|
Instructions
 Take Another Course
Post-Test
Glossary
|
Antibiotic Therapies
Definitive treatment is determined
by biopsy results and susceptibility studies. Previous SSTIs and a history of
antibiotic complications may prove valuable in helping to choose the best
treatment options. While awaiting results, treatment can begin to reduce the continued contamination of the infected site and
broad-spectrum antibiotic treatment, such as cephalosporins, quinolones, and
penicillins is indicated. If MRSA is likely present, the choice of antibiotic may include
vancomycin or linezolid.
Pathogens that are commonly
recovered from SSTIs include Staphylococcus aureus, Pseudomonas
aeruginosa, Escherichia coli, Enterococcus spp., Klebsiella
spp., Enterobacter spp., and others. Staph infections are
commonly treated with penicillins or cephalosporins unless they are resistant to
these medications. Methicillin-resistant S. aureus (MRSA) has become a
common finding in complicated SSTIs
(CSSTIs) and are associated with longer hospital stays, invasive
procedures, resistance due to previous antibiotic use or previous MRSA
infections, diabetes, and chronic wounds or poor wound healing. Table 1 outlines
selected categories of SSTIs, commonly associated pathogens, and examples of
recommended antimicrobial management.
Table 1. Categories of SSTIs,
Causative Pathogens, and Selected IV Antibiotic Treatments
|
Infection Type |
Pathogens and Management |
|
Impetigo,
erysipelas, cellulitis |
Staphylococcus aureus, Streptococcus
pyogenes
Penicillin (erysipelas), penicillinase-resistant
penicillin (ie, nafcillin) or first-generation cephalosporin (ie,
cefazolin); clindamycin or vancomycin if allergic to penicillin; a
tapered course of systemic corticosteroids may provide an adjunct to
reduce local inflammation in uncomplicated cases |
|
Necrotizing infections |
S. pyogenes, Vibrio vulnificus, Aeromonas
hydrophila, methicillin-resistant S. aureus, Clostridium
spp.
Clindamycin and penicillin; variety of antibiotics
for mixed infections. |
|
Animal bites
(including human bites) |
S. aureus, Bacteroides tectum,
Fusobacterium spp., Capnocytophaga spp., Porphyromonas spp., Pasteurella
multocida, Eikenella corrodens*, Peptostreptococcus spp., Prevotella spp.
Ampicillin-sulbactam or ertapenem; Cefoxitin or
carbapenem antibiotics if mildly allergic to penicillins; doxyclycline,
trimethoprim-sulfamethoxazole, or fluoroquinolone with clindamycin if
more severely allergic to penicillins;
*resistant to
first-generation cephalosporins, macrolides, clindamycin,
aminoglycosides |
|
Surgical site infections |
S. pyogenes, Clostridium spp. A variety of
aerobic or anaerobic infectious organisms can cause surgical site
infections which, if after 48 hours post-surgery, presents with fever of
>38.5 C or tachycardia may require both antibiotics and surgical
intervention. Antibiotic choices vary according to infection site as an
intestinal/genital site or a non-intestinal site. |
|
|