Skin and Soft tissue

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ModuleVIIISkinSoftTissueandUrinaryTractInfections.html

Topic VIII: Skin/Soft Tissue and Urinary Tract Infections 

Introduction

This topic will discuss two additional infectious disease topics, skin/soft tissue infections and urinary tract infections.  Both kinds of infections are very common in both the outpatient and inpatient settings.  Be sure to follow the same infectious disease concepts regarding antimicrobial selection as were discussed in the previous topic.

SSTIs

Skin and soft tissue infections encompass a variety of infections such as:  impetigo, folliculitis, furuncles, carbuncles, erysipelas, diabetic foot infections and cellulitis.  Our focus will be primarily on cellulitis and diabetic foot infections.  It is important with any infectious disease to keep up to date with local resistance patterns and emerging resistant organisms such as methicillin resistant staphylococcus aureus (MRSA), to aid in your decision making.

Appropriate wound care, as well as preventative measures for subsequent infections, is important for many types of SSTIs.

The most common organisms involved in cellulitis are staphylococcus aureus and B-hemolytic streptococci.  Community-acquired methicillin resistant staphylococcus aureus (CA-MRSA) should be considered in patients with risk factors or in an area with increasing prevalence of organism.  (Table 73-3)

Diabetic foot infections are often polymicrobial and can involve gram +, gram - and anaerobic bacteria.  Often resistant organisms (especially if recurrent infection) may be of concern.  Broad spectrum empiric coverage is essential here.  (Table 73-6)

UTIs

Urinary tract infections are classified both my location (upper and lower) as well as causation (complicated or uncomplicated). The treatment choices, dose, as well as treatment duration vary greatly dependent on the classification of the infection. Local resistance patterns and urine cultures are helpful in appropriately managing UTIs.

Bacteriuria does not always indicate an infection.  Be familiar with the diagnostic criteria for significant bacteriuria (Table 79-1) and understand when treatment is necessary.

Escherichia coli is the causative agent in up to 85% of uncomplicated UTIs.   

Treatment of urinary tract infections varies greatly in terms of medication, dose and treatment duration depending on the location of the UTI as well as the cause (complicated or uncomplicated). (Table 79-2 and Table 79-3)

Be cautious of resistant organisms in patients with recurrent UTIs.  

Special considerations for treatment are necessary for pregnant women, patients with catheters and UTIs in men.   

Objectives

At the completion of this module the student will be able to:

Skin and Soft Tissue Infections:

  • understand the common organisms involved in various skin and soft tissue infections.
  • recognize the common adverse effects, drug interactions and monitoring parameters for medications used for skin and soft tissue infections.
  • create a treatment plan for patients with cellulitis.

Urinary Tract Infections (UTI):

  • recognize the symptoms of upper (pyelonephritis) and lower (bladder) urinary tract infections.
  • identify the common organisms involved in UTIs.
  • create a treatment plan for a patient with both complicated and uncomplicated urinary tract infections.
  • appropriately monitor a patient taking antibiotics for a urinary tract infection.

Readings 

Pharmacotherapy Principles and Practice

  • Chapter 73: Skin and Soft Tissue Infections
  • Chapter 79: Urinary Tract Infections
Dynamed Summaries:

Videos

 
Module VIII Discussions & Assignments 
Discussion 

Often infections have several treatment possibilities, depending on both patient specific and disease specific characteristics.  Below is a very short case, and I want you as a class to compare and contrast the listed treatment options.  The focus will be on safety and efficacy of the regimens, all considered possible choices by the Infectious Disease Society of America's treatment guidelines for Acute Uncomplicated Cystitis.   

HT is a 31 year old female with acute, uncomplicated cystitis and no known drug allergies.  She has no significant PMH or medications.  Her urine culture shows a susceptible E. coli (susceptible to all treatments listed below).  Please compare the safety and efficacy of the following options.  What would make you choose one over another?

1.  nitrofurantoin 100 mg po BID x 7 days

2.  TMP/SMX DS (160 mg/800 mg) po BID x 3 days

3.  levofloxacin 250 mg po daily x 3 days

4.  cephalexin 500 mg po q12hrs x 7-14 days

I want you all to discuss and add to or dispute each other's thoughts and ideas.

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section. 

Module VIII: Skin and Soft Tissue/UTI Discussion

 Assignments

Exam 2: Somatic Disorders and Infectious Disease

Post your initial response by Wednesday at midnight. Respond to one student by Sunday at midnight.  Both responses should be a minimum of 150 words, scholarly written, APA formatted, and referenced.  A minimum of 2 references are required (other than your text). Refer to the Grading Rubric for Online Discussion in the Course Resource section. 

Special Guidance on APA formatting in Discussion Posts APA formatting is required in discussion posts with the following two exceptions (due to limitations with the text editor in LIVE):  double line space and indent 1/2 inch from the left margin. Discussion posts will NOT be evaluated on those two formatting requirements. All other APA formatting guidelines should be followed. For example, in-text citations must be formatted with the appropriate information and in the correct sequence (Author, year), reference list entries must include all appropriate information following  guidelines for capitalization, italics, and be in the correct sequence. Refer to the APA Publication Manual 7th ed. for each source type's specific requirements. Please let your instructor know if you have any questions.

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