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PDAT6 ID > 25 - Osteomyelitis & Diabetic Foot > Flashcards

25 - Osteomyelitis & Diabetic Foot Flashcards

1
Q

What is the Gold Standard in diagnosing

OSTEOMYELITIS

A

BONE BIOPSY
w/ Bacterial growth & Histologic Findings
Of
inflammation & necrosis

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2
Q

Diabetic Foot Infection Treatment

1st line Therapy

Moderate
MSSA + Streptococcus
Enterobacteriaceae + anaerobes

A

Amoxicillin / Clavulanate

Ampicillin / Sulbactam

Piperacillin / Tazobactam

  • *2-3 Weeks**
  • until infection has cleared*
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3
Q

Diabetic Foot Infection Treatment

Moderate
MSSA + Streptococcus
Enterobacteriaceae + anaerobes
+
MRSA Risk Factor
H/O MRSA infxn OR High MRSA Prevelence

A

MODERATE + MRSA Risk Factor

  • *AMPICILLIN/SULBACTAM_ + _VANCOMYCIN**
  • *2-3 Weeks**

Moderate Treatment:
Amoxicillin / Clavulanate

Ampicillin / Sulbactam

Piperacillin / Tazobactam

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4
Q

Diabetic Foot Infection Treatment

Moderate
MSSA + Streptococcus
Enterobacteriaceae + anaerobes
+
P. Aeruginosa Risk Factor
MACERATED would OR High Prevelence

A

MODERATE + P.Aeruginosa Risk Factor (MACERATED)

  • *PIP TAZO**
  • *2-3 Weeks**

Moderate Treatment:
Amoxicillin / Clavulanate

Ampicillin / Sulbactam

Piperacillin / Tazobactam

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5
Q
  • *Hematogenous** Osteomyelitis
  • *Vertebral**

is _____microbial?

A

MONOmicrobial

Hematogenous = MONOmicrobial
VERTEBRAL

Hema - Mono

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6
Q

Osteomylitis Treatment
Gram Negatives

  • *Enterobacteriaceae**
  • *E. Coli / K. Pneumoniae / Enterobacter / Citrobacter**

PCN ALLERGY or PO Therapy

A

Alternate for PCN allergy or PO therapy:
CIPROFLOXACIN

Normal:
CefePIME or Ertapenem

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7
Q

Osteomyelitis:

Which bacteria are considered

Enterobacteriaceae?

A

E. Coli

Kleb. Pneumoniae

Enterobacter

Citrobacter

Treat with:
CefePIME or Ertapenem

Alternate for PCN allergy:
Ciprofloxacin

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8
Q

Osteomylitis Treatment
Gram Negatives

  • *Enterobacteriaceae**
  • *E. Coli / K. Pneumoniae / Enterobacter / Citrobacter**

1st Choice

A

CefePIME

Ertapenem

Alternate for PCN allergy:
Ciprofloxacin

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9
Q

Diabetic Foot Infection Treatment

1st line Therapy

SEVERE
IV ONLY
VERY BROAD:
MRSA / Streptococcus / Enterobaceteriae
Anaerobes / P.aeruginosa

A

SEVERE = VCM ALL 3

Vancomycin

Cefepime

Metronidazole

Moerate or Severe = 2-3 Weeks
until infection has cleared

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10
Q

Diagnosis of Osteomyelitis

A

Local Signs of Inflammation
VV
Probe-to-Bone Test = useful for EXCLUSION

Positive Result
VVV
Radiologic Imaging** or **BONE BIOPSY
bone biopsy = gold standard

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11
Q

Osteomylitis Treatment

  • *Streptococcus spp.**
  • *PCN RESISTANT**

1st Choice

A

base on susceptibilities:

CeftriaXone

or

Vancomycin

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12
Q

Osteomyelitis Treatment

MSSA
Staphlococcus

ALTERNATE CHOICE

A

PCN Allergy:
VANCOMYCIN

Alt:
BACTRIM DS** + **RIFAMPIN

N-O-C
Nafcillin** or **Oxacillin
or
CefaZolin

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13
Q

Osteomylitis Treatment

When to add RIFAMPIN?
to regular treatment of:

MSSA
or
MRSA** + **Coagulase NEG Staphylococci

A

RIFAMPIN in COMBO
has synergistic activity against BIOFILMS
for
PROSTHETIC JOINTS
or
Alternative PO THERAPY

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14
Q

Osteomylitis Treatment

MSSA
Staphlococcus

1st Choice

A

N-O-C

Nafcillin** or **Oxacillin

or

CefaZolin

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15
Q

Osteomylitis Treatment
Gram Negatives

  • *Salmonella Spp**
  • SICKLE CELL*

ALTERNATE

A

Alternate:
CEFTRIAXONE

normal:

CIPROFLOXACIN
Salmonella = typically with SICKLE CELL

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16
Q

Osteomylitis Treatment
Gram Negatives

Salmonella Spp

1st Choice

A

CIPROFLOXACIN

Salmonella = typically with SICKLE CELL

Alternate:
CeftriaXone

17
Q

Osteomylitis Treatment

DURATION

&

Special Considerations?

A

minimum of

  • *>** 6 Weeks
  • consider IV –> PO switch for NON-B-lactam ABs*

EXCEPTION:
> 8 Weeks
VERTEBRAL OSTEOMYELITIS
+
PARAvertebral ABSCESS** OR **MRSA Infection

18
Q

Diabetic Foot Infection Treatment

1st line Therapy

MILD
Oral –> target MSSA & Streptococcus

A

Cephalexin

Augmetin

Clindamycin

  • *1-2 Weeks**
  • until the infection has cleared*
19
Q

Diabetic Foot Infection Treatment

1st line Therapy

MILD
+
MRSA Risk Factor
H/O MRSA Infxn OR High Local MRSA prevelence

A

MRSA Risk Factor:
CEPHALEXIN** + **BACTRIM (sulfa+trimeth)
Mild = 1-2 Weeks
until the infection has cleared

Normal Mild Treatment:
Cephalexin** OR **Augmentin** OR **Clindamycin

20
Q

Diabetic Foot Infection Treatment

1st line Therapy

MILD
+
P. Aeruginosa Risk Factor
MECERATED WOUND OR High Local P.Aeruginosa Prevelence

A

P. Aeruginosa Risk Factor = Macerated Wound
CEPHELEXIN** + **CIPROFLOXACIN
Mild = 1-2 Weeks
until the infection has cleared

Normal Mild Treatment:
Cephalexin** OR **Augmentin** OR **Clindamycin

21
Q

Osteomylitis Treatment
Gram Negatives

P. Aeruginosa

PCN ALLERGY

A

Alternate for PCN allergy:
CIPROFLOXACIN

Normal:
CefePIME or MEROpenem

22
Q

Osteomylitis Treatment
Gram Negatives

P. Aeruginosa

1st Choice

A

CefePIME

MEROpenem

Alternate for PCN allergy:
Ciprofloxacin

23
Q

Osteomylitis Treatment

  • *MRSA**
  • *Coagulase Negative Staphylococcus**

ALTERNATE Choice

A

DAPTOMYCIN
or
Bactrim DS** + **RIFAMPIN

Normal:
VANCOMYCIN

24
Q

Osteomylitis Treatment

  • *MRSA**
  • *Coagulase Negative Staphylococcus**

1st Choice

A

VANCOMYCIN

25
Q

Osteomylitis Treatment

Streptococcus spp.

1st Choice

A

CeftriaXone

Penicillin G

PCN Allergy:
Vancomycin

26
Q

Osteomylitis Treatment

  • *Streptococcus spp.**
  • pcn sensitive*

PCN Allergy

A

PCN Allergy:
VANCOMYCIN

Normal:

CeftriaXone
or
Penicillin G

27
Q

Osteomyelitis Risk Factors

A

Bactremia
expecially with hardware

Compound Fracture

Recent Surgery

Chronic/Poorly Healing Wounds
decibitus ulcers / diabetic foot infection

28
Q

Osteomyelitis due to
Contiguous Infection and Diabetic Foot infections
(Broken Bones/Post traumatic)

is _____microbial?

A

POLYmicrobial

  • *POLY**
  • *Continguous Infection**

Diabetic Foot / Broken Bones / Post-Traumatic

29
Q

Most Common Bacteria

Osteomyelitis

A

STAPH. AUREUS
MRSA is increasing

Streptococcus

Gram -NEG- Bacilli

P. Aeruginosa

Anaerobes

30
Q

WHEN to treat EMPIRICALLY + What Abx?

for
Osteomyelitis?

A

typically NOT treating empirically –> want cultures first

only if:
HEMODYNAMICALLY UNSTABLE
cover for:
MRSA / Streptococci / Gram-NEG- bacilli

VANCOMYCIN** + **CEFEPIME

PCN ALLERGY:
instead of cefepime –> cipro or aztreonam

31
Q

Special Considerations for:
Vertebral Osteomyelitis

RISK FACTORS FOR BACTEREMIA

A

Vertebral Osteomyelitis
typically caused by hematogenous spread

Increased risk for bacteremia:

  • *IVDA**
  • *HEMODIALYSIS**
  • *Immunocompromised Host**
32
Q

Special Considerations for
Posttraumatic Osteomyelitis

Recommendations

A

1/4 of compound fractures –> Osteomyelitis

Within 6 HOURS of open Trauma
IRRIGATION + DEBRIDEMENT
+
PROPHYLAXIS
Vancomycin + Cefepime
for 1-3 days post trauma

avoid FQ’s due to reduced fracture healing

33
Q

Diabetic Foot Infections

RISK FACTORS

A

Patients with these are at HIGH RISK:
inspect feet DAILY

Peripheral Neuropathy

PAD = Peripheral Arterial Disease

Immune Impairment

PDAT6 ID (31 decks)

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