Skin and Soft Tissue Infections: MRSA and Beyond
|
|
- Conrad Gilmore
- 7 years ago
- Views:
Transcription
1 Skin and Soft Tissue Infections: MRSA and Beyond Catherine Liu, M.D. Assistant Clinical Professor Division of Infectious Diseases University of California, San Francisco Abscesses Cellulitis Recurrent SSTI Animal Bites Necrotizing fasciitis Other SSTI Overview 1
2 Case 1 20 y/o Mpresents with 3 days of an enlarging, painful lesion on his L arm that he attributes to a spider bite T 36.9 BP 118/70 P 82 What is the appropriate management of this patient? A. Incision and drainage alone B. Incision and drainage plus oral anti MRSA antimicrobial agent C. Oral anti MRSA antimicrobial agent 2
3 Abscesses Incision and drainage is the primary treatment (AII). For simple abscesses or boils, I&D alone likely adequate Do antibiotics provide additional benefit? 100% 80% Clinical cure 60% 40% 20% 0% p=.25 p=.12 p=.52 cephalexin TMP-SMX TMP-SMX Rajendran'07 Duong'09 Schmitz'10 Antibiotic Placebo 1 Rajendran AAC 2007; 2 Duong Ann Emerg Med 2009; 3 Schmitz G Ann Emerg Med 2010; Liu CID 2011; 52: Antibiotic therapy is recommended for abscesses associated with: Severe, extensive disease, rapidly progressive with associated cellulitis or septic phlebitis Signs & sx of systemic illness Associated comorbidities, immunosuppressed Extremes of age Difficult to drain area (e.g. face, hand, genitalia) Failure of prior I&D (AIII) Liu CID 2011; 52:
4 Microbiology of Purulent SSTIs: ER Patients non B hemolytic strep 4% other 8% unknown 9% viridans strep, 2% other/ unknown, 15% B hemolytic strep 3% MSSA 17% MRSA 59% B hemolytic strep, 2% coag neg staph, 6% MSSA 16% MRSA 59% Moran NEJM 2006; Talan CID 2011 Purulent Cellulitis Cellulitis associated with purulent drainage or exudate without a drainable abscess Empiric Rx for CA MRSA is recommended (AII). Empiric Rx for hemolytic strep unlikely needed (AII). Duration of therapy: 5 10 days, individualize based on clinical response Liu CID 2011; 52:
5 Outpatient purulent cellulitis: Empiric Rx for CA MRSA MRSA MSSA hemolytic strep Comments TMP/ SMX 1 2 DS tab BID Doxycycline, Minocycline 100 mg BID Clindamycin TID Linezolid 600 mg BID + + Low rates of resistance + + Low rates of resistance +/ ( resistance) + + C. diff risk Most expensive option Case 2 28 year old woman with erythema of her left foot x 48 hours. No purulent drainage, exudate or abscess. T 37.0 BP 132/70 P 78 Eells SJ et al Epidemiology and Infection
6 What is the appropriate management of this patient? A. Clindamycin 300 mg PO tid B. Cephalexin 500 mg QID C. Cephalexin 500 mg QID and TMP/ SMX 2 DS tab PO bid Nonpurulent Cellulitis: hemolytic strep vs. staph? Empiric Rx for hemolytic strep recommended (AII) Prospective study 1, 248 hospitalized pts 73% due to hemolytic strep 27% with no identified cause. Overall 96% response rate to lactam antibiotic (cefazolin, oxacillin, cephalexin, dicloxacillin). Retrospective study 2 treatment failures with TMP SMX vs. lactam or clindamycin * Consider coverage for MRSA if: History/evidence of MRSA infection elsewhere, failure to respond to lactam 1 Jeng et al Medicine 2010; 2 Elliott et al Pediatrics 2009; Liu CID 2011; 52:
7 Cephalexin vs. Cephalexin + TMP SMX in patients with Uncomplicated Cellulitis N=146 Pallin CID 2013; 56: Outpatient nonpurulent cellulitis: Empiric Rx for hemolytic streptococci, +/ MRSA MRSA MSSA hemolytic strep Penicillin V K 500 mg QID/ Amoxicillin 500 mg TID Dicloxacillin 500 mg QID Cephalexin 500 mg QID Clindamycin mg TID Linezolid 600 mg BID Rare +/ / ( resistance)
8 322 hospitalized patients with cellulitis, abscess, complicated SSTI 97% of cases had S. aureus or Streptococcus spp. 74% S. aureus or Streptococcus ONLY Microbiology of SSTI: Hospitalized Patients Enterococci 3% Jenkins CID 2010; 51: Antibiotic Utilization Following Implementation of a QI Project on Management of Inpatient SSTI * *Recommended empiric vanco *Discouraged gram neg/ anaerobic *Suggested Rx for 7 days * * * *p<.05 Jenkins Arch Intern Med 2011; 171:
9 Other Outcomes Median duration of Rx (13 vs. 10d, p<.001) No differences in clinical outcomes Clinical failure (7.7% vs. 7.4%, p=ns) Recurrent infection Rehospitalization due to SSTI Length of hospital stay Jenkins Arch Intern Med 2011; 171: Complicated SSTI Surgical debridement & empiric Rx for MRSA pending cx Antibiotic Adult Vancomycin mg/kg IV Q8 12 Linezolid 600 mg PO/ IV BID Daptomycin 4 mg/kg IV QD Telavancin 10 mg/kg IV QD Ceftaroline 600 mg IV Q12 Tigecycline 100 mg IV x 1, then 50 IV Q12 9
10 Summary: empiric management of SSTIs Purulent (MRSA) Non purulent (β hemolytic strep) Uncomplicated Complicated I&D Consider addition of anti MRSA antibiotic in select situations 1 I&D plus vancomycin (or alternative),no gram neg in most cases 3 Cephalexin 500 QID Dicloxacillin 500 QID Consider MRSA active agent in select situations 2 Vancomycin (or alternative), no gram neg in most cases 3 1. Systemic illness, purulent cellulitis/wound infection, comorbidities, extremes of age, abscess difficult to drain or face/hand, septic phlebitis, lack of response of to I&D alone. PO antibiotic : TMP SMX 1 2 DS BID, Clindamycin 300 mg TID, Doxycycline 100 PO BID 2. History/ evidence of MRSA elsewhere, failure to respond to lactams 3. Except: critically ill pts with serious SSTI (nec fasc), perirectal/ periorbital infections, decubitus ulcer infections, severe diabetic foot infections, animal bites, water exposure Recurrent SSTI Recurrent abscess, furunculosis: Staphylococcus aureus (MRSA and MSSA) Recurrent cellulitis: hemolytic streptococci 10
11 Recurrent Staphylococcal SSTI Decolonization strategies: do they work? Mupirocin based regimens appear to be effective in reducing S. aureus colonization BUT no data shows decolonization prevents recurrent SSTI Hygiene education: keep draining wounds covered, wash hands after touching infected wound, avoid sharing personal items, clean high touch surfaces Regimens to consider: Mupirocin +/ chlorhexidine or bleach x 5 10 days Dilute bleach baths: ¼ cup per ¼ tub (13 gallons) of water for 15 min, 2x/week for 3 mths Liu CID 2011; 52: ; Fritz ICHE 2011; 32: Household vs. Individual Decolonization? Open label RCT children with community onset SSTI and S. aureus colonization (nares, axilla, inguinal) 2 Index case vs. household decolonization (mupirocin + CHG baths x 5d) All received hygiene education: Avoid sharing personal hygiene items Use liquid pump or pour soaps and lotions (vs. bar soaps and lotion jars) Launder towels and washcloths after each use Launder bed linens once weekly No difference in rate of eradication of S. aureus 1 month: 50% vs. 51% (p = 12 months: 54% vs. 66% (p=.28) Fritz CID 2012; 54:
12 Recurrent SSTI among Cases and Household Contacts p=.008 p=.02 p=.02 p=.12 Fritz CID 2012; 54: Recurrent Cellulitis Is there a role for antibiotic prophylaxis? Most patients have predisposing factor: Obesity, lymphedema, venous insufficiency, prior trauma/ surgery to area, tinea pedis Management approach: Treat underlying conditions whenever possible (e.g. compressive stockings, Rx interdigital maceration/ tinea, emollients to avoid dryness/ cracking, diuretics) Prophylactic antibiotics if frequent recurrence Penicillin VK 250 mg PO twice daily Benzathine PCN 1.2 MU IM monthly Stevens CID
13 PCN for Prevention of Recurrent Cellulitis Multicenter, double blind RCT 274 pts with recurrent cellulitis Penicillin 250 mg BID vs. placebo x 12 mths Patient characteristics: Chronic edema (66%), venous stasis (25%), tinea pedis (36%) Outcomes: Recurrent cellulitis: 22% (PCN) vs. 37% (placebo), p=.01 After treatment stopped, no difference Thomas NEJM 2013; 368: Case 3 21 yo M is tossing a ball in Golden Gate Park with a friend. As he goes after the ball, he passes close to a dog that was resting in the shade with his owner. The dog jumps up and bites him on the leg inflicting several puncture wounds on the calf. 13
14 In addition to wound care, what is the appropriate management of this patient? A. No antibiotic prophylaxis is necessary B. Antibiotic prophylaxis with clindamycin C. Antibiotic prophylaxis with amoxicillin/ clavulanate D. Administer rabies immunoglobulin and rabies vaccine for post exposure prophylaxis E. C and D Microbiology of Animal Bites: What s in their mouth and on your skin Average 5 organisms (range 0 16) per wound Dogs Cats Pasturella sp 50% 75% Streptococcus sp. 46% 46% Staphylococcus aureus 20% 4% Anaerobes mixed w/ aerobes 48% 63% Anaerobes alone 1% 0% Talan NEJM
15 Antibiotic Coverage for Pasteurella What you want to use but won t work cephalexin dicloxacillin clindamycin What works Amoxicillin/ penicillin doxycycline fluoroquinolones Animal bites Empiric treatment regimens Amoxicillin/clavulanic acid +/ anti MRSA Pen allergy: cipro + clindamycin or moxifloxacin Prophylaxis? Moderate severe bites w/ crush injury Deep puncture wounds (i.e. cat bites, 50% infection risk) Bites involving face, hands Immunocompromised (splenectomized) 15
16 Rabies what type of bites are high risk? Animal Type Dog, cats, ferrets Skunk, raccoons, foxes, bats Livestock, small rodents, rabbits, large rodents Evaluation and disposure of animal Suspected/confirmed rabid Healthy Animal lost Regarded as rabid unless proven negative by lab test Consider individually Post exposure prophylaxis Prophylaxis 10 days observation/test Contact DPH Immediate prophylaxis Almost never require prophylaxis Case 4 39 yo M IVDU with 1 day h/o L leg pain and erythema, worsening pain and swelling x 48 hours T 39.2 P120 BP96/60 R22 98%RA 18>40<425, left shift 16
17 What would your empiric therapy be in this case? A. Admit, IV vancomycin and piperacillintazobactam B. Call surgery, IV vancomycin and clindamycin C. Call surgery, IV vancomycin, piperacillintazobactam, clindamycin Necrotizing skin and soft infections Monomicrobial (Group A strep > S. aureus, Clostridia, gram neg rare) Polymicrobial (gram +, gram, anaerobes) associated w/ abdominal surgery, decub ulcers, IVDU, spread from GU tract 17
18 Risk Factors for Necrotizing SSTI IVDU Diabetes Obesity Chronic immunosuppression Often no precipitating factor Anaya DA. Clin Infect Dis Clinical Presentation Nonspecific complaints: pain, GI (N/V/D), influenza like symptoms Physical exam difficult to distinguish from cellulitis, sometimes only mild local erythema pain out of proportion Missed Dx of Necrotizing Fasciitis Initial Diagnoses by No. PCP/ER Musculoskeletal Pain 6 (40%) Influenza 3 (20%) Gastroenteritis 2 (13%) Hemorrhoids 1 (6%) Gout 1 (6%) 1 burn 1 (6%) Varicella 1 (6%) Bisno CID 2000 Wong CH Crit Care Med
19 % of patients Necrotizing soft tissue infections: physical findings on admission Late findings n=89; 14% dx with necfascon admit Wong CH. Jour of Bone and Joint Surg Necrotizing soft tissue infections: radiographic techniques Plain films Low sensitivity Helpful if gas present CT and ultrasound May identify other Dx (abscess) MRI Enhanced sensitivity, low specificity Dufel S, Martino M. J Fam Pract. 2006;55(5):
20 Summary: Management of necrotizing skin and soft tissue infections Early surgical consult/ intervention Empiric antimicrobial therapy Piperacillin/tazobactam or carbapenem (group A strep, other gram pos, gram negs and anaerobes) plus Clindamycin (group A strep toxin inhibition) plus Vancomycin (MRSA) Case 5 53 yo M ER physician presents with 9 day history of progressive cellulitis of L forearm. Initially noted a pustule self I&D, started keflex + clindamycin x 4 days. Progressive erythema and drainage. Started IV vanco + ceftriaxone with no improvement after 3 days. 20
21 Further history History of chronic benign neutropenia 3 weeks ago, trip to Arizona where cleared brush in order to replace a water drip line and scraped his arm 2 weeks ago, worked in home (Merced) vegetable garden clearing eggplant and pepper brushes 7 days ago, cleaned his fish tank No animal or tick bites Only recent travel to Arizona All of the following are possible causes of his infection EXCEPT: A. Mycobacterium marinum B. Coccidioides immitis C. Nocardia brasiliensis D. Brucella melitensis E. Sporothrix schenkii 21
22 Gram stain from wound culture Nocardia brasiliensis Nocardia Soil inhabitant Worldwide distribution Incubation period: <1 6 weeks Often with mild systemic symptoms Nocardia brasiliensis > asteroides for cutaneous disease Diagnosis: biopsy and culture Partially acid fast, gram variable branching rods. Treatment: TMP SMX x 4 6 months 22
23 26 yo M with 6 week history of R hand papule ulcer Multiple visits to ED and urgent care, Receives several courses of abx, no improvement Leishmania panamensis 23
24 Which of the following reflect true infectious cellulitis? 24
25 Which of the following reflect true infectious cellulitis? True cellulitis Acute on chronic stasis dermatitis Acute stasis dermatitis Contact dermatitis David Derm Online J 2011 Masqueraders of Infectious Cellulitis Stasis dermatitis Superficial thrombophlebitis and deep venous thrombosis Contact dermatitis Insect stings/tick bites Drug reactions Gouty arthritis Foreign body reaction (e.g. surgical mesh, orthopedic implants) Lymphedema Malignancy (e.g. T cell lymphoma) Falagas ME Ann Intern Med
26 Summary Drainage/ debridement is the mainstay of therapy of all purulent skin and soft tissue infections. For purulent cellulitis, cover for CA MRSA. For non purulent cellulitis, cover for hemolytic strep For most hospitalized patients with SSTI, coverage against S. aureus and streptococci is adequate; gram negative and anaerobic coverage unnecessary. If no response to standard antibiotic therapy, consider alternative diagnoses (e.g. unusual infections, noninfectious etiologies), BIOPSY for culture and pathology. Thank you! 26
Skin and Soft Tissue Infections
Skin and Soft Tissue Infections Cellulitis Note: The most common etiology of cellulitis with purulent drainage is S. aureus, although Group A streptococci and other streptococcal species can also present
More informationBlue Team Teaching Module: Periorbital/Orbital Infections
Blue Team Teaching Module: Periorbital/Orbital Infections Format: 1. Case 2. Topic Summary 3. Questions 4. References Case: A 3-year-old boy presents with 2 days of increasing redness, swelling, and pain
More informationFingernail/Nailbed Wounds Animal Bites
Fingernail/Nailbed Wounds Animal Bites Fingernail & Nailbed Injury Kent Benedict, MD, FACEP Clinical Associate Professor of Medicine Stanford University Crush Injury to Finger Crushed Finger X-Ray Anatomy
More informationTaking the Bite out of Dog ma
Taking the Bite out of Dog ma Dr. Michael Woo MD, CCFP(EM), RDMS Director, Emergency Medicine Ultrasonography Associate Professor, Department of Emergency Medicine Ultrasound uottawa DEM 25 May 2013 ACKNOWLEDGEMENTS
More informationEAST CAROLINA UNIVERSITY INFECTION CONTROL POLICY. Methicillin-resistant Staph aureus: Management in the Outpatient Setting
EAST CAROLINA UNIVERSITY INFECTION CONTROL POLICY Methicillin-resistant Staph aureus: Management in the Outpatient Setting Date Originated: Date Reviewed: Date Approved: Page 1 of Approved by: Department
More informationSkin and Soft tissue Infections: new bugs, old drugs Disclosure Statement Sponsor: Goodman Photographic Presented by: Dr. Kristopher Wiebe, MD, CCFP (EM) Presented to: BC Chapter, Canadian Society of Hospital
More informationHealth PEI: Provincial Antibiotic Advisory Team Skin & Soft Tissue Infection Empiric Treatment Guidelines Prevention
Syndrome Cellulitis / Erysipelas/ Necrotizing Fasciitis If Fournier s gangrene (pelvic / genital area gangrene) suspected: same treatment as severe sepsis. PLEASE NOTE: Redness and edema increase for 1-2
More informationUrinary Tract Infections
Urinary Tract Infections Overview A urine culture must ALWAYS be interpreted in the context of the urinalysis and patient symptoms. If a patient has no signs of infection on urinalysis, no symptoms of
More informationTreatment of skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus in adults
1 of 6 9/24/2010 11:16 AM Official reprint from UpToDate www.uptodate.com 2010 UpToDate Treatment of skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus in adults Author
More informationCCHCS Care Guide: Skin & Soft Tissue Infections
GOALS Early diagnosis and treatment of skin and soft tissue infections Infection control measures to prevent transmission to others Incision & drainage if abscess present Evidence based use of antibiotics
More informationManagement of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections
Management of Methicillin-Resistant Staphylococcus aureus (MRSA) Infections Federal Bureau of Prisons Clinical Practice Guidelines April 2012 Clinical guidelines are made available to the public for informational
More informationWhy Do Some Antibiotics Fail?
Why Do Some Antibiotics Fail? Patty W. Wright, M.D. April 2010 Objective To outline common reasons why antibiotic therapy is not successful and how this can be avoided. And to teach you a little bit about
More informationMETHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) COMMUNITY ACQUIRED vs. HEALTHCARE ASSOCIATED
METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) COMMUNITY ACQUIRED vs. HEALTHCARE ASSOCIATED Recently, there have been a number of reports about methicillin-resistant Staph aureus (MRSA) infections
More informationState of Kuwait Ministry of Health Infection Control Directorate. Guidelines for Prevention of Surgical Site Infection (SSI)
State of Kuwait Ministry of Health Infection Control Directorate Guidelines for Prevention of Surgical Site Infection (SSI) September 1999 Updated 2007 Surgical Wound: According to 1998 Kuwait National
More informationCellulitis and Abscess: Emergency Department Clinical Practice Guideline (CPG)
Cellulitis and Abscess: Emergency Department Clinical Practice Guideline (CPG) Clinical Practice Guideline Protocol Approved by: Division of Pediatric Emergency Medicine Date of Approval: 4/14 2013 SSM
More informationAntibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis
Antibiotic-Associated Diarrhea, Clostridium difficile- Associated Diarrhea and Colitis ANTIBIOTIC-ASSOCIATED DIARRHEA Disturbance of the normal colonic microflora Leading to alterations in bacterial degradation
More informationAntibiotic Guidelines: Ear Nose and Throat (ENT) Infections. Contents
Antibiotic Guidelines: Ear Nose and Throat (ENT) Infections. Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: DCSS & Tertiary Medicine
More informationWound Care on the Field. Objectives
Wound Care on the Field Brittany Witte, PT, DPT Cook Children s Medical Center Objectives Name 3 different types of wounds commonly seen in sports and how to emergently provide care for them. Name all
More informationClostridium Difficile Colitis. Presented by Mark Skains August 2003
Clostridium Difficile Colitis Presented by Mark Skains August 2003 What is Clostridium Difficile Gram positive rod Produces spores (hang out in diverticula) Forms Endotoxin A + B which cause diarrhea.
More informationUse of Packing for Surgical Wounds. Maggie Benson Clinical Problem Solving II
Use of Packing for Surgical Wounds Maggie Benson Clinical Problem Solving II Purpose Present patient management s/p Incision and Drainage in an outpatient setting Examine evidence for the use of wound
More information8/5/2014. We have no commercial or financial conflict of interest
Erica Runningdeer, MSN, MPH, RN Illinois Department of Public Health Gail Itokazu, PharmD John H Storger Jr. Hospital of Cook County Sarah Becca Peglow, MD Rush University Medical Center John H Stroger,
More informationLeukocytoclastic Vasculitis and Stasis Dermatitis With Id Reaction
Id Reaction December 01, 2007 By David L. Kaplan, MD [1] A Photo Quiz to Hone Dermatologic Skills Case 1: A slightly pruritic eruption developed on the lower legs of a 39-year-old woman after she had an
More informationClinical Infectious Diseases Advance Access published January 4, 2011
Clinical Infectious Diseases Advance Access published January 4, 2011 IDSA GUIDELINES Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant
More informationFungal Infection in Total Joint Arthroplasty. Dr.Wismer Dr.Al-Sahan
Fungal Infection in Total Joint Arthroplasty Dr.Wismer Dr.Al-Sahan Delayed Reimplantation Arthroplasty for Candidal Prosthetic Joint Infection: A Report of 4 Cases and Review of the Literature David M.
More informationDevelop an understanding of the differential diagnosis of pseudomembranous colitis
Update on Clostridium difficile Colitis Clostridium difficile infection has recently emerged in populations without any known risk factors. This presentation will focus on the historical background, diagnosis,
More informationPractice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America
Clinical Infectious Diseases Advance Access published June 18, 2014 IDSA GUIDELINE Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious
More informationMRSA. Living with. Acknowledgements. (Methicillin-Resistant Staphylococcus aureus)
How can I keep myself healthy? Hand washing and use of an alcohol-based hand sanitizer are the primary way to prevent acquiring or transmitting bacteria. If you get a cut or scrape, wash it well with soap
More informationConnie Austin June 2012
Rabies Exposures: When is Prophylaxis Recommended and Update on Communicable Disease Rule Changes Connie Austin June 2012 Rabies Transmission Bite from infected mammal (not birds, amphibians, reptiles)
More informationCOMMON BACTERIAL SKIN INFECTIONS IN GENERAL PRACTICE
COMMON BACTERIAL SKIN INFECTIONS IN GENERAL PRACTICE The two most common bacteria to cause skin infections are staphylococcus aureus (staph aureus ) and streptococcus pyogenes ( strep) (see Table 1). Staphylococcus
More informationAPPENDIX B: UWHC SURGICAL ANTIMICROBIAL PROPHYLAXIS GUIDELINES
APPENDIX B: UWHC SURGICAL ANTIMICROBIAL PROPHYLAXIS GUIDELINES Principles of prophylaxis 1) Use antimicrobials for surgical procedures where prophylactic antimicrobials have been found to be beneficial.
More informationStaphylococcus aureus Bloodstream Infection Treatment Guideline
Staphylococcus aureus Bloodstream Infection Treatment Guideline Purpose: To provide a framework for the evaluation and management patients with Methicillin- Susceptible (MSSA) and Methicillin-Resistant
More informationAntimicrobial Stewardship for Hospital Acquired Infection Prevention: Focus on C. difficile infection
Antimicrobial Stewardship for Hospital Acquired Infection Prevention: Focus on C. difficile infection Emi Minejima, PharmD Assistant Professor of Clinical Pharmacy USC School of Pharmacy minejima@usc.edu
More informationORTHOPAEDIC INFECTION PREVENTION AND CONTROL: AN EMERGING NEW PARADIGM
ORTHOPAEDIC INFECTION PREVENTION AND CONTROL: AN EMERGING NEW PARADIGM AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS 77th Annual Meeting March 9-12, 2010 New Orleans, Louisiana COMMITTEE ON PATIENT SAFETY PREPARED
More informationPre-operative M.R.S.A. Screening Information for Patients
Infection Prevention and Control Pre-operative M.R.S.A. Screening Information for Patients This information is designed for patients undergoing MRSA screening before coming into hospital for a planned
More informationANTIBIOTICS IN SEPSIS
ANTIBIOTICS IN SEPSIS Jennifer Curello, PharmD, BCPS Clinical Pharmacist, Infectious Diseases Antimicrobial Stewardship Program Ronald Reagan UCLA Medical Center October 27, 2014 The power of antibiotics
More informationPrimary Options for Acute Care: Management of Adult Cellulitis
Primary Options for Acute Care: Management of Adult Cellulitis These guidelines provide support for IV Management of Cellulitis in the community for initial oral treatment has failed. This is to be used
More informationMusculoskeletal Infection Care Process Model
Musculoskeletal Infection Care Process Model Musculoskeletal infections are serious and potentially life-threatening. Musculoskeletal infections include necrotizing fasciitis, septic arthritis, osteomyelitis,
More informationDr Hoi Ping Mok/Infectious Diseases Guidelines/28.12.11 Review < 28.12.16
Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality Guideline for the management of skin and soft tissue
More informationHighlights of the Revised Official ICD-9-CM Guidelines for Coding and Reporting Effective October 1, 2008
Highlights of the Revised Official ICD-9-CM Guidelines for Coding and Reporting Effective October 1, 2008 Please refer to the complete ICD-9-CM Official Guidelines for Coding and Reporting posted on this
More informationGuidelines for the Management of Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Infections in the US Navy and Marine Corps
Guidelines for the Management of Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Infections in the US Navy and Marine Corps AUGUST 2005 Navy Environmental Health Center 620 John
More informationMalpractice and the Infectious Disease Any Physician WHAT YOU SHOULD KNOW! Why this talk? Why me?
Malpractice and the Infectious Disease Any Physician WHAT YOU SHOULD KNOW! G.R. Donowitz 2015 Why this talk? Why me? Expert witness for a long time Defense and Plaintiff work Have said, No, no case and
More informationSURGICAL PROPHYLAXIS: ANTIBIOTIC RECOMMENDATIONS FOR ADULT PATIENTS
Page 1 of 8 TITLE: SURGICAL PROPHYLAXIS: ANTIBIOTIC RECOMMENDATIONS FOR ADULT PATIENTS GUIDELINE: Antibiotics are administered prior to surgical procedures to prevent surgical site infections. PURPOSE:
More informationAppropriate Treatment for Children with Upper Respiratory Infection
BCBS ACO Measure Appropriate Treatment for Children with Upper Respiratory Infection HEDIS Measure CPT II coding required: YES Click here to go to Table of Contents BCBS Measure: Page 50 of 234 Dated:
More informationLiving healthy with MRSA
Stamford Health System Having MRSA means what? Living healthy with MRSA Discharge information for patients and families WASHING YOUR HANDS IS THE KEY!!! Staph aureus is a bacteria that lives on your skin
More informationBlack Hills Healthcare System
Black Hills Healthcare System Methicillin Resistant Staphylococcal Aureus (MRSA) Patient and Family Information What is MRSA? Staphylococcus Aureus, often referred to simply as staph, is a bacteria commonly
More informationC-Difficile Infection Control and Prevention Strategies
C-Difficile Infection Control and Prevention Strategies Adrienne Mims, MD MPH VP, Chief Medical Officer Adrienne.Mims@AlliantQuality.org 1/18/2016 1 Disclosure This educational activity does not have commercial
More informationMRSA, Hand Hygiene and Contact Precautions
MRSA, Hand Hygiene and Contact Precautions Wesley Medical Center Department of Education May 2007 Authors: Lois Rahal, RN, BSN, CIC Brandy Jackson, RN, BSN Hope Helferich, RNC, BSN 1 Objectives Upon completion
More informationPrevention and Recognition of Obstetric Fistula Training Package. Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula
Prevention and Recognition of Obstetric Fistula Training Package Module 8: Pre-repair Care and Referral for Women with Obstetric Fistula Early detection and treatment If a woman has recently survived a
More informationgrowing problem By: Jena Cummins, Doctor of Pharmacy Candidate
Clostridium difficile: A growing problem By: Jena Cummins, Doctor of Pharmacy Candidate Introduction The word difficile il is Latin for the word difficult. Clostridium difficile, affectionately known as
More informationCritically evaluate the organization of diabetic foot ulcer services and interdisciplinary team working
Rationale of Module Accurate nursing assessment is the key to effective diabetic foot ulcer prevention, treatment and management. A comprehensive assessment identifies ulcer aetiology and the factors which
More informationMassachusetts Department of Developmental Services MRSA, VRE, and C. Diff Management Protocol
Massachusetts Department of Developmental Services MRSA, VRE, and C. Diff Management Protocol PURPOSE: To provide guidance for personnel in order to prevent the spread of Antibiotic Resistant Microorganisms
More informationStreptococcal Infections
Streptococcal Infections Introduction Streptococcal, or strep, infections cause a variety of health problems. These infections can cause a mild skin infection or sore throat. But they can also cause severe,
More informationPRMCE ANTI-INFECTIVES SELECTION GUIDELINE FOR ADULTS
PRMCE ANTI-INFECTIVES SELECTION GUIDELINE FOR ADULTS SKIN AND SOFT TISSUE INFECTIONS: Mild A. Cellulitis: MRSA uncommonly causes cellulitis in the absence of a wound abscess. Add empiric anti-mrsa therapy
More informationAntibiotic Prophylaxis for the Prevention of Infective Endocarditis and Prosthetic Joint Infections for Dentists
PRACTICE ADVISORY SERVICE FAQ 6 Crescent Road, Toronto, ON Canada M4W 1T1 T: 416.961.6555 F: 416.961.5814 Toll Free: 1.800.565.4591 www.rcdso.org Antibiotic Prophylaxis for the Prevention of Infective
More informationDiabetic Foot Ulcers and Pressure Ulcers. Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences
Diabetic Foot Ulcers and Pressure Ulcers Laurie Duckett D.O. Plastic and Reconstructive Surgeon Oklahoma State University Center for Health Sciences Lecture Objectives Identify risk factors Initiate appropriate
More informationNewYork-Presbyterian Hospital Sites: Columbia University Medical Center Guideline: Medication Use Manual Page 1 of 12
Page 1 of 12 TITLE: ANTIBIOTICS IN ADULT PATIENTS EMPIRIC USE GUIDELINES, COLUMBIA UNIVERSITY MEDICAL CENTER MEDICATION GUIDELINE PURPOSE: These are the 2011 guidelines for the empiric use of antibiotics
More informationPerson Centered Care: Walk the Talk
Person Centered Care: Walk the Talk Integration of Nurse Practitioner (NP) Role into Extendicare Michener Hill Long Term Care (LTC) Presented by: Sandi Engi MN, NP Michener Hill Extendicare November 25
More informationTAKING CARE OF WOUNDS KEY FIGURE:
Chapter 9 TAKING CARE OF WOUNDS KEY FIGURE: Gauze Wound care represents a major area of concern for the rural health provider. This chapter discusses the treatment of open wounds, with emphasis on dressing
More informationDisease Site Breast. Less than 120 kg: Cefazolin 2 grams IV Greater than or equal to 120 kg: Cefazolin 3 grams IV. Head & Neck
Patients scheduled for surgery should have the following antibiotics administered prior to their procedure Vancomycin and Ciprofloxacin are to be initiated 60 to 120 minutes prior to incision and all other
More informationLab ID Events MRSA Bloodstream Infection and C. difficile
Lab ID Events MRSA Bloodstream Infection and C. difficile MDRO and CDI Module Methicillin-resistant Staphylococcus (MRSA), Vancomycinresistant Enterococcus(VRE), certain gram negative bacilli, Clostridium
More informationb. Povidone Iodine 5% Swabsticks, Single Pack (4 packs) c. Clean gloves
Program Agenda SUBJECT: Universal Decolonization Protocols for Pre-operative Orthopedic Patients EFFECTIVE DATE: 5/2014 REVISED DATE: I. Policy: The largest fraction of hospital acquired infections (HAIs),
More informationTo Order, Visit the Purchasing Page for Details
Go Back to the Top To Order, Visit the Purchasing Page for Details Chapter Bacterial Infections Cutaneous bacterial infections are caused by resident or transient bacteria in the epidermis and mucosa.
More informationGUIDELINES FOR THE MANAGEMENT OF PVL ASSOCIATED STAPHYLOCOCCUS AUREUS INFECTIONS IN THE HOSPITAL ENVIRONMENT
GUIDELINES FOR THE MANAGEMENT OF PVL ASSOCIATED STAPHYLOCOCCUS AUREUS INFECTIONS IN THE HOSPITAL ENVIRONMENT Post holder responsible for Policy: Directorate/Department responsible for Policy: Lead Nurse
More informationPractice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections
IDSA GUIDELINES Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections Dennis L. Stevens, 1,3 Alan L. Bisno, 5 Henry F. Chambers, 6,7 E. Dale Everett, 13 Patchen Dellinger,
More informationDisclosures. Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics
Mitzi Joi Williams, MD Neurologist MS Center of Atlanta, Atlanta, GA Disclosures Consultant and Speaker for Biogen Idec, TEVA Neuroscience, EMD Serrono, Mallinckrodt, Novartis, Genzyme, Accorda Therapeutics
More informationAdult CCRN/CCRN E/CCRN K Certification Review Course: Integumentary and Musculoskeletal
Adult CCRN/CCRN E/CCRN K Certification Review Course: Integumentary and Musculoskeletal Carol Rauen RN BC, MS, PCCN, CCRN, CEN Integumentary IV infiltration Pressure ulcers Wounds Infectious Surgical Trauma
More informationReading and Analyzing Scientific Articles. Wednesday, October 20, 2010
Reading and Analyzing Scientific Articles Wednesday, October 20, 2010 Zuber D. Mulla, Ph.D. Associate Professor & Director of Epidemiologic Research Department of OB/GYN and Affiliate Associate Professor
More informationAdvice for those affected by MRSA outside of hospital
Advice for those affected by MRSA outside of hospital If you have MRSA this leaflet provides information and advice for managing your day-to-day life. 1 About MRSA There are lots of different types or
More informationPlastic, Vascular & Podiatry the Georgetown Model
Plastic, Vascular & Podiatry the Georgetown Model Christopher Attinger,, MD SVS June 15,2011 Chicago Disclosure: None for this talk Wound Center Financial Viability: outline Clinical success Team approach
More informationA case of concurrent deep venous thrombosis, pseudoaneurysm, and extremity abscess in an intravenous methamphetamine abuser
A case of concurrent deep venous thrombosis, pseudoaneurysm, and extremity abscess in an intravenous methamphetamine abuser BY MATTHEW L HARRISON Abstract Introduction. Intravenous drug abuse is a global
More informationPost-surgical V.A.C. VeraFlo Therapy with Prontosan Instillation on Inpatient Infected Wounds * COLLECTION OF CASE STUDIES
COLLECTION OF CASE STUDIES Post-surgical V.A.C. VeraFlo Therapy with Prontosan Instillation on Inpatient Infected Wounds * *All patients were treated with systemic antibiotics Post-surgical V.A.C. VeraFlo
More informationPractice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections
IDSA GUIDELINES Practice Guidelines for the Diagnosis and Management of Skin and Soft-Tissue Infections Dennis L. Stevens, 1,3 Alan L. Bisno, 5 Henry F. Chambers, 6,7 E. Dale Everett, 13 Patchen Dellinger,
More informationAppendix M: Guidelines for the Prophylaxis and Management of Intraabdominal, Biliary, and Appendiceal Infections
Appendix M: Guidelines for the Prophylaxis and Management of Intraabdominal, Biliary, and Appendiceal Infections University of Wisconsin Hospital and Clinics Intraabdominal Infections Prophylaxis and Management
More informationSURGICAL ANTIBIOTIC PROPHYLAXIS. Steve Johnson, PharmD, BCPS Prime Therapeutics, Inc
SURGICAL ANTIBIOTIC PROPHYLAXIS Steve Johnson, PharmD, BCPS Prime Therapeutics, Inc OBJECTIVES Discuss antibiotic use as prophylaxis vs presumptive therapy vs treatment of infections. Discuss risk factors
More information10. Treatment of peritoneal dialysis associated fungal peritonitis
10. Treatment of peritoneal dialysis associated fungal peritonitis Date written: February 2003 Final submission: July 2004 Guidelines (Include recommendations based on level I or II evidence) The use of
More informationManaging Challenging Cases in Refractive Surgery
Managing Challenging Cases in Refractive Surgery Missouri Optometric Association Stephen A. Wexler, MD Eric E. Polk, OD, FAAO Outline The presenters will review challenging cases they have managed in refractive
More informationSurgical Site Infection Prevention
Surgical Site Infection Prevention 1 Objectives 1. Discuss risk factors for SSI 2. Describe evidence-based best practices for SSI prevention 3. State principles of antibiotic prophylaxis 4. Discuss novel
More informationHome Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes
Home Health Care ICD-10-CM Coding Tip Sheet Overview of Key Chapter Updates for Home Health Care and Top 20 codes Chapter 4: Endocrine, Nutritional and Metabolic Diseases (E00-E99) ICD-10-CM diabetes mellitus
More informationInterim Guidelines for the Management of Community-Associated Methicillin-Resistant Staphylococcus aureus Infections in Primary Care February 2006
Table of Contents 1. Background... 2 2. Diagnosis... 2 3. Susceptibility Patterns of MRSA... 3 4. Management... 3 5. Decolonization of the Patient... 4 6. Prevention and Control... 5 7. Information for
More informationApproach to Lower Extremity Osteomyelitis. A radiologic tour of a patient encounter
Approach to Lower Extremity Osteomyelitis A radiologic tour of a patient encounter David Guo,, HMS III Gillian Lieberman, MD BIDMC, October 2009 Our learning goals Review lower extremity anatomy Discuss
More informationSolid Organ Transplantation
Solid Organ Transplantation Infection Prevention And Control Transplant Atlantic 2011 October 13/2011 Kathy Hart Introduction In the past several years, the drugs that we use, the surgeries themselves,
More informationCDR Matt Armentano, PT, DPT, OCS FMC Lexington
CDR Matt Armentano, PT, DPT, OCS FMC Lexington Define standard acceptable rates of surgical site infections in lower extremity total joint procedures Describe risk factors for surgical site infections
More informationSports Dermatology. Atlantic Sports Health Damion A. Martins, MD Director Dean Padavan, MD Brett Keller, MD
Sports Dermatology Atlantic Sports Health Damion A. Martins, MD Director Dean Padavan, MD Brett Keller, MD Objectives NJSIAA Skin Checks Disease Identification and Management Bacterial Fungal Viral Return
More informationSkin and Soft Tissue Infections
Prim Care Clin Office Pract 33 (2006) 697 710 Skin and Soft Tissue Infections Robert L. Rogers, MD, FAAEM, FACEP, FACP*, Jack Perkins, MD Department of Emergency Medicine, The University of Maryland School
More informationGEORGIA DEPARTMENT OF CORRECTIONS Floyd Veterans Memorial Building Room 952 - East Tower Atlanta, Georgia 30334
Sonny Perdue Governor GEORGIA DEPARTMENT OF CORRECTIONS Floyd Veterans Memorial Building Room 952 - East Tower Atlanta, Georgia 30334 1 MEMORANDUM TO: FROM: Medical Directors, Medical Administrators, &
More informationIntra-abdominal abdominal Infections
Intra-abdominal abdominal Infections Marnie Peterson, Pharm.D., BCPS Dept. of Pediatric Infectious Diseases Medical School University of Minnesota Intra-abdominal abdominal Infections Intra-abdominal abdominal
More informationPIGEON FEVER: DIAGNOSIS, TREATMENT, AND PREVENTION. Tiffany L. Hall, DVM, DACVIM Brazos Valley Equine Hospital Navasota, TX 936-825-2197
PIGEON FEVER: DIAGNOSIS, TREATMENT, AND PREVENTION Tiffany L. Hall, DVM, DACVIM Brazos Valley Equine Hospital Navasota, TX 936-825-2197 Many equine veterinarians in Texas are seeing an increasing number
More informationIntegumentary System Individual Exercises
Integumentary System Individual Exercises 1. A physician performs an incision and drainage of a subcutaneous abscess in his office for a particularly uncooperative established patient. How should this
More informationtreatment of varicose and spider veins patient information SAMPLE a publication by advancing vein care
treatment of varicose and spider veins patient information a publication by advancing vein care Since most veins lie deep to the skin s surface, vein disorders are not always visible to the naked eye.
More informationCDC 2015 STD Treatment Guidelines: Update for IHS Providers Sharon Adler M.D., M.P.H.
CDC 2015 STD Treatment Guidelines: Update for IHS Providers Sharon Adler M.D., M.P.H. Clinical Faculty, CA Prevention Training Center Disclosure Information Sharon Adler MD, MPH I have no financial relationships
More informationREAD THIS LEAFLET VERY CAREFULLY, AND KEEP IT IN A SAFE PLACE. FLU IS SPREADING IN IRELAND, AND THIS INFORMATION IS IMPORTANT FOR YOU AND YOUR FAMILY.
READ THIS LEAFLET VERY CAREFULLY, AND KEEP IT IN A SAFE PLACE. FLU IS SPREADING IN IRELAND, AND THIS INFORMATION IS IMPORTANT FOR YOU AND YOUR FAMILY. Information and medical advice for the public on Pandemic
More informationTired, Aching Legs? Swollen Ankles? Varicose Veins? An informative guide for patients
Tired, Aching Legs? Swollen Ankles? Varicose Veins? An informative guide for patients Are You at Risk? Leg problems are widespread throughout the world, but what most people don t know is that approximately
More informationEvaluation & Management. Guidelines. Presented by: Kristi A. Gutierrez CCS-P, CPC, CEMC
Evaluation & Management Documentation and Coding Guidelines Presented by: Kristi A. Gutierrez CCS-P, CPC, CEMC Objectives Participants will gain a working knowledge of Medicare s 1995 Evaluation & Management
More informationCommon Breast Complaints:
: Palpable mass Abnormal mammogram with normal physical exam Vague thickening or nodularity Nipple Discharge Breast pain Breast infection or inflammation The physician s goal is to determine whether the
More informationVARICELLA ZOSTER (VZ) VIRUS, CHICKENPOX & SHINGLES GUIDANCE
VARICELLA ZOSTER (VZ) VIRUS, CHICKENPOX & SHINGLES GUIDANCE Summary This guidance provides background information on varicella zoster (VZ), chickenpox and shingles and sets out the infection control measures
More informationVisit ER at 09:14. ER & infection conference. Present illness. Past history. Physical examination
Visit ER at 09:14 ER & infection conference A 50 y/o female, Sereve left neck and chest pain for 3 weeks Chief complaint: left neck and chest pain for 3 weeks Triage: III T/P/R:36.2/79/20, BP=130/78, SpO2=99%
More informationPressure Ulcers in the ICU Incidence, Risk Factors & Prevention
Congress of the Critical Care Society of South Africa Sun City, 10-12 July 2015 Pressure Ulcers in the ICU Incidence, Risk Factors & Prevention Stijn BLOT Dept. of Internal Medicine Faculty of Medicine
More informationHemodialysis catheter infection
Hemodialysis catheter infection Scary facts In 2006, 82% of patients in the United States initiated dialysis via a catheter The overall likelihood of Tunneled cuffed catheters use was 35% greater in 2005
More informationManagement of Neurologically Intact Patient with Cervical Epidural Abscess
Management of Neurologically Intact Patient with Cervical Epidural Abscess Jason C. Eck, DO, MS Center for Sports Medicine & Orthopaedics Chattanooga, TN Overview Pathophysiology and epidemiology of epidural
More informationMANAGEMENT OF TUBERCULOSIS
MANAGEMENT OF TUBERCULOSIS Dean B. Ellithorpe, M.D. Clinical Professor of Medicine Section of Pulmonary Diseases, Critical Care and Environmental Medicine Tulane University School of Medicine INTRODUCTION
More information