皮肤软组织感染（英文PPT）Skin and Soft Tissue Infection (SSTI).ppt

Skin and Soft Tissue Infection (SSTI) Neil Flynn, M.D., M.P.H. Professor of Clinical Medicine, Emeritus Department of Internal Medicine Division of Infectious Diseases Discussion Goals Why do injectors get skin infections? What is cellulitis? Abscess? Systemic infection? What is necrotizing fasciitis? (“Nec fasc”) How and why do they occur? How do I evaluate them? What are the warning signs of serious infection? How are they treated? How are they prevented? Why do injectors get skin infections? There are bacteria on the skin that are pushed under the skin by the needle There are bacteria in the dope The dope itself can cause the same reaction under the skin that bacteria do When the dope is injected into a vein it goes to the lung and the lung is better at killing bacteria than the skin is When injectors run out of veins the only way to inject the dope is to “skin pop” or “muscle” It’s almost always “skin popping”, NOT “muscling” because the needles almost never go deep enough to reach muscle Cellulitis In cellulitis the skin is red, hot, and painful. Cellulitis can exist alone, with no pus, or it can surround an area of pus. Pus is commonly called “an abscess”. We have all had cellulitis. The smallest cellulitis is the redness around a zit. A large area of cellulitis can involve a whole area of the body, such as the face, an arm or a leg, etc. What’s happening in a cellulitis. Cellulitis Cellulitis Treatment of Cellulitis Give the right antibiotic This is usually NOT Keflex anymore Over half of the cellulitis infections are now resistant to treatment with Keflex and similar antibiotics Current antibiotics of choice are clindamycin, doxycycline, or trimethoprim-sulfa (“Bactrim”, “Septra”) Severe cellulitis should probably be treated initially with IV antibiotics, especially if the person has a high fever and appears ill from the infection Abscess When the tissue in the area of cellulitis turns to pus under the surface of the skin, the collection of pus is ter