Skin &soft tissue infection
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Transcript of Skin &soft tissue infection
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Skin & Soft Tissue
InfectionBy: dr ismah
Ortho department
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Anatomy
hospitals.unm.edu
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Epidemiology • Skin and soft-tissue infections (SSTIs) are a
common reason for presentation to outpatient practices, emergency rooms, and hospitals
• They account for more than 14 million outpatient visits in the United States each year and visits to the emergency room and admissions to the hospital for them are increasing
• Hospital admissions for SSTIs increased by 29% from 2000 to 2004
Edelsberg J, Taneja C, Zervos M, et al. Trends in US hospital admissionsfor skin and soft tissue infections. Emerg Infect Dis 2009; 15:1516–1518.
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Erysipelas
Cellulitis
NF
Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66
Gas gangrene
6Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections:
2014 Update by the Infectious Diseases Society of America
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Thank you
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Cellulitis • Often caused by Group A β - haemolytic streptococci,
(Streptococcus pyogenes)
• The infected area is painful, hot and oedematous
• Non-raised skin lesions with indistinct margin, sometimes with lymphangitis
• There is usually no localization of the infection or pus formation
• May associate with insect bites, trauma or ill fitting shoes
• IV C Pen 2.4 Mu, IV Cloxacillin. Dressing with CHD cream
Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66
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INDICATIONS FOR ADMISSION:-
• Severe or rapidly worsening infection
• Patient systemically unwell
• Uncertainty regarding the diagnosis (need to out rule DVT)
• Immunocompromised patient. Diabetes mellitus – if unstable
• Children under one year of age or elderly without goodhome support
• Lack of response to home treatment at 48 hoursJohnny Loughnane
Irish College of General Practitioners April 2006
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Cellulitis
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Necrotizing fascitis• An aggressive subcutaneous infection that tracks
along the superficial fascia, which comprises all the tissues between the skin and underlying muscles
• Rapid progression
• Physical exam Skin bullae Ischemic patches Swelling, edema Crepitus
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
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• Features that suggest involvement of deeper tissues include
(1) severe pain that seems disproportional to the clinical findings; (2) failure to respond to initial antibiotic therapy;(3) the hard, wooden feel of the subcutaneous tissue, extending beyond the area of apparent skin involvement; (4) systemic toxicity, often with altered mental status; (5) edema or tenderness extending beyond the cutaneous erythema; (6) crepitus, indicating gas in the tissues; (7) bullous lesions;(8) skin necrosis or ecchymoses
Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
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Anaya DA, Dellinger EP. Necrotizing soft-tissue infection :
diagnosis and management. ClinInfect Dis 2007; 44:705–710,
Oxford University Press.
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Treatment • Surgical debridement• Antibiotic
Type 1 Type 2
Polymicrobial infection. Immunocompromised.
Group A strep
Cloxacillin 2g IV q4-6hPLUSMetronidazole 500mg IV q8hPLUSGentamicin1 5mg/kg IV q24h
Benzylpenicillin 2-4 mega units IV q4hPLUSClindamycin 600mg IV q8h
ALTERNATIVES:3rd gen. CephalosporinsPLUSMetronidazole 500mg IV q8hORβ-lactam/β-lactamase inhibitors, e.g.Ampicillin/Sulbactam 1.5g IV q8hORAmoxycillin/Clavulanate 1.2g IV q8hPLUS/MINUSGentamicin1 5mg/kg IV q24h
National_Antibiotic_Guideline_2008
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Gas gangrene• Clostridium perfringens
• Gram-positive obligate anaerobic spore-forming rods that produce exotoxins
• Causes muscle necrosis and vessel thrombosis, hemolysis and shock
• Rx : Benzylpenicillin 2-4 mega units IV q4h PLUS Metronidazole 500mg IV q8h PLUS/MINUS Gentamicin1 5mg/kg IV q24h
18University of Kansas Medical Center- http://www.kumc.edu/
swelling, edema, discoloration and ecchymosis, blebs and hemorrhagic bullae