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Skin and Soft Tissue Infections
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Skin &soft tissue infection

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cellulitis, NF, gas gangrene

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Skin &soft tissue infection

  1. 1. By: dr ismah Ortho department 1
  2. 2. 2 hospitals.unm.edu
  3. 3. • 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 3 Edelsberg J, Taneja C, Zervos M, et al. Trends in US hospital admissions for skin and soft tissue infections. Emerg Infect Dis 2009; 15:1516–1518.
  4. 4. 4
  5. 5. 5 Erysipelas NF Cellulitis Gas gangrene Cleveland Clinic Journal of Medicine-2012-RAJAN-57-66
  6. 6. 6 Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
  7. 7. 7
  8. 8. • 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 8
  9. 9. 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 good home support Johnny Loughnane • Lack of response to home treatment Irish College at 48 of General hours Practitioners April 2006 9
  10. 10. 10 Cellulitis
  11. 11. • An aggressive subcutaneous infection that tracks along the superficial fascia, which comprises all the tissues between the skin and underlying muscles Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: • Rapid progression • Physical exam  Skin bullae  Ischemic patches  Swelling, edema  Crepitus 2014 Update by the Infectious Diseases Society of America 11
  12. 12. 12
  13. 13. • 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 13 Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
  14. 14. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection : diagnosis and management. ClinInfect Dis 2007; 44:705–710, Oxford University Press. 14
  15. 15. 15
  16. 16. • Surgical debridement • Antibiotic 16 Type 1 Type 2 Polymicrobial infection. Immunocompromised. Group A strep Cloxacillin 2g IV q4-6h PLUS Metronidazole 500mg IV q8h PLUS Gentamicin1 5mg/kg IV q24h Benzylpenicillin 2-4 mega units IV q4h PLUS Clindamycin 600mg IV q8h ALTERNATIVES: 3rd gen. Cephalosporins PLUS Metronidazole 500mg IV q8h OR β-lactam/β-lactamase inhibitors, e.g. Ampicillin/Sulbactam 1.5g IV q8h OR Amoxycillin/Clavulanate 1.2g IV q8h PLUS/MINUS Gentamicin1 5mg/kg IV q24h National_Antibiotic_Guideline_2008
  17. 17. • 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 17
  18. 18. swelling, edema, discoloration and ecchymosis, blebs and hemorrhagic bullae University of Kansas Medical Center- http://www.kumc.edu/ 18
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cellulitis, NF, gas gangrene

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