1. Morning Report Karen Estrella-Ramadan

2. COMPLICATED SKIN AND SKIN STRUCTURE INFECTIONS

3. 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.

4. FDA: Center for Drug Evaluation and Research criteria CSSI’s 1. Involvement of deep tissues, including subcutaneous fat 2. Need for significant surgical intervention 3. Involvement of the perianal area 4. Infection of the foot in a diabetic patient 5. Presence of significant coexisting diseases, including diabetes mellitus, an immunocompromised state, and obesity. ABSSi’s 1. 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

5. As a review… Uncomplicated skin infections: ◦ Impetigo, erysipelas, folliculitis, furunculosis, and, in some cases, superficial cellulitis

6. Complicated: ◦ Cellulitis:  necrotizing fasciitis  Septic arthritis, and osteomyelitis, often will have overlying cellulitis ◦ Lymphangitis ◦ Carbuncles Only 5% will have blood cx (+)

7. Etiology SX wounds: S pyogenes and Clostridium perfringens can lead to infection within 48 hours of operation. Necrotizing fascitis:  S pyogenes + aerobic, anerobic, facultative organism  15% will not have an identicable cause

8. Management pain that is disproportionate to physical findings blisters, ecchymosis, bullae, or crepitus Rapid progression Pus

9. When to send them to OR http://jac.oxfordjournals.org/content/53/suppl_2/ii37.full.pdf+html

10. Antibiotics Skin and soft tissue skin infections… ◦ please see table on page 4page 4

11. IDSA

12. References University School of medicine, Cleveland OH ◦ http://www.ccjm.org/content/74/Suppl_4/S21.full.pdf 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 http://cid.oxfordjournals.org/content/41/10/1373.full.pdf+html FDA-guidelines ◦ http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegul atoryInformation/Guidances/UCM071185.pdf http://www.fda.gov/downloads/Drugs/GuidanceComplianceRegul atoryInformation/Guidances/UCM071185.pdf http://journals.lww.com/aswcjournal/Fulltext/2012/03000/Co mplicated_Skin_and_Skin_Structure_Infections__A.1.aspx# http://journals.lww.com/aswcjournal/Fulltext/2012/03000/Co mplicated_Skin_and_Skin_Structure_Infections__A.1.aspx# Clinical presentation: ◦ http://cid.oxfordjournals.org/content/33/Supplement_2/S84.full.p df+html http://cid.oxfordjournals.org/content/33/Supplement_2/S84.full.p df+html