Management of Skin and Soft Tissue Infections in

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Nonpurulent Cellulitis: pathogen? β-hemolytic strep vs. S. aureus? • Prospective study, hospitalized patients (N=248) Methods – Acute and convalescent titers (ASO and anti-DNaseB) – Rx with β -lactam antibiotics (cefazolin/oxacillin) Results – 73% due to β-hemolytic strep; 27% none identified – 96% response rate to β-lactam antibiotic Siljander T. Clin Infect Dis. 2008 Jeng A. Medicine 2010. Elliott Pediatrics 2009 Summary: empiric management of SSTIs Uncomplicated Complicated •I&D Purulent (MRSA) Consider addition of anti-MRSA antibiotic in select situations 1 •I&D plus vancomycin (or alternative) 2 Non-purulent (β-hemolytic strep) • Cephalexin 500 QID • Dicloxacillin 500 QID Consider addition of MRSA active agent if no response 1 •Vancomycin (or alternative) 2 1. Systemic illness, purulent cellulitis/wound infection, comorbidities, extremes of age, abscess difficult to drain or face/hand, septic phlebitis, lack of response of to I&D alone. PO antibiotic : TMP-SMX 1 DS BID, Clindamycin 300 mg TID, Doxycycline 100 PO BID 2. Daptomycin, linezolid, telavancin, ceftaroline Empiric treatment of uncomplicated nonpurulent cellulitis? • Anti-β-hemolytic strep antibiotic (+/- anti-MSSA) Drug Adult Dose Cephalexin 500 QID Dicloxacillin 500 QID Clindamycin* 300-450 TID Linezolid* 600 BID *Have activity against MRSA • If poor response, add anti-MRSA antibiotic Empiric antibiotics for complicated SSTI Antibiotic Adult Pediatric Vancomycin 15-20 mg/kg IV Q8-12 15 mg/kg IV Q6 Linezolid 600 mg PO/ IV BID 10 mg/kg PO/IV Q8 Daptomycin 4 mg/kg IV QD Ongoing study Telavancin 10 mg/kg IV QD *No data Ceftaroline 600 mg IV Q12 *No data 4/12/2011 4
Classic impetigo Ecythema Impetigo Case 3 Bullous impetigo • Patient presents with 4 th abscess in 4 months • Prior abscesses have been treated with I&D and antibiotics with resolution • He asks if there is anything he can do to prevent recurrences Impetigo • Definition: superficial, intra-epidermal infection • Epi: Common in children, highly communicable • Pathogens: S. aureus, Group A strep • Treatment: – Few lesions (topical = systemic) • Mupirocin or Retapamulin ointment – Multiple lesions (systemic >> topical) • Pick agent(s) active against CA-MRSA and Group A strep How would you manage this patient? A. Emphasize personal hygiene measures B. Decolonize with mupirocin and chlorhexidine C. Decolonize with TMP-SMX and rifampin D. All the above 9% 65% 11% 15% A. B. C. D. 4/12/2011 5
Page 1 and 2: Management of Skin and Soft Tissue
Page 3: When to culture a purulent SSTI?
Page 7 and 8: Intra-nasal mupirocin to prevent CA
Page 9 and 10: Why is early diagnosis so important
Page 11 and 12: Animal bites: bacteriology What’s
Page 13: Nodular lymphangitis: management?

Management of Skin and Soft Tissue Infections in

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