Skin And Soft Tissue Infections: (Ssti) Questions And Answers

SKIN AND SOFT TISSUE INFECTIONS: (SSTI) QUESTIONS AND ANSWERS

● 2qsmostqscommonqsbacteriaqsthatqscauseqsskinqsinfections:qsS.qsAureusqs&qsS.qspyogenes
○ Gramqs(+)qs-qsStaphqs-qsmostqscommonqs-qscanqscauseqsMRSA
○ Gramqs(-)qs-qspresentqsinqswoundqsinfectionsqscausedqsby:
■ animalqsbites
■ traumaqsorqssurgery
■ exposedqstoqsinfectedqswaterqs(E.coli,qspseudomonasqsaeruginosa,qsprot
eusqsmirabilis)
● Skinqsinfectionsqscanqsbeqsnon-purulentqsorqspurulent

Folliculitis,qsFuruncle,qsCarbuncle
● MostqscommonlyqscausedqsbyqsS.qsAureusqs-qsMRSA
● Commonqsinqsathletes,qsshaving,qswaxing,qshotqstubs
● Occursqsinqsareasqswithqscoarseqshair

➔ Presentation:
◆ Pustulesqsinqshairqsshaft
◆ Tendernessqsandqsredness
◆ Ifqsrecurrentqs-qsaskqsifqsptqshasqsDM
◆ Noqsdiagnostics/labsqsneededqs-qsusually
● Ifqsrecurrentqsfurunclesqsandqscarbuncles
○ Culture
● IfqsMRSAqssuspected
○ Cultureqsnaresqsandqsaxilla
➔ Treatments:
◆ Hygiene
◆ Warm,qsmoistqscompress
◆ Betadine/Hibiclensqswashqs(Antisepticqswash)

➔ TreatmentqsforqsFolliculitis
◆ BenzoylqsPeroxideqs5%,qsBactrobanqsTID
◆ Clindamycinqsgel

➔ TreatmentqsforqsPurulentqsSSTI
◆ 1stqslineqs-qsIncisionqs&qsDrainageqs(I&D)
◆ C&S

, ➔ TreatmentsqsforqsFuruncleqsandqsCarbuncleqs(PO)
◆ Keflexqs500mgqs(Cephalosporinqs1stqsGen)qsq12qsxqs10-14qsdays
◆ MRSA
● BactrimqsDSqsODqs(Sulfonamide)qsxqs10qs-14qsdays
● Clindamycinqs300qsmgqsq6hqsxqs14qsdays

Cellulitis
● MostqscausedqsbyqsMRSA,qsStrep,qsH.qsFlu
● DifferentialqsDX:
○ Gout
○ Dermatitis
○ HerpesqsZoster

➔ Presentation:
◆ Erythema
◆ Warmth
◆ Pain
◆ Lymphedema
◆ Fissuring
◆ Abscess

➔ Diagnosticqstest/Labs:
◆ C&S
◆ CBCqs(Leukocytosis)
◆ BloodqsCX,qsESR
◆ Imagingqstoqsr/oqsOM

➔ Management:
◆ Hygiene,qselevation,qsmoistqsheat
◆ Pharma:
● Uncomplicated/nonsystematic:
○ PCNqs500qsmgqsq6
○ Keflexqs500qsmgqsq12qsxqs10-14qsdays
◆ IDSAqs-qsrxqsminqs5qsdays,qsextendqsifqsnoqsimprovement
○ MRSA:
◆ BactrimqsDSqsODqsxqs10-14qsdays
◆ Clindamycinqs300qsmgqsq6h

, ◆ Ptqsw/qscomorbidity:qsDM/HF
● Non-ulcer
○ Amoxicillin/Clavulanateqs500qsmgqsq12hqsxqs7-10qsdays
○ Quinoloneqs-qsCiproqs500-750qsmgqsq12hqsxqs7-14qsdays
◆ Gramqs(-)qsandqsanaerobicqscoverage
● Mildqsulcer
○ Ciproqs+qsClindamycin

◆ Followqsup:qs48qsHOURS!!!

➔ ReferqstoqsIDqs/Hospitalizeqsptsqsif:
◆ Immunocompromisedqsptqs=qsHOSPITALqsALWAYS!
◆ S/sqsofqstoxicity
● Tqs>100.5
● Hypotension
● Sustainedqstachycardia
◆ Rapidqsprogressionqsofqserythema
◆ Rapidqsprogressionqsofqsclinicalqsfindingsqsafterqs48hrsqsofqsantibxqstx
◆ Inabilityqstoqstolerateqsoralqstherapy
◆ Proximityqsofqstheqslesionqstoqsanqsindwellingqsmedicalqsdeviceqs(prostethicqs
jtqsorqsvascularqsgraft)
◆ Periorbitalqscellulitisqs=qsINPATIENTqsTX/qsREFERqsALWAYS!
◆ ReferqstoqsID:qshandqsinfection,qsinfectionqsfromqsbitesqs(considerqsadmission)

Dermatitis:
● ContactqsDermatitis
○ Allergic
■ Causes:qsNickelqs(jewelry),qsmedicationsqs(topicalqscream/ointments),qspois
onqsoaks,qspersonalqsproducts
■ Location:qsexposedqsareas,qsusuallyqshands
■ Symptoms:qspredominantlyqspruritus
■ Surfaceqsappearance:qsvesiclesqsandqsbullae
■ Lesionqsborders:qsdistinctqsangles,qsline,qsandqsborders
○ Irritant
■ Causes:qssolvents,qsbleach,qsalcohol,qschemicalsqsinqspersonalqsproducts
■ Location:qsusuallyqshands
■ Symptoms:qsburning,qspruritus,qspain
■ Surfaceqsappearance:qsdryqsfissuredqsskin
Lesionqsborders:qslessqsdistinct

, ➔ Diagnostics:
◆ ThoroughqsH&P
◆ diagnostic/labsqs-qsusuallyqsnotqsnecessaryqsunlessqsinfectionqsisqssuspected
● KOH
● Culture
● Patchqstestingqstoqsidentifyqscontactqsallergenqs-qsdermatologist
➔ Management:
◆ Symptomqsmanagement
◆ Identifyqscausativeqsagentsqsandqsavoid
◆ Preventqsinfection
◆ Pharma:
● Calamineqslotion,qscoolqscolloidalqsoatmealqsbathqstoqsreduceqspruritus
● Benadrylqs25-50qsmgqsPOqsPRN
● Mildqscases
○ Hydrocortisoneqscreamqsinqsaqsnon-rxqsstrengthqseg:qs0.1%
○ Midqs-qshighqspotencyqstopicalqssteroidsqsBID:
◆ Triamcinoloneqs0.1%qs-qsKenalog,qsAristocort
◆ Clobetasolqs0.05%qs-qsTemovate
● Barrierqscreamqs-qsZincqsoxideqs-qsmoistureqsandqsprotectqsskin
◆ UseqsofqsRXqscorticosteroid:
● Noqsimprovementqsinqsrashqsorqscontqstoqsspreadqs2-3qsdaysqsofqsself-care
● Itchingqsand/orqspainqsisqsSEVERE.
◆ UseqsPOqsorqsIMqssystemicqstherapy:
● Largeqsportionqsofqsskinqs(20%)
● Genitalqsorqsperiorbitalqsarea
● Ifqsveryqssevere
● Prednisoneqs0.5qs-qs1qsmgqsperqskg/day
○ s/sqsshouldqssubsideqsinqs12-24qshrs
○ Ifqstxqsisqseffectiveqsafterqsinitialqstherapy,qsdoseqsreduceqsbyqs50%qs
xqs5-7qsdays
◆ Antihistaminesqs-qscanqshelpqsw/qspruritusqsbutqssideqseffectsqscanqshelp
➔ Education:qsNOqsscratching,qsidentifyqsandqsavoidqscausativeqsagent,qsMOISTURIZE

● AtopicqsDermatitis
○ MostqscommonqsinqsAsianqsandqsAA
➔ Presentation:
◆ Dryqsskin
◆ Flexuralqssurface
◆ Lichenificationqsandqsscalingqs-qschronic
➔ Diagnosticqscriteria: