamycin in the treatment regimen for necrotizing fasciitis, beyond its antibacterial activity?
Following incision and drainage of a cutaneous abscess, a patient is prescribed oral antibiotics. Which antibiotic would be MOST appropriate in this scenario?
Following incision and drainage of a cutaneous abscess, a patient is prescribed oral antibiotics. Which antibiotic would be MOST appropriate in this scenario?
In the management of recurrent skin abscesses, after initial drainage and culture, what is the NEXT appropriate step?
In the management of recurrent skin abscesses, after initial drainage and culture, what is the NEXT appropriate step?
Which intervention is MOST critical in the management of necrotizing fasciitis?
Which intervention is MOST critical in the management of necrotizing fasciitis?
A patient presents with an early, non-distinct skin infection. Which clinical finding is MOST suggestive of necrotizing fasciitis?
A patient presents with an early, non-distinct skin infection. Which clinical finding is MOST suggestive of necrotizing fasciitis?
In the management of a patient with necrotizing fasciitis, what represents the optimal duration of intravenous antibiotics following the most recent debridement?
In the management of a patient with necrotizing fasciitis, what represents the optimal duration of intravenous antibiotics following the most recent debridement?
For a patient diagnosed with Fournier gangrene, what is the most critical initial step in management?
For a patient diagnosed with Fournier gangrene, what is the most critical initial step in management?
What is the MAIN predisposing factor commonly associated with Fournier gangrene?
What is the MAIN predisposing factor commonly associated with Fournier gangrene?
What is the MAIN objective of surgical exploration/debridement?
What is the MAIN objective of surgical exploration/debridement?
Which of the following characteristics is MOST indicative of severe non-purulent SSTI?
Which of the following characteristics is MOST indicative of severe non-purulent SSTI?
In a patient with cellulitis who has recently undergone gynecologic surgery and radiation therapy, which specific bacterial etiology should raise the HIGHEST level of concern and prompt targeted antibiotic selection?
In a patient with cellulitis who has recently undergone gynecologic surgery and radiation therapy, which specific bacterial etiology should raise the HIGHEST level of concern and prompt targeted antibiotic selection?
Regarding the management of impetigo, under what circumstance would oral rather than topical antibiotics be MOST appropriate?
Regarding the management of impetigo, under what circumstance would oral rather than topical antibiotics be MOST appropriate?
When should systemic antibiotics be added to incision and drainage (I&D) for mild infection of cutaneous abscesses?
When should systemic antibiotics be added to incision and drainage (I&D) for mild infection of cutaneous abscesses?
What is the usual treatment for furnucles?
What is the usual treatment for furnucles?
Based on the outline in the slides which of the following is the correct order of infections (SSTIs)?
Based on the outline in the slides which of the following is the correct order of infections (SSTIs)?
Which of the following best describes the initial presentation of cellulitis?
Which of the following best describes the initial presentation of cellulitis?
Which the of following is a sign of Necrotizing Fasciitis, but not cellulitis?
Which the of following is a sign of Necrotizing Fasciitis, but not cellulitis?
A positive reading of less than 5% from a blood culture is?
A positive reading of less than 5% from a blood culture is?
What are the main infections caused by Non-purulent ABSSSIs?
What are the main infections caused by Non-purulent ABSSSIs?
Regarding the management of severe non-purulent SSTIs, which intervention should be prioritized?
Regarding the management of severe non-purulent SSTIs, which intervention should be prioritized?
In managing recurrent skin abscesses, after the process of drying and culturing, what is the NEXT appropriate step?
In managing recurrent skin abscesses, after the process of drying and culturing, what is the NEXT appropriate step?
80% of the cases caused by Fournier Gangrene are caused by?
80% of the cases caused by Fournier Gangrene are caused by?
What part of the body does Fournier Gangrene target?
What part of the body does Fournier Gangrene target?
Which are the FIRST things that happen through Carbuncle Management?
Which are the FIRST things that happen through Carbuncle Management?
Which of the following is NOT a sign of severity in Non-Purulent SSTI?
Which of the following is NOT a sign of severity in Non-Purulent SSTI?
What is the recommendation for a patient with necrotizing fasciitis and has been administered an antimicrobial agent?
What is the recommendation for a patient with necrotizing fasciitis and has been administered an antimicrobial agent?
For treatment with antibiotics for skin infections which duration is mostly used?
For treatment with antibiotics for skin infections which duration is mostly used?
What is the FIRST thing someone should do when dealing with recurrent skin abscesses?
What is the FIRST thing someone should do when dealing with recurrent skin abscesses?
What should be considered for a patient who receives the following symtpoms "Gynecologic cancer w/ surgery/radiation"?
What should be considered for a patient who receives the following symtpoms "Gynecologic cancer w/ surgery/radiation"?
A patient diagnosed with impetigo based on clinical presentation should next undergo what?
A patient diagnosed with impetigo based on clinical presentation should next undergo what?
What are the two most common causative organisms of Impetigo?
What are the two most common causative organisms of Impetigo?
What is the typical duration of treatment with an oral agent when treating impetigo caused by S. aureus?
What is the typical duration of treatment with an oral agent when treating impetigo caused by S. aureus?
For treatment for a patient with Strep Skin infections, which of the following amounts of Penicillin units should be considered?
For treatment for a patient with Strep Skin infections, which of the following amounts of Penicillin units should be considered?
What is a key feature of carbuncles?
What is a key feature of carbuncles?
According to the FDA, what is the required lesion size for a bacterial skin and structure infection?
According to the FDA, what is the required lesion size for a bacterial skin and structure infection?
What is the recurrence rate percentage for cellulitis?
What is the recurrence rate percentage for cellulitis?
Which of the following is a factor for recurrent cellulitis?
Which of the following is a factor for recurrent cellulitis?
Which of the following is a bacterial causative organism for necrotizing?
Which of the following is a bacterial causative organism for necrotizing?
In necrotizing fasciitis, what is the implication of bacterial toxins beyond direct tissue damage?
In necrotizing fasciitis, what is the implication of bacterial toxins beyond direct tissue damage?
Why is clindamycin often included in the treatment regimen for necrotizing fasciitis, in addition to its antibacterial properties?
Why is clindamycin often included in the treatment regimen for necrotizing fasciitis, in addition to its antibacterial properties?
In the management of severe non-purulent SSTIs, which intervention should be prioritized alongside antibiotic therapy?
In the management of severe non-purulent SSTIs, which intervention should be prioritized alongside antibiotic therapy?
What distinguishes Fournier gangrene from other necrotizing soft tissue infections?
What distinguishes Fournier gangrene from other necrotizing soft tissue infections?
For a patient with a severe non-purulent SSTI and requires empiric antibiotic therapy, what would be the most appropriate combination to start?
For a patient with a severe non-purulent SSTI and requires empiric antibiotic therapy, what would be the most appropriate combination to start?
What statement reflects the appropriate use of systemic antibiotics in the management of cutaneous abscesses?
What statement reflects the appropriate use of systemic antibiotics in the management of cutaneous abscesses?
In managing recurrent skin abscesses, what is the purpose of evaluating and considering other underlying causes that may be contributing to recurring infections?
In managing recurrent skin abscesses, what is the purpose of evaluating and considering other underlying causes that may be contributing to recurring infections?
Following incision and drainage of a carbuncle, antibiotic choice should be guided by:
Following incision and drainage of a carbuncle, antibiotic choice should be guided by:
A patient presents with a skin infection characterized by pain that is severely disproportionate (out of proportion) to the visible clinical findings. What does this suggest?
A patient presents with a skin infection characterized by pain that is severely disproportionate (out of proportion) to the visible clinical findings. What does this suggest?
What patient population requires systemic antibiotics for mild cutaneous abscesses?
What patient population requires systemic antibiotics for mild cutaneous abscesses?
A patient presents with an early-stage skin infection. Which of the following findings would most strongly suggest necrotizing fasciitis over cellulitis?
A patient presents with an early-stage skin infection. Which of the following findings would most strongly suggest necrotizing fasciitis over cellulitis?
For recurrent skin abscesses, what is the next step in management after draining and culturing?
For recurrent skin abscesses, what is the next step in management after draining and culturing?
Which patient is MOST likely to benefit from prophylactic antibiotics for recurrent cellulitis?
Which patient is MOST likely to benefit from prophylactic antibiotics for recurrent cellulitis?
Which of the following empiric IV antibiotic regimens would be MOST appropriate for necrotizing fasciitis caused by Streptococcus pyogenes?
Which of the following empiric IV antibiotic regimens would be MOST appropriate for necrotizing fasciitis caused by Streptococcus pyogenes?
A 58-year-old male presents with a necrotizing infection of the perineum that is subsequently diagnosed as Fournier gangrene. Which comorbidity is MOST commonly associated with this condition?
A 58-year-old male presents with a necrotizing infection of the perineum that is subsequently diagnosed as Fournier gangrene. Which comorbidity is MOST commonly associated with this condition?
Flashcards
SSTI Review
SSTI Review
Review common skin and soft tissue infections.
Purulent vs. Non-Purulent SSTIs
Purulent vs. Non-Purulent SSTIs
Differentiate between purulent and non-purulent SSTIs and manage each appropriately.
SSTI Comprehension
SSTI Comprehension
Understand epidemiology, pathogenesis, microbiology, clinical features, diagnosis, and treatment for purulent, non-purulent SSTIs, and necrotizing fasciitis
ABSSSI Definition
ABSSSI Definition
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What does SSTI stand for?
What does SSTI stand for?
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What is an SSTI?
What is an SSTI?
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Impetigo Causative Organisms
Impetigo Causative Organisms
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What is Impetigo's presentation?
What is Impetigo's presentation?
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Mild, Moderate, or Severe?
Mild, Moderate, or Severe?
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What do cutaneous abscesses look like?
What do cutaneous abscesses look like?
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Treating Furuncles
Treating Furuncles
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What are furuncles?
What are furuncles?
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How do you manage Cellulitis?
How do you manage Cellulitis?
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What are carbuncles?
What are carbuncles?
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Necrotizing Fasciitis
Necrotizing Fasciitis
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How should Necrotizing Fasciitis be addressed?
How should Necrotizing Fasciitis be addressed?
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What are SSTIs?
What are SSTIs?
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Key Aspects of SSTIs
Key Aspects of SSTIs
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What is SSTI?
What is SSTI?
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What is SSI?
What is SSI?
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What is ABSSSI?
What is ABSSSI?
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Treatment for impetigo
Treatment for impetigo
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Purulent SSTI – Severe?
Purulent SSTI – Severe?
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How should cutaneous abscesses be managed?
How should cutaneous abscesses be managed?
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Furuncles Presentation
Furuncles Presentation
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How does carbuncles present?
How does carbuncles present?
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Decolonization of Recurrent Skin Abscesses
Decolonization of Recurrent Skin Abscesses
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Cellulitis Management
Cellulitis Management
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Presentation of Necrotizing Fasciitis?
Presentation of Necrotizing Fasciitis?
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Necrotizing Fasciitis & Toxins
Necrotizing Fasciitis & Toxins
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Impetigo
Impetigo
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Cutaneous Abscesses
Cutaneous Abscesses
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Furuncles
Furuncles
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Carbuncles
Carbuncles
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Cellulitis
Cellulitis
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Cutaneous Abscesses Management
Cutaneous Abscesses Management
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Cutaneous Abscesses Causative Organism
Cutaneous Abscesses Causative Organism
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Decolonization
Decolonization
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Managing Carbuncles
Managing Carbuncles
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Treating Cellulitis
Treating Cellulitis
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Necrotizing Fasciitis Management
Necrotizing Fasciitis Management
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Cellulitis Presentation
Cellulitis Presentation
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Necrotizing fasciitis presentation
Necrotizing fasciitis presentation
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Study Notes
- The lecture is about Skin and Soft Tissue Infections (SSTIs).
Objectives
- Review the most common skin and soft tissue infections (SSTIs).
- Be able to differentiate between purulent and non-purulent SSTIs
- Understand the appropriate management for each type of SSTI.
- Learn to discuss the epidemiology, pathogenesis, microbiology, clinical manifestations, diagnosis, and treatment of purulent and non-purulent SSTIs and necrotizing fasciitis.
SSTI Definitions
- SSTI is a skin and soft tissue infection.
- SSI refers to a skin and skin structure infection.
- ABSSSI is an acute bacterial skin and skin structure infection.
Epidemiology
- Approximately 14 million people per year get skin and soft tissue infections (SSTIs).
- Inpatient admissions and outpatient office visits for SSTIs increased by 65% over a 9-year period in the early 2000s.
- SSTIs account for 2% of all hospitalizations.
- SSTIs account for 6.3 million physician office visits each year.
SSTIs
- SSTIs involve any or all layers of the skin, fascia, and muscle.
- They are generally caused by a single pathogen.
- Exceptions include diabetic foot infections, bite wounds, and burn wounds.
Pathophysiology
- Intact skin provides a defense against infection.
- Disruption of normal host defenses, such as through skin puncture or abrasion, can lead to infection.
- Most SSTIs are caused by organisms present on the skin surface.
Outline of SSTIs
- The lecture will cover:
- Impetigo
- Purulent ABSSSIs
- Non-purulent ABSSSIs
- Necrotizing fasciitis
Impetigo
- Impetigo presents with erythematous papules that evolve into vesicles and pustules that rupture.
- This leads to a honey-colored dry discharge on an erythematous base.
- The papules are small, raised skin lesions.
- Vesicles and pustules are fluid- or pus-filled bumps.
- Diagnosis is typically based on clinical presentation, with Gram stain and culture not usually necessary.
- The most common causative organisms are Staphylococcus aureus and Streptococcus species.
- Treatment includes topical mupirocin applied twice daily for 5 days, as effective as oral antimicrobials.
- An oral agent active against S. aureus can also be used for 7 days, especially if the organism is methicillin-susceptible.
- Oral treatments are preferred if there are numerous lesions or outbreaks affecting multiple people.
Purulent SSTI Severity
- Mild cases have none of the severity features.
- Moderate cases are marked by systemic signs of infection.
- Severe cases include failed incision and drainage with antibiotics, systemic infection signs (>38°C, HR >90 bpm, RR > 24, abnormal WBC), or immunocompromised patients.
Management of SSTIs
- Management of SSTIs is broken down into
- Non-purulent SSTIs
- Purulent SSTIs
Purulent SSTIs
- Cutaneous abscesses, furuncles, and carbuncles are types of purulent SSTIs.
- Cutaneous abscesses are collections of pus that are painful, tender, and red nodules encircled by erythematous swelling, most commonly caused by Staphylococcus aureus.
- The first-line management of cutaneous abscesses is incision and drainage (I&D).
- Moderate-to-severe cases require culture and susceptibilities testing.
- Adding systemic antibiotics does not improve cure rates for mild infections.
- Consider antibiotics for moderate-to-severe cases with systemic infection, extremes of age, multiple abscesses, severely impaired host defenses, or lack of response to I&D.
- Furuncles are superficial infections of the hair follicle, presenting as inflammatory nodules with overlying pustules, typically caused by S. aureus.
- Furuncles often rupture and drain spontaneously or with moist heat.
- Large furuncles may require I&D with or without culture and sensitivity testing.
- Systemic antibiotics are usually unnecessary unless there are fever or other signs of systemic infection.
- Carbuncles involve several adjacent furuncles, forming an inflammatory mass with pus draining from multiple orifices, commonly on the back of the neck.
- The management of carbuncles involves first-line I&D with or without culture and sensitivity testing.
- Systemic antibiotics are typically only necessary in the presence of fever or other signs of systemic infection.
Recurrent Skin Abscesses
- Should be addressed with drainage and culture early.
- Treat the identified pathogen.
- Evaluate for and consider other causes, such as implementing a 5-day decolonization regimen.
- Decolonization involves:
- Intranasal mupirocin applied twice daily
- Daily chlorhexidine washes
- Decontamination of towels, sheets, and clothes.
Purulent SSTI Summary
- Staphylococcus aureus should be considered as the primary causative agent.
- First-line management involves incision and drainage (I&D).
- Cultures and susceptibilities testing should be done for moderate or severe infections.
- Consider antibiotics as indicated.
Antibiotic Treatment Options for Purulent SSTIs
- For MRSA (IV): vancomycin, daptomycin, ceftaroline, telavancin, dalbavancin, oritavancin, and delafloxacin.
- For MRSA (PO): linezolid, tedizolid, clindamycin, doxycycline, minocycline, or trimethoprim-sulfamethoxazole.
- For MSSA (IV/PO): nafcillin, oxacillin, dicloxacillin, cephalexin, or cefazolin.
Non-Purulent SSTI Severity
- Mild infections show none of the below symptoms.
- Moderate infections show signs or symptoms of systemic infection.
- Severe infections indicate the following
- Failed antibiotics
- Systemic signs of infection (Systemic signs of infection: >38°C, HR >90 bpm, RR > 24, abnormal WBC)
- Immunocompromised
- Signs of deeper infection (skin sloughing, hypotension, organ dysfunction)
Non-Purulent ABSSSI
- These conditions include diffuse, superficial spreading.
- Erysipelas and cellulitis are examples.
- Cellulitis often presents with fragile skin, trauma, ulceration, and edema from venous insufficiency.
- Breaks in the skin may be unapparent or small.
- It’s most common on the lower legs and involves skin that is red, swollen, and warm to the touch.
Cellulitis Microbiology
- Streptococcus species is the most common cause, including group A Strep.
- For moderate infection, consider MSSA.
- Other considerations include:
- Gynecologic cancer with surgery/radiation with Group B Strep
- Open wound or known MRSA colonization with MRSA
Cellulitis Management
- Elevate the affected area.
- Cultures are typically unnecessary.
- Blood cultures might be positive less than 5% of the time.
- Exceptions include on chemotherapy, severe systemic features, animal bites, water immersion injuries, neutropenia, and severe cell-mediated immunodeficiency.
Antibiotics for Strep Skin Infections
- IV options include
- Penicillin 2-4 million units q4-6h
- Clindamycin 600-900 mg q8h
- Nafcillin 1-2 g q4-6h
- Oral options include
- Penicillin VK 250-500 mg q6h
- Cephalexin 500 mg q6h
Recurrent Cellulitis
- Annual recurrence rates range from 8-20%.
- Predisposing factors include edema, obesity, eczema, venous insufficiency, toe web abnormalities, tobacco use, and homelessness.
- Consider prophylactic antibiotics for patients who have 3-4 episodes per year despite controlling predisposing factors.
- Options include penicillin (PO/IM) and erythromycin.
Necrotizing Fasciitis
- Necrotizing fasciitis is also known as a flesh-eating infection.
- It involves a deep with aggressive infection that can lead to major tissue destruction and death.
- It may develop from an initial break in the skin or have no known portal of entry and be due to nonpenetrating trauma.
- It requires a surgical emergency.
Presentation/Findings of Necrotizing Fasciitis
- Initial presentation is similar to cellulitis.
- Pain is out of proportion to the examination.
- The tissue feels hard and wooden.
- Crepitus, a cracking/crunching sound due to air, may be present.
- CT/MRI may show edema or necrosis.
- The fascia is swollen and grey with a brownish exudate, but there is no true pus.
Causative Organisms of Necrotizing Fasciitis
- Streptococcus pyogenes.
- Staphylococcus aureus.
- Aeromonas hydrophila.
- Vibrio vulnificus.
- Polymicrobial infections
- Related to Perianal abscesses, decubitus ulcers, injection sites in IVDU
- Spread from genital site
Necrotizing Fasciitis Treatment Plan
- Prompt surgical intervention.
- Broad empiric antibiotic treatment must be started.
- Broad empiric antibiotic treatment, targeting MRSA, aerobes, and anaerobes.
- Vancomycin/linezolid/daptomycin, PLUS one of the following. - Piperacillin/tazobactam - Carbapenem - Ceftriaxone + metronidazole - Fluoroquinolone + metronidazole
- Duration of treatment continues until
- Debridement is no longer necessary, combined with Clinical improvement.
- Patient needs to be Fever-free for 48-72 hours.
Treatment of Necrotizing Infections
- Mixed infections can be treated with - Piperacillin-tazobactam PLUS vancomycin - Imipenem-cilastatin - Meropenem - Ertapenem - Cefotaxime PLUS metronidazole OR clindamycin
- Streptococcus species or Clostridium species can be treated with - Penicillin PLUS clindamycin
- Staphylococcus aureus can be treated with - Nafcillin/oxacillin - Cefazolin - Vancomycin - Clindamycin
- Aeromonas can be treated with - Doxycycline PLUS ciprofloxacin
- Bacterial toxins may result in organ failure, shock, and tissue destruction.
- Adjunct clindamycin may use used to help suppression of toxin and cytokine production - Also consider: IVIG OR Linezolid
Fournier Gangrene
- A type of necrotizing soft tissue infection that involves the scrotum, penis, or vulva.
- Common onset is between ages 50-60 years; 80% w/ underlying diseases, commonly diabetes
- It is most often polymicrobial.
- It should be treated as with other necrotizing fasciitis infections.
FDA Guidance on ABSSSI
- The FDA defines acute bacterial skin and skin structure infection (ABSSSI) as a bacterial infection of the skin.
- With lesion size area of at least 75 cm².
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Description
This lecture reviews common skin and soft tissue infections (SSTIs) and their management. It differentiates between purulent and non-purulent SSTIs. Also, it discusses the epidemiology, pathogenesis, microbiology, clinical manifestations, diagnosis, and treatment of various SSTIs.
