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Cellulitis, C.diff GI Infections, Diabetic Foot Infections - Coggle Diagram
Cellulitis
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Signs and Symptoms
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Systemic symptoms: hypotension, dehydration, altered mental status
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Severe cellulitis criteria: Fever >38C, HR > 90bpm, RR > 24 bpm, WBC count >12,000/L
Diagnosis
Cultures of cutaneous aspirates, biopsies, or swabs not recommended unless patient is undergoing chemotherapy
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Etiology
Infection of the epidermis or dermis that is commonly caused by S. aureus (mostly purulent cellulitis) and S. pyogenes (non-purulent cellulitis)
At risk populations: Injection drug users, surgery patients, older patients
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Goals of Therapy
Rapid eradication of the infection and prevention of further complications, without use of excessive antimicrobials that contribute to resistance or cost
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C.diff GI Infections
Diagnosis
Non-severe: WBC ≤ 15,000 cells/mm3 (15*109/L); SCr < 1.5 mg/dL (133 µmol/L)
Severe: WBC > 15,000 cells/mm3 (15*109/L); SCr > 1.5 mg/dL (133 µmol/L)
Fulminant: hypotension or shock, ileus and/or megacolon
BP, HR, RR, O2-saturation
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Monitoring/Prevention
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Hand washing/ Alcohol use: hand washing is preferred but not evidence that one is more effective than the other
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Etiology
- gram (+) spore-forming colonies in large intestine - Toxin A [TcdA] and Toxin B [TcdB] are released and cause symptomatic CDI.
- other symptomatic causes: production of binary toxin, mutations causing hyperproduction of toxins, antibiotic resistance, increased sporulation, and mutations that increase adherence to the intestinal lumen
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Diabetic Foot Infections
Diagnosis
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Deep-tissue samples for culture (biopsy, curettage, or needle aspiration of drainage)
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Classifications
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Mild
Local infection only involving the skin and subcutaneous tissue; if erythema is present, must be >0.5 and <2cm around ulcer
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Moderate
Local infection with erythema >2cm around ulcer, involving structures deep than skin and subcutaneous tissue (ex. abscesses, osteomyelitis, septic arthritis, fasciitis); no SIRS criteria
Severe
Local infection with >2 SIRS criteria: temp > 38C (100.4F); HR >90; RR >20; WBC >12,000 or <4,000 bands
Etiology
Mild cases indicate monomicrobial infection; severe cases indicate potential polymicrobial infection
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MRSA has become more prevalent pathogen for DFI and may be associated with an increased risk of treatment failure and worse patient outcomes
Signs and Symptoms
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Lesion characteristics: erythema, edema, warmth, presence of pus, draining sinuses, pain, and tenderness
Patients may not report pain, just swelling and edema
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Goals of therapy
- Successfully treat infected wounds using effective nondrug and antibiotic therapy
- Prevent additional infectious complications
- Preserve as much normal limb function as possible
- Avoid unnecessary use of antimicrobials that contribute to increased resistance
- Minimize toxicities and cost while increasing pt QoL