Morning Report

Morning ReportMorning Report

Karen Estrella-Ramadan

COMPLICATED SKIN AND COMPLICATED SKIN AND SKIN STRUCTURE SKIN STRUCTURE

INFECTIONSINFECTIONS

The primary challenge in managing skin and soft-tissue infections is to avoid delays in diagnosis and thereby prevent uncomplicated infections from progressing.

Including: hospitalization, prompt initiation of antimicrobial therapy, or surgical consultation.

FDA: Center for Drug Evaluation FDA: Center for Drug Evaluation and Research criteriaand Research criteria

CSSI’s1. Involvement of deep tissues, including subcutaneous fat2. Need for significant surgical intervention3. Involvement of the perianal area4. Infection of the foot in a diabetic patient5. Presence of significant coexisting diseases, including

diabetes mellitus, an immunocompromised state, and obesity.

ABSSi’s1. wound infections, major cutaneous abscesses, infected

burns accompanied by redness, edema, and/or induration of a minimum surface area of 75 sq cm (15x5cm or at least 5cm outside margins peripheral area of wound), accompanied by lymph node enlargement or systemic symptoms such as fever 38C (100.4- F) or greater

As a review…As a review…Uncomplicated skin infections:◦Impetigo, erysipelas, folliculitis,

furunculosis, and, in some cases, superficial cellulitis

Complicated:◦ Cellulitis:

necrotizing fasciitis Septic arthritis, and

osteomyelitis, often will have overlying cellulitis

◦ Lymphangitis◦ Carbuncles

Only 5% will have blood cx (+)

EtiologyEtiology

SX wounds:S pyogenes and Clostridium perfringenscan lead to infection within 48 hours of operation.

Necrotizing fascitis:S pyogenes + aerobic, anerobic, facultative organism15% will not have an identicable cause

ManagementManagement•pain that is disproportionate to physical findings• blisters, ecchymosis, bullae, or crepitus •Rapid progression

Pus

When to send them to ORWhen to send them to OR

http://jac.oxfordjournals.org/content/53/suppl_2/ii37.full.pdf+html

AntibioticsAntibioticsSkin and soft tissue skin

infections…◦please see table on page 4

IDSA

ReferencesReferences

University School of medicine, Cleveland OH◦ http://www.ccjm.org/content/74/Suppl_4/S21.full.pdf

John Hopkins, Upenn guidelines◦ http://cid.oxfordjournals.org/content/

41/10/1373.full.pdf+html FDA-guidelines

◦ http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/UCM071185.pdf

http://journals.lww.com/aswcjournal/Fulltext/2012/03000/Complicated_Skin_and_Skin_Structure_Infections__A.1.aspx#

Clinical presentation:◦ http://cid.oxfordjournals.org/content/33/

Supplement_2/S84.full.pdf+html