Antibiotics for prevention and treatment of orthopaedic infections Flashcards

1
Q

What antibiotic should be used for Staph aureus

A

Flucloxacillin

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2
Q

If penicillin allergic, what antibiotic should be given for Staph aureus

A

Clindamycin

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3
Q

What antibiotic should be used for coliforms

A

Gentamicin

sometimes cephalosporin like ceftriaxone

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4
Q

What prosthetic poses the highest risk of infection in the US

A

Fracture fixation device

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5
Q

What is a biofilm

A

A biofilm is any group of microorganisms in which cells stick to each other on a surface

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6
Q

What antibiotic treatment should be used for Prosthetic Joint infections

A

High dose for a long time (may mean IV)

Or Surgical - retention of prosthesis or Removal of prosthesis

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7
Q

What pathogens cause Acute primary infections

A

Staph Aureus

Streptococcus sp.

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8
Q

What pathogens cause chronic infections

A

CoNS

Propionibacteria

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9
Q

In what 2 conditions are bacteria phenotypically resistant to bacteria

A

In abscesses or biofilms

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10
Q

What are the 3 parts of the Tayside protocol for Prosthetic joint infections

A
  1. No AB pre-operatively
  2. Minimum 3 bone/ tissue / us samples for culture
  3. minimum 6 weeks AB before clean surgery
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11
Q

Why are at least 3 bone samples required?

A
  1. Superficial swabs are a waste of time as they show skin flora rather than a deep infection
  2. Bone samples can get contaminated with skin flora in theatre/ lab
  3. CoNS are normal part of skin flora
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12
Q

If the PJI organism is gram positive, what is the antibiotic of choice

A

Flucloxacillin

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13
Q

If the PJI patient is penicillin allergic, what do we use

A

Vancomycin

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14
Q

If a PJI organism is gram negative, what is the antibiotic of choice

A

Cotrimoxazole

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15
Q

If a patient has had a knee replacement, how long should the treatment last

A

6 months

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16
Q

If the patient has had a hip replacement, how long should the treatment last?

A

3 months

17
Q

Give 3 key points about CRP

A
  1. Not always elevated, especially in chronic infections
  2. Influenced by many underlying diseases and surgery
  3. Useful in monitoring cases without major surgery
18
Q

Why is PJIs on the increase

A

more use of orthopaedic implants

19
Q

When should prophylaxis be given in patients undergoing clean or clean-contaminated surgery?

A

Between 2 hours before and 2 hours after surgery

20
Q

Who should manage infections which are uncommon and complex

A

Specialists

21
Q

Who should be involved in the MDT for PJIs

A

Orthopaedic surgeon
Senior nurse
Medical micorbiologist/ ID specialist
Pharmacist

22
Q

What are some side effects of gentamicin

A

Nausea
Vomiting
Upset stomach

23
Q

How long is gentamicin used for

A

3 days

24
Q

What is the main benefit of using ciprofloxaxin

A

Once daily

25
Q

What is the AB used in prophylaxis

A

Coamoxiclav

26
Q

When should prophylaxis be discontinued

A

No later than 24 hours after surgery