Skin & Skin Structure Infections

Any systemic symptoms automatically place the patient in the severe category!

The question asks for the missing word that completes the list of the 4 Cs. The previous words in the list are "crowing, cleanliness, contamination," and the missing word is "contact." This suggests that the 4 Cs are related to some sort of criteria or factors, possibly in a specific context such as hygiene or disease prevention.

Contiguous osteomyelitis refers to an infection that spreads from an adjacent soft-tissue infection. It is often caused by direct inoculation from trauma or surgery and commonly occurs in the long bones, feet, and toes. This type of infection is different from hematogenous osteomyelitis, which occurs when bacteria from another part of the body spread through the bloodstream to the bone.

Linezolid is the correct answer because it is known to have the potential to cause irreversible peripheral neuropathy and thrombocytopenia if used for more than 2 weeks. This side effect is important to consider when prescribing linezolid and monitoring patients who are on this medication for an extended period of time.

Erysipelas is a bacterial skin infection characterized by intense red color, raised, and well-demarcated edges. It is commonly associated with streptococci (s. pyogenes) and sometimes staphylococcus bacteria. Penicillin (PCN) is typically the treatment of choice if the infection is caused by streptococci.

Diabetic foot infections can be caused by various pathogens, but the most commonly isolated ones are Staphylococcus aureus and Enterococcus faecalis. However, it is important to note that gram-positive, gram-negative, and anaerobic bacteria can also be present in these infections. Additionally, not all diabetic foot ulcers are infected, so it is crucial to evaluate the wound and determine if an infection is present. Cultures should be taken from the wound to identify the specific pathogens and guide appropriate treatment.

Elevated CRP levels can indicate inflammation in the body, and in the context of infections, it is commonly seen in osteomyelitis. Osteomyelitis is a bone infection caused by bacteria or fungi, leading to inflammation and increased CRP levels. Diabetic foot infection, cellulitis, and necrotizing fasciitis can also cause elevated CRP, but osteomyelitis is specifically associated with bone infections.

A foot puncture wound through the shoe can lead to osteomyelitis, an infection of the bone, due to the presence of pseudomonas bacteria. Pseudomonas is a common cause of osteomyelitis in this type of injury, as it thrives in moist environments and can easily enter the wound. This bacterium is known to cause severe infections and can be difficult to treat, often requiring a combination of antibiotics. Therefore, it is important to promptly identify and treat pseudomonas infections in foot puncture wounds to prevent the development of osteomyelitis.

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Erysipelas is a type of infection that commonly occurs on the leg and is characterized by an intense burning pain. This infection affects the skin and underlying tissues, causing redness, swelling, and warmth. It is usually caused by bacteria entering through a break in the skin. Erysipelas can be differentiated from other similar infections like cellulitis, impetigo, osteomyelitis, and necrotizing fasciitis based on its specific symptoms and location.

Oral therapy preferred for simple infections. Tigecycline is generally avoided because of N/V...not daptomycin.

Clindamycin is the correct answer because it has additional benefits beyond antimicrobial effects in treating necrotizing fasciitis caused by streptococcus infection. Clindamycin can modify cytokine production and suppress toxins, which are important in managing the inflammatory response associated with this condition. This makes Clindamycin an effective choice for treating necrotizing fasciitis caused by streptococcus infection.

Clindamycin is not traditionally recommended for MRSA secondary to inducible resistance. This is because MRSA strains can develop resistance to clindamycin through a mechanism called inducible resistance. Inducible resistance means that the bacteria can switch on genes that confer resistance to clindamycin when exposed to certain antibiotics. Therefore, clindamycin may not be effective against MRSA strains that have inducible resistance.

The correct answer is ceftaroline and tigecycline. These two antibiotics are not typically used to cover for MRSA, so any systemic regimen other than these two would likely have vancomycin added to provide coverage for MRSA.

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Necrotizing fasciitis is a severe and rapidly spreading soft tissue infection. It requires operative intervention in addition to antibiotics because surgical debridement is necessary to remove the necrotic tissue and control the infection. The infection causes severe, constant pain, bullae (fluid-filled blisters), gas in soft tissues, edema, and skin necrosis. Rapid spreading of the infection may still occur despite antibiotic therapy. Lower extremity involvement is common, with over 66% of cases presenting in this area. On physical examination, the subcutaneous tissues are usually hard to the touch, making it difficult to distinguish between muscle and fascia.

Usually occurs on face and extremities. Treat MSSA with dicloxacillin/cephalexin. Treat MRSA with doxycycline/bactrim.

Usually caused by s. aureus. A furuncle only involves individual follices.