deadly soft tissue infections - squ.edu.om of medicine/departments... · objectives •to be able...
TRANSCRIPT
![Page 1: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/1.jpg)
Deadly soft tissue infections
Dr. Faisal Al sawafi
Emergency Physician
Ibra Hospital
![Page 2: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/2.jpg)
![Page 3: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/3.jpg)
Case 1
• 70 year old male , known case of
diabetes, not HTN, present with history
of redness , pain over perineal area for
last 2 days..
• o/e
• Temp 39, pr 120, bp 100/60
• minimal tenderness on scrotum and penis
![Page 4: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/4.jpg)
![Page 5: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/5.jpg)
Objectives
• To be able to recognize soft tissue infections early
• To formalize an approch for dealing with patient of soft tissue infection
• Understand importance of MRSA infections in management of soft tissue infection.
• Able to differentiate which cases need admission versus discharge
![Page 6: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/6.jpg)
Anatomy
![Page 7: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/7.jpg)
![Page 8: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/8.jpg)
importance
• Common
• Vague presentations and difficult
examinations.
• MRSA
![Page 9: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/9.jpg)
![Page 10: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/10.jpg)
MRSA
• global emerging
• cause severe, invasive infections
• Cause around 59% of purulent skin and
soft tissue infections in patient >18
years old.
• 75% of purulent skin abscess in children
![Page 11: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/11.jpg)
![Page 12: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/12.jpg)
![Page 13: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/13.jpg)
![Page 14: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/14.jpg)
Risk factors
• DM
• Hospitalization
• Admission in ICU
• Previous antibiotic use
• Endotracheal intubation with MV
• Nasogastric or gastrotomy tube
• Foleys catheter
• Immunosuppression or chronic illness
![Page 15: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/15.jpg)
• Absence of “risk factors” does NOT
exclude MRSA
because
• About 50% have no risk factors
![Page 16: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/16.jpg)
Diagnosis
• On clinical background
• Any skin or soft tissue infections or
sepsis
![Page 17: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/17.jpg)
Treatment
Miller LG, et al. Clin Infect Dis.
Fridkin SK, et al. N Engl J Med.
![Page 18: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/18.jpg)
Susceptibility
patterns are
dynamic & vary
geographically
![Page 19: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/19.jpg)
![Page 20: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/20.jpg)
Variable sensitivity
• Clindamycin (83-95%)
• Tetracycline (81-92%)
• Ciprofloxacin (15-79%)
• Erythromycin (6-44%)
![Page 21: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/21.jpg)
Case 2
![Page 22: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/22.jpg)
![Page 23: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/23.jpg)
Ludwigs angina
• Cellulitis of submandibular and
subligual space
• 50 – 80% : bad dental hygiene
![Page 24: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/24.jpg)
Why it is deadly
• Life threatining, rapid aggressive
• difficult airway management
• Mortality 5- 10%
![Page 25: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/25.jpg)
• May spread to deep cervical fascia,
carotid sheath and retropharyngeal
space , cause mediastinitis
• Organism : fusobacterium,
bacteroides, anerobes, spirochetes
(0ral cavity anaerobes) may mixed
with staph and strep
![Page 26: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/26.jpg)
Signs and symptoms
• Febrile, neck pain, odynophagia,
dysphagia, drooling, leaning forward.
• Tender, symmetrical swelling in
submandibular area.
• Cyanosis, tachypnea, stridor, agitation
![Page 27: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/27.jpg)
Diagnosis
![Page 28: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/28.jpg)
![Page 29: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/29.jpg)
Treatment
• Airway
• Airway
• Airway
![Page 30: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/30.jpg)
![Page 31: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/31.jpg)
Antibiotics
• Pinicillins with clindamycin
• Ampicillin-sulbactam, metronidazole
and penicillin, imipenim-cilastatin,
piperacillin-tazobactem
• MRSA coverage
![Page 32: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/32.jpg)
Steroids
• contraversial
![Page 33: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/33.jpg)
Surgery
• Not responds to medical therapy
• Crepitus and purulent secretions
![Page 34: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/34.jpg)
Case 3
• 12 year old girl present with left eyelid
swelling and red skin around eye for
last 2 days. She has also URTI
symptoms.
• o/e :
• Temp 38, eyelid redness , normal eye
exam. Normal visual acuity
![Page 35: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/35.jpg)
Periorbital cellulitis
![Page 36: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/36.jpg)
Orbital cellulitis
![Page 37: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/37.jpg)
Orbital cellulitis
• Ocular emergency.
• Infection of tissue posterior to orbital
septum.
• Caused by : ethmoidal sinusitis ,
endophthalmitis, trauma, poor dental hygiene
![Page 38: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/38.jpg)
Organism
• Staph aureus
• Strep. pneumoniae
• H.influena
![Page 39: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/39.jpg)
Why it is deadly ?
• Orbital abscess
• Brain abscess
• osteomyelitis
• Meningitis
• Cavernous sinus thrombosis
![Page 40: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/40.jpg)
signs
• Periorbital redness and swelling
• Decrease visual acuity
• Proptosis
• Chemosis
• Double vision
• Limitation of eye movement.
![Page 41: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/41.jpg)
Diagnosis
• CT
![Page 42: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/42.jpg)
Treatment
• Antibiotics (aerobea and anaerobes)
• 2nd or 3rd generation cephalosporin
• Ampicillin – sulbactem
• Carbapenems
• Fluroquinolones (penicillin allergy)
• Metronidazole or clindamycin for
anaeobes
![Page 43: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/43.jpg)
Case 4
• 60 year old male, k/c/o DM on
treatment, present with left thigh pain,
redness and blisters for 2 days
• o/e
• temp 39.5, pr 110, bp 110/70
![Page 44: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/44.jpg)
![Page 45: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/45.jpg)
Necrotizing fasciitis
![Page 46: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/46.jpg)
Why it is deadly
• Extensive soft tissue infection
• Systemic toxicity
• High morbidity
• Mortality is 25 – 35%
![Page 47: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/47.jpg)
Risk factors
• Age
• DM
• Peripheral vascular disease
• Alcoholism
• Heart disease
• Renal and heart failure
• Cancer, hiv
![Page 48: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/48.jpg)
Microbiology
• Type 1 polymicrobial :
• Type II monomicrobial :
(staphylococcus, streptococcus,
clostridim species and MRSA)
• Type III : vibrio vulnificus
![Page 49: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/49.jpg)
Clinical features
• Pain out of proption on physical
examination
• Redness, tenderness
• Crepitus
• Fever
• tachycardia
![Page 50: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/50.jpg)
![Page 51: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/51.jpg)
Diagnosis: XRAY
![Page 52: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/52.jpg)
US
![Page 53: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/53.jpg)
CT ; sensitivity 80%
![Page 54: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/54.jpg)
Treatment
• Early resussitation
• Packed RBC transfusion
• Empirical antibiotic (ampicillin
sulbactam, 3rd cephalo, carbapenem)
Surgical consult
Operative exploration
![Page 55: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/55.jpg)
Fourniers gangrene
![Page 56: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/56.jpg)
Clostridial myonecrosis
![Page 57: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/57.jpg)
• Caused by : clostridim prifingens
• Deadly : limb and life threatinng
• Treatment : penicillin + clindamycin
![Page 58: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/58.jpg)
Case 5
• 40 year old male with peripheral
vascular disease, present with redness
over left lower limb for 5 days with
fever and rigors
• o/e: temp 39, pr 105, bp 120/60
• Ill defined Erythema, swelling up to mid
leg
![Page 59: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/59.jpg)
![Page 60: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/60.jpg)
Why it is deadly
• Acute fast spread of infection
• Systemic toxicity
• Limb threatining
![Page 61: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/61.jpg)
Risk factors
• Immunocompromized
• Peripheral vascular disease
• Lymphedema
• Skin breakdown
• venous insufficiency
![Page 62: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/62.jpg)
Microbiology
• 80 % gram positive
• Beta-hemolytic streptococci
• Staph aureus (MRSA)
• Less common
• Haemophilus influenza
• Organisms from animal or human bites
![Page 63: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/63.jpg)
Diagnosis
• Inflammatory markers
• Blood culture
• Needle aspiration
• Culture of pus, bullae
• US +- doppler
clinical
![Page 64: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/64.jpg)
cobblestoning
• US finding of cellulitis
![Page 65: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/65.jpg)
Treatment
• For outpatient: cephalexin or
clindamycin or tetracyclin
• Inpatient : vancomycin, clindamycin,
linezolid and daptomycin
![Page 66: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/66.jpg)
MRSA coverage
• If
• purulent discharge
• Penetrating trauma
• Known MRSA colonization
• IV drug use
![Page 67: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/67.jpg)
Toxic shock syndrome
• toxin-mediated bacterial skin
syndrome
![Page 68: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/68.jpg)
Why deadly soft tissue infection
• Bacteremia is common with positive
blood cultures in about 60%.
• Serious multisystem complications are
common, including : DIC, RF, ARDS
![Page 69: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/69.jpg)
![Page 70: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/70.jpg)
![Page 71: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/71.jpg)
Treatment
• Critical care resuscitation
• Removal of potential source
• Antibiotics including clindamycin and
vancomycin
• Surgical consultation
![Page 72: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/72.jpg)
![Page 73: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/73.jpg)
![Page 74: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/74.jpg)
![Page 75: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/75.jpg)
Summary
• Early recognition of soft tissue infection
• Do not forget MRSA coverage when
suspected
• Early antibiotic for devastating soft
tissue infections
• Early surgical consultation for
necrotizing faccitis
![Page 76: Deadly soft tissue infections - squ.edu.om of Medicine/Departments... · Objectives •To be able to recognize soft tissue infections early •To formalize an approch for dealing](https://reader030.vdocuments.us/reader030/viewer/2022040700/5d4fde8b88c99348698bc900/html5/thumbnails/76.jpg)
Thanks alot