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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Evaluate the signs and symptoms of skin and soft tissue infections (SSTIs).

  • Recommend appropriate empiric nonpharmacologic and pharmacologic treatment options for patients presenting with SSTIs.

  • Differentiate between the definition and clinical manifestations of mild, moderate and severe SSTI.

  • Compare and contrast the clinical characteristics and presentation of a purulent vs nonpurulent SSTI.

  • Design an antimicrobial treatment regimen for a purulent and nonpurulent SSTIs that are either: mild, moderate or severe.

  • Develop a list of alternative therapeutic options for the treatment of purulent and nonpurulent SSTIs that are either: mild, moderate or severe.

  • Identify treatment modalities for decolonizing a patient with recurrent purulent SSTIs.

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PATIENT PRESENTATION

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Chief Complaint

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“I have a boil on my butt, and I cannot sit down for class.”

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HPI

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Jimmie Chipwood is a 19-year-old college student who presents to the ED with a new-onset “boil” on his right buttock. He noticed some pain and irritation in the right buttock area over the past week, but thought it was due to having slid into second base during a baseball game. The pain gradually increased over the next few days, and he went to the student health center, where they cleaned the wound and gave him a prescription for clindamycin 300 mg QID for 7 days. They recommended he try to keep the area covered until the antibiotic began to work. Today, Jimmie returned to the student health center for further evaluation and was referred to the ED for further care for his continued SSTI. At the ED, Jimmie says the area on his buttock is worse, and he cannot sit down for class. He reports only partial adherence to the clindamycin regimen, because he often forgets to take it and says it makes him nauseous.

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PMH

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Right gluteal skins and soft tissue infection, diagnosed approximately 1 week ago (Rx for clindamycin was given, but the patient reports nonadherence).

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Surgical History

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  • 2010—appendectomy

  • 2012—repair of left ACL

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SH

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Denies any alcohol or illicit drug use.

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Meds

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Clindamycin 300 mg PO QID × 7 days (prescribed at student health center visit 1 week ago; patient did not complete full course).

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All

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Penicillin (hives as a child)

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Immunizations

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Up-to-date per student health center records

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ROS

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Negative except for complaints noted in HPI

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Physical Examination

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Gen
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WDWN Caucasian male in no acute distress, but with noticeable pain when he walks and tries to sit

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VS
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