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1、Skin and Soft Tissue Infection (SSTI)Neil Flynn, M.D., M.P.H.Professor of Clinical Medicine, EmeritusDepartment of Internal MedicineDivision of Infectious Diseases2Discussion GoalsWhy do injectors get skin infections?What is cellulitis? Abscess? Systemic infection?What is necrotizing fasciitis? (“Ne
2、c 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?3Why 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 d
3、ope 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” Its almost always
4、“skin popping”, NOT “muscling” because the needles almost never go deep enough to reach muscle4CellulitisIn 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 sm
5、allest 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.Whats happening in a cellulitis. 5Cellulitis6CellulitisFeatures:RedSwollenWarm to touchNo areas of pusPainfulTenderCellulitis7CellulitisDescribe the
6、features that make this cellulitis8Treatment of CellulitisGive the right antibioticThis is usually NOT Keflex anymoreOver half of the cellulitis infections are now resistant to treatment with Keflex and similar antibioticsCurrent antibiotics of choice are clindamycin, doxycycline, or trimethoprim-su
7、lfa (“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 infection9AbscessWhen the tissue in the area of cellulitis turns to pus under the surface of the skin, the collection of pus is term
8、ed an “abscess”The pus in the abscess consists of dead, liquified tissue, billions of white blood cells (the infection fighting cells) and, often, the black tar heroinThe most common bacteria in the abscess is “staph”, or Staphylococcus aureus (aureus means golden, which is the color of the colonies
9、 of this bacteria when it is grown on a Petri dish in the lab)There are many other bacteria that can cause abscesses10AbscessFeatures:Cellulitis presentSwollenSoft center, feels like fluid underneathPainfulTender CellulitisAbscess11AbscessLarge abscessPossibly up to a cup of pus when openedCrinkling
10、 of the skin suggests the swelling is going down12AbscessLarge abscess about to be incised (cut open) and drained of pus. This is too large to drain in the office.13Treatment of AbscessesAbscesses should be drainedThis can be done at home with a sterilized single edged razor blade, or an Exacto knif
11、eSterilize by heating in a flame, allow to coolClean the skin off with alcohol or iodine before opening the abscessIf the abscess has a lot of cellulitis around it, an antibiotic is probably needed14“Sterile” Cellulitis and Abscesses If you inject sterile (no bacteria in it) tar heroin under the ski
12、n the body will react to it in the same way as it does to bacteriaThe cellulitis may not get better with antibioticsThe abscess forms around the tar heroin that is sitting in a glob under the skin15Necrotizing FasciitisWhen the bacteria in a cellulitis or abscess start spreading quickly between the
13、fat layer and the muscle underneath it is termed necrotizing fasciitisNecrotizing means turning living flesh to dead fleshFasciitis means the infection is spreading along the space between the fat and the muscle underneathThe infection cuts off the blood supply to the tissue above it and the tissue
14、diesThe bacteria also enter the bloodstream and cause severe systemic illness called “sepsis”16The result of “skin popping” -Multiple injection site abscesses17Necrotizing fasciitis18Indications of Necrotizing FasciitisIf the area of redness is spreading rapidly (this means about inch or more per ho
15、ur) this may be “nec fasc”If the area is extremely painfulIf the person shows signs of bacteria getting into the bloodstream (fever, change in mental function such as delirium, profound weakness)Draw a line around the red area with a pen, then watch for spreading beyond the lineIf spreading inch or
16、more per hour, go to a hospital19Cellulitis with abscessIf rapid spreading beyond this line occurs, this may be necrotizing fasciitis, and requires surgery20Necrotizing fasciitis21Treatment of Necrotizing FasciitisCut all the dead tissue out, and keep cutting until only living tissue is leftGo back and do the same thing every few hours, as often as necessary, until the infection stops s
