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1. Clinical considerations for skin and soft tissue infections include the affected tissue layers, extent of invasion, anatomical location, causative pathogen, and clinical progression and manifestations.
2. Infections are classified as superficial or deep soft tissue infections. Superficial infections include cellulitis, erysipelas, furuncles, and lymphangitis. Deep infections involve deeper tissues and fascia and commonly involve Streptococcus pyogenes or Clostridium perfringens.
3. Treatment recommendations from clinical practice guidelines include antibiotics such as penicillin for superficial infections and penicillin plus clindamycin for necrotizing soft tissue infections. Surgical intervention is often needed for deep infections.
1. Clinical considerations for skin and soft tissue infections include the affected tissue layers, extent of invasion, anatomical location, causative pathogen, and clinical progression and manifestations.
2. Infections are classified as superficial or deep soft tissue infections. Superficial infections include cellulitis, erysipelas, furuncles, and lymphangitis. Deep infections involve deeper tissues and fascia and commonly involve Streptococcus pyogenes or Clostridium perfringens.
3. Treatment recommendations from clinical practice guidelines include antibiotics such as penicillin for superficial infections and penicillin plus clindamycin for necrotizing soft tissue infections. Surgical intervention is often needed for deep infections.
1. Clinical considerations for skin and soft tissue infections include the affected tissue layers, extent of invasion, anatomical location, causative pathogen, and clinical progression and manifestations.
2. Infections are classified as superficial or deep soft tissue infections. Superficial infections include cellulitis, erysipelas, furuncles, and lymphangitis. Deep infections involve deeper tissues and fascia and commonly involve Streptococcus pyogenes or Clostridium perfringens.
3. Treatment recommendations from clinical practice guidelines include antibiotics such as penicillin for superficial infections and penicillin plus clindamycin for necrotizing soft tissue infections. Surgical intervention is often needed for deep infections.
2. lokasi anatomis 3. Patogen penyebab 4. progresivitas dan manif klinis Klasifikasi: 1. Superfisial soft tissue inf.: a. selulitis - ec gram (+) aerob; bisa jg gram (-) dan fungi (imunokompromise) - Tx: + AB oral 3-5 hari: 1st gen sefalo or semisintetik penisilin + opening the wound b. erisipelas - more extensive forms of celulitis - Tx: + debri + penisilin G IV 16rb-20rb U c. furunkel d. limfangitis - penyebaran infeksi via drainase limfatik - tx: AB IV utk gram positif 2. Deep soft tissue inf. - Faktor risiko: + ggn sistem imun dan pertahanan host + compromise of fascial blood supply + adanya mikroba - Ec: + commonly S. pyogenes or C. perfringens + rarely P aeruginosa or vibrio vulnificans + bisa jg polimikrobial (pyogenes, aureus, E coli, anaerob, fungi, dll) - Manifestasi: + first sign: fever and confusion + drainage of watery, grayish fluid from wound or open sore + kulit berwarna copper + brawny induration + skin blebs or krepitasi + bisa juga: Sb^^, N^, TD V, syok, incipient MSOF with DIC, rabdomiolisis> ren al failure - PP: Ro: gas in the soft tissue - Tx: a. resusitasi b. insisi-biopsi di OK, kultur pus c. debri semua jaringan terinfeksi, pertimbangkan amputasi utk life-saving . AB: First line: = penisilin G (16-20x10^6/24 jam) + = vancomycin + = aminoglikosida/sefalo 3rd gen + = klindamisin/metro Alternatives: = vancomycin + = broad spectrum agent (imipenem-cilastatin/ampicilin-sulbactam/ticarcilin-cl avulanate/piperacillin-tazobactam Amoterisin kalau curiga fungi - Antara lain a. necrotizing fasciitis b. necrotizing myositis c. parasitic muscle infections d. pyomyositis ======================== Summary of Recommendations from Practice Guidelines for Dx & Tx of Skin and soft tissue infections, infectious diseases society of america Level I - Impetigo + mupirocin as topical (kalo tunggal) + kalo multipel: oral = bulous: PCN or penisilinase resistant PCN = nonbulous: OCB or 1st gen sefa - Erisipelas + PCN + penisilinase resistan PCN or 1st gen sefa kalo curiga stafilokokus - selulitis + penisilinase resisten PCN or 1st gen sefa + vanko or klinda kalo alergi PCN - abses kutan: insisi drainase - furunkulosis: + rekuren: mupirosin or klinda 150 mg/day 3 bln - MRSA: linezolide, daptomycin, vancommycin - Necrotizing soft tissue infection: surgical intervention - Type I NSTI: ampicilin sulbactam + cipro + klinda for community acquired - Type II NSTI: klinda/PCN combination therapy Level II - Furunkulosis: eradicate staph carrier state among colonized persons - Type I NSTI: AB for gram (+) and (-) and anaerob - Type II NSTI: consider IVIG, kalo c. perfringens: pCN/clinda combination ther apy - Animal bites: + coamox PO or ampisilin sulbacam or ertapenem: suitable thdp pasturella multo cida + alternatif: piperasilin-tazobactam, imipenem-cilastatin, meropenem Level III: - Abses kutan: gram stain, kultur, AB sistemik - furunkel - animal bites: hindari 1G sefa, penisilin resisten PCN, makrolid, dan klinda: poor activity P. multocida - Human bite: ampisilin-sulbaktam IV or cefoxitin