Quick Review: Bacterial Skin Infections

by Stephen Holt, MD, MS

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    00:02 Okay, let's do a couple quick questions to review.

    00:05 Remember, I'll ask a question, you can pause the screen and when you're ready to review the answer, just unpause the screen.

    00:11 So, question number one: All of the following are common manifestations of necrotizing fasciitis except: Okay, number 1 - tenderness out of proportion for the exam.

    00:29 Yes, that's one of those classic pathognomonic features that we'll see for necrotizing fasciitis on a board question.

    00:35 Number 2 - well-demarcated borders.

    00:38 That's definitely false.

    00:40 Patients with necrotizing fasciitis have edema deep in the dermis and it can actually be very difficult to establish where the borders of the infection are.

    00:48 Number 3 - presence of crepitus.

    00:50 Yes, you may see that with any gas-producing organisms.

    00:54 Number 4 - Bullous lesions are manifestations that sometimes we do see necrotizing fasciitis and absolutely you're gonna have systemic signs and symptoms in such patients.

    01:04 So our answer is that, well-demarcated borders are not a common manifestation of necrotizing fasciitis.

    01:11 Alright, our next and final question: Which of the following is NOT an appropriate antibiotic choice? Okay, number 1 - mild impetigo.

    01:28 Yup you can absolutely get by with just topical mupirocin.

    01:31 Number 2 - erysipelas with fevers and chills.

    01:35 This sounds like a moderate to severe case of a group A strep infection an IV ceftriaxone would definitely be appropriate Next up, cellulitits with fevers and chills.

    01:45 Well due to the increased prevalence of methicillin-resistant Staph. aureus, we would really need to use IV vancomycin in this case.

    01:52 Next up is suspected necrotizing fasciitis.

    01:56 Well remember that with necrotizing fasciitis, you need to use broad spectrum antibiotics.

    02:01 You can't just get by with IV cephalexin.

    02:04 You typically need to be able to treat against potentially polymicrobial infections with staph, strep, pseudomonas and a variety of anaerobic bacteria as well.

    02:12 Thus, such patients should get something more like Vancozosyn plus clindamycin due to its antitoxin effects.

    02:20 In addition, as I mentioned earlier, the patient with suspected necrotizing fasciitis is probably gonna require a surgical consultation to debride any necrotic tissue and drain any fluid collections.

    02:30 It's actually really quite a gruesome diagnosis.

    02:34 Lastly, just to round things out with the mild cellulitis, you can definitely get by with just oral Bactrim which treats the majority of community-acquired MRSA infections.

    02:43 And with that, I think we've covered all the bacterial skin infections.

    About the Lecture

    The lecture Quick Review: Bacterial Skin Infections by Stephen Holt, MD, MS is from the course Skin Infections.

    Included Quiz Questions

    1. Broad-spectrum antibiotics and a surgical consultation
    2. Watchful waiting
    3. Escharotomy
    4. Low-molecular-weight heparin
    5. Intravenous vancomycin

    Author of lecture Quick Review: Bacterial Skin Infections

     Stephen Holt, MD, MS

    Stephen Holt, MD, MS

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