Podcast #78 – Skin and Soft Tissue Infection Pearls with Robert Dachs


Back in April 2017 we went to SEMPA 360 and we have been saving some pearls just for a reminder of what SEMPA can offer when it comes to a conference.  The long wait is over and to help support our SEMPA friends we have an interview of some quick pearls from expert Robert Dachs.
We have talked about skin and soft tissue infections many times in the past.  However, Robert Dachs discusses some points we have not specifically mentioned in the past.  One of the biggest points is that staph and strep infections are not simply two different bacteria.  Specifically, we are worried about streptococcus pyogenes when it comes to strep infections which can cause everything from erysipelas to celluitis to even necrotizing fasciitis.  However, when discussing staph we are classically differentiating from purulent and non-purulent versions with the former being methicillin resistant and the latter not being so (MRSA versus MSSA).  More frequently we are seeing community acquired MRSA (USA300) which is different than the previouslylong-known hospital acquired version USA100 that plagued certain parts of the hospital.  Adding an antibiotic can be beneficial but there is some controversy.

When it comes to antibiotics, the three most common are trimethoprim-sulfamethoxazole (TMP-SMX), clindamycin, anddoxycycline.  The dosing of TMP-SMX is of some debate.  Furthermore, there is a gene that can be induced with MRSA that can lead to sudden resistance to clindamycin which would require a certain test to identify.

As a quick but important side note, colonization is not only in the nose.  We can see it in the axilla, perineum, and throat.  There is not a great answer in how to get rid of this either as the data can also be found controversial.

A quick apology for the audio.  The original interview was done remotely and with equipment that did not work quite as planned.  Also, we are looking to a new recording setup so the beginning and end may also sound different.  We are open to feedback and hope you can give us your thoughts.

Let us know what you think by giving us feedback here in the comments section or contacting us on Twitter or Facebook.  Remember to look us up on Libsyn and on iTunes.  If you have any questions you can also comment below, email at thetotalem@gmail.com, or send a message from the page.  We hope to talk to everyone again soon.  ​Until then, continue to provide total care everywhere.

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