Antibiotics for prevention and treatment of orthopaedic infections Flashcards
What antibiotic should be used for Staph aureus
Flucloxacillin
If penicillin allergic, what antibiotic should be given for Staph aureus
Clindamycin
What antibiotic should be used for coliforms
Gentamicin
sometimes cephalosporin like ceftriaxone
What prosthetic poses the highest risk of infection in the US
Fracture fixation device
What is a biofilm
A biofilm is any group of microorganisms in which cells stick to each other on a surface
What antibiotic treatment should be used for Prosthetic Joint infections
High dose for a long time (may mean IV)
Or Surgical - retention of prosthesis or Removal of prosthesis
What pathogens cause Acute primary infections
Staph Aureus
Streptococcus sp.
What pathogens cause chronic infections
CoNS
Propionibacteria
In what 2 conditions are bacteria phenotypically resistant to bacteria
In abscesses or biofilms
What are the 3 parts of the Tayside protocol for Prosthetic joint infections
- No AB pre-operatively
- Minimum 3 bone/ tissue / us samples for culture
- minimum 6 weeks AB before clean surgery
Why are at least 3 bone samples required?
- Superficial swabs are a waste of time as they show skin flora rather than a deep infection
- Bone samples can get contaminated with skin flora in theatre/ lab
- CoNS are normal part of skin flora
If the PJI organism is gram positive, what is the antibiotic of choice
Flucloxacillin
If the PJI patient is penicillin allergic, what do we use
Vancomycin
If a PJI organism is gram negative, what is the antibiotic of choice
Cotrimoxazole
If a patient has had a knee replacement, how long should the treatment last
6 months
If the patient has had a hip replacement, how long should the treatment last?
3 months
Give 3 key points about CRP
- Not always elevated, especially in chronic infections
- Influenced by many underlying diseases and surgery
- Useful in monitoring cases without major surgery
Why is PJIs on the increase
more use of orthopaedic implants
When should prophylaxis be given in patients undergoing clean or clean-contaminated surgery?
Between 2 hours before and 2 hours after surgery
Who should manage infections which are uncommon and complex
Specialists
Who should be involved in the MDT for PJIs
Orthopaedic surgeon
Senior nurse
Medical micorbiologist/ ID specialist
Pharmacist
What are some side effects of gentamicin
Nausea
Vomiting
Upset stomach
How long is gentamicin used for
3 days
What is the main benefit of using ciprofloxaxin
Once daily
What is the AB used in prophylaxis
Coamoxiclav
When should prophylaxis be discontinued
No later than 24 hours after surgery
