Clinical Pharmacy.....An over view on Skin and Soft Tissue Infections...

1. Skin and Soft Tissue
Infections
Presented By:
Imran Ahammad Chowdhury

2. Defination :
Skin and soft tissue infections encompass a
range of clinical diagnoses from furuncles and
carbuncles to necrotizing fasciitis. They account
for 17% of all clinic visits and most often can be
deal with as an outpatient. As this module
pertains mainly to the inpatient setting, the
discussion below will focus on erysiplelas,
cellulitis, abscess, and necrotizing fasciitis.

3. SSTIs Objectives
 To classify types of skin infections.
 To present a case of cellulitis and discuss management.
 To discuss differences in the management of
community associated versus hospital associated
SSTIs.
 To present a case of decubitus ulcer and discuss
management.
 To describe management of animal bite wounds.

4. Skin and Soft Tissue Infections Disease
 Cellulitis
 Impetigo
 Erysipelas
 Abscess
 Animal bite
 Human bite
 Surgical site infection
 Necrotizing fasciitis

5. Cellulitis
 65% relative increase since 1999.
 600,000 admissions annually.

6. Risk Factors for Cellulitis
 Obesity
 Edema
 Venous insufficiency
 Lymphatic obstruction
 Inflammatory dermatoses – eczema
 Repeated cellulitis
 Subcutaneous injection or illegal drugs
 Previous cutaneous damage

7. Treatment of Cellulitis
 Penicillins:
Penicillin (group A streptococcus only): orally/IM
Nafcillin (MSSA or streptococcus)
Dicloxacillin orally
 Cephaloporins: (1st generation)
Cefazolin IV
Cephalexin/cefprozil orally
 Macrolides:
Erythromycin/Azithromycin/Clarithromycin
 Clindamycin
 Vancomycin IV: PCN allergic
 Linezolid IV/PO

8. Impetigo
 staphylococcus , streptoccus infection which
presented with honey crust skin after blisters rupture.
Rx : broad spectrum Abcs.

9. Case of Impetigo
 Caused by gp A strep (rarely gp B,C and G) and
S.aureus
 Disease of children (age 2-5) but can occur in adults
 Predisposing factors include warm climate, crowding,
poor hygiene
Treatment of Impetigo:
 Penicillin (drug of choice)
 PCN-allergic: erythromycin PO x 7 to 10 days
 Mupirocin: topical less effective than oral therapy

10. Erysipelas
(localized cellulitis) sharply demarcated streptcoccal
infection of lymphatic vessels, usually associated with
broken skin on face, erythema, Oedema
do --- C/S
Rx : broad spectrum Abcs

11. Case of Erysipelas
 Caused by gp A strep (occasionally other gps)
 Bimodal distribution -- infants/children and older
adults
 Usually face and extremities; abdomen if assoc with
surgery
 Painful, raised, erythematous, rapidly spreading lesion
with well demarcated edges
 Systemic symptoms common
 Therapy same as non-culturable cellulitis

12. Treatment
 Penicillin
 1st gen. cephalosporin
 Macrolide

13. Skin Abcess
 Is a collection of pus (dead neutrophils) that has
accumulated in a cavity formed by the tissue in which
the pus resides on the basis of an infectious process
(usually caused by bacteria or parasites)

14. Treatment of Abcess
 Vancomycin
Animal Bites
 Pasteurella – mc organism

15. Treatment of Animal Bites
• mpicillin/sulbactam
• Piperacillin/tazobactan
• Cefoxitin
• Meropenem
• Ertapenem
Human Bite

16. Treatment of Human Bite
 Cefoxitin
 Ampicillin/sulbactam
 Ertapenem(restricted to ID and Surgery)

17. Surgical Site Infection
 Pain, swelling, erythema, purulent drainage
 Usually have no clinical manifestations for at least 5
days after operation
 Most resolve without antibiotics
Treatment
 Cefazolin
 Clindamycin
 Vancomycin if MRSA is suspected

18. Neutropenia and SSTI’s
 ALWAYS blood CULTURES
 Initial infection - <7 days neutropenia
Treatment
 Carbapenems
 Cefepime
 Ceftazidine
 Piperacillin/tazobactam