ANMCGuidelineforUncomplicatedSkinandSoftTissueInfection - PDF document

ANMCGuidelineforUncomplicatedSkinandSoftTissueInfection Thisguideline shouldnotbeused forthefollowing: - Infecteddiabeticulcerorvascularulcer-Humanoranimalbite-Criticalillness -Clinicalconcernfornecrotizingfasciitis-Periorbitalororbitalcellulitis-Bacteremia -Surgicalsiteinfection-Pregnancy Complicatingriskfactorswarrantalternativetreatmentstrategies;considerInfectiousDiseasesconsultation KeyPoints: Beta-hemolyticstreptococciarethemostcommoncauseofnon-purulentcellulitis MRSAisthemostcommoncauseofabscessandpurulentskininfections Gram-negativeoranaerobiccoverageisunnecessary Elevateaffectedarea ThefollowingareNOTroutinelyindicated forinitialmanagement : ESR bloodcultures woundswab,fungal,orAFBcultures plainfilms CTorMRI Outpatient SuspectedPathogen(s) RecommendedTreatment OtherComments Cellulitis without purulentfocus Betahemolytic Streptococci (MostcommonlyGrpA,also GrpB,GrpC,GrpGstrep) 1) Antibiotic: Amoxicillin500mgPOTID Alternative1 st lineorPCNallergy: Cephalexin500mg-1gmPOTID CephalosporinorType-1PCNallergy: Clindamycin450mgPOTID 2) Ibuprofen600mgPOTID ifno contraindicationstoNSAIDtherapy 3)Elevateaffectedarea AbxTreatmentDuration: 5-7days Cellulitis with purulentfocus Beta - hemolytic Streptococci MethicilinSusceptible Staphylococcusaureus (MSSA) MethicilinResistant Staphylococcusaureus (MRSA) 1)I&D 2)SendpurulentdrainageforGS&Culture 3)Ifindicated, Antibiotic : TMP/SMXDS1tabPOBID *Sulfaallergy : 2n

dLine Clindamycin450mgPOTID 3rdLine Doxycycline100mgPOBID 4) Ibuprofen600mgPOTID ifno contraindicationstoNSAIDtherapy 5) Elevateaffectedarea Drainageisthemostimportantintervention. Antibioticsmaynotbenecessary fordrained abscesseswithoutsurroundingindurationor erythema AbxTreatmentDuration: 5-7days Note:RecurrentMRSAinfectionsneednotbe culturedateverypresentation ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! e y Points • Beta-hemolytic streptococci are the most c o mm o n ca u s e o f n o n-p u r u l e nt c e llulitis • M R S A is th e m o st c o mm o n cause of abscess and purulent skin infections • G ram-n e gativ e o r ana e r o bic c o v e rag e is unnecessary • Elevate affected area(s) Th e following ar e NOT routin e ly indicat e d for initial manag e m e nt: • E S R • bl oo d c u lt u r e s wound swab, fungal, or AFB cultures plain films, CT or MRI 2-3 days? o tic S t e p-d o wn Th e rapy: Cephalexin 1gm PO TID *Cephalosporin or Ty pe-1 PCN allergy: Clindamycin 450 mg PO TID e lin e for Uncomplicat e d Skin and Soft Tissu e Inf e ction (Inpati e nt) e s e nt? e ct e d diab e tic u lc e r o r vasc u lar u lc e r - Hu man or animal bite o nc e rn f o r n e cr o tizing f a sciitis, calc u lat e L R I N EC score and obtain immediate surgical consultation. Dee p tiss ue inf e cti o n

-P e rin e al/v u lvar/p e rianal infection o e ous absc e ss pr e s e nt? e rf o rm b e dsid e u ltras ou nd and/ o r n ee dl e aspiration if uncertain) e d SSTI • Treatment varies • Consider ID consultation e s o e ous absc e ss o Blood cultures if systemically ill, S u perficial wo u nd c u lt u re N OT e nt drainag e or e xudate Plain film only if concern for foreign o dy Co nsid e r u ndrain e d f o c u s o f infection o For non-purulent cellulitis, consider IV vancomycin Co ns u lt I D services e s e nt c e llulitis o tic S t e p-d o wn Th e rapy: o e s 5 days sufficient for well-drained abscess e nt c e llulitis ou t s u rr ou nding c e llulitis Du rati o n o f th e rapy may b e e xt e nd e d f o r 1) I&D 2) S e nd p u r u l e nt drainag e f o r G S & Cu lt u re 3) Antibiotic: Vancomycin 1 gm IV q12hr 4) Ibuprofen 600mg PO TID if no c o ntraindicati o ns t o N S AI D therapy 5) El e vat e aff e ct e d ar e a • Blood cultures if systemically ill, diabetic, or other immunosuppression • S u perficial wo u nd c u lt u re N OT indicated • Plain film only if concern for foreign b o dy 1) Antibiotic: Cefazolin 2 gm IV q8hr *Cephalosporin or Type-1 PCN allergy: Clindamycin 600 mg IV q8hr 2) Ibuprofen 600mg PO TID if no c o ntraindicati o ns t o N S AI D therapy 3) El e vat e aff e ct e d ar e a 4) Treat tinea pedis if applicab