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Dr. Freschi antibiotics > Articles > Flashcards

Articles Flashcards

1
Q

Power-Pulsed Lavage article

A
  • Significantly reduces the amount of bacteria

- if it does not hurt go ahead and use it.

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2
Q

Patzakis article

A

-Foot divided into three sections for puncture wounds

-Highest to lowest for development of osteomyelitis:
Zone 1> Zone 2> Zone 3

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3
Q

Nail puncture through a rubber soled shoe

A
  • Unsuccessful treatment group more likely to have received antibiotics in the community
  • Unsuccessful treatment group waited longer to go to ED
  • Gram + bacteria (cover staph)
  • Gram - bacteria (cover pseudo)
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4
Q

Plantar puncture wounds in Children

A 
Time of presentation:
Day of injury:
-prophylactic tetanus
-cleansing of puncture
-x-ray or sonography

24-36 hours after injury

  • hospitalize for parenteral antibiotics
  • perform surgery

1 week after injury

  • retained foreign body must be removed
  • osteomyelitis

Later symptoms
-deeper infections present

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5
Q

Hawthorn fragment in a child’s foot

A

-MRI may not be the best mode of visualization, use an ultrasound

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6
Q

Definition of SIRS

A

SIRS= more than one of the following:

  • temp extremes
  • high HR
  • High Resp
  • High WBC
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7
Q

Definition of sepsis

A

SIRS+infection

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8
Q

Severe sepsis

A

Sepsis+ organ dysfunction, hypoperfusion abnormality, or sepsis induced hypotension

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9
Q

Septic shock

A
  • a subset of severe sepsis

- sepsis induced hypotension

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10
Q

MODS

A

-a continuum where the organ fail to maintain homeostasis

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11
Q

Types of fevers (5)

A
  • infection: most common cause
  • cytokine-mediated fevers
  • central fevers:harm to the thermoregulatory regions of brain
  • fever of unknown origin
  • drug fever
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12
Q

Postoperative fevers (5)

A
  • Day 1: Systemic Inflammatory response syndrome
  • Day 2-3: respiratory causes
  • Day 3-5: Urinary tract infection
  • Day 4-7: wound infection, DVT and acute gout

Day 5-8: drug fever

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13
Q

Surgical management of diabetic foot infections

A
  • broad spectrum antibiotics should be prescribed

- need a stepwise approach when it comes to these patients

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14
Q

Performing serum inflammatory markers for the diagnosis and follow up of patients with osteo

A

Inflammatory markers are: CRP, ESR, White blood cells, Procalcitonin.

  • They will decline after initiation of antibiotic treatment
  • ESR is the best marker used to monitor the response to therapy in patients with osteo. ESR declines in soft tissue infections not osteo
  • Using inflammatory markers, particularly ESR with observation will go a long way
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15
Q

Acute Phase reactants predict risk of amputations in diabetic foot infections

A
  • post treatment CRP level is a strong predictor of treatment failure and amputation risk in patients with diabetic foot ulcers
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16
Q

Value of WBC with differential in acute diabetic foot infection

A
  • diagnosis of infection is made primarily on the basis of clinical signs
  • a normal WBC and white cell differential should not deter the physician from taking appropriate action.
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17
Q

Angiograms: what do they visualize (3)

A
  • distribution of disease
  • length and severity of diseased segments
  • demonstrate inflow and outflow vessels
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18
Q

Types of angiograms

A
  • Computed tomography angiogram (CTA)
  • Magnetic Resonance Angiogram (MRA)
  • Digital subtraction Arteriography (DSA)
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19
Q

Computed Tomography Angiogram

A
  • IV iodine rich contrast injected.
  • CT scanning used

A rapid exam but not good for renal disease and becomes shadowed due to calcification.

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20
Q

Magnetic resonance angiogram

A

Does not require IV contrast (but if it does will use Gadolinium)

-This is a more expensive exam than the rest however gives you a very clear picture

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21
Q

Digital Subtraction arteriography

A

Gold standard

  • Will give a superior resolution with lower doses of contrast in real time.
  • However will have much higher exposure to radiation
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22
Q

CO2

A
  • used as a negative contrast agent in DSA by displacing the blood.
  • a great alternative for patients with renal failure or contrast allergy
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23
Q

Echocardiograms

-2 types and what are they used for

A

TTE and TEE

  • TTE is a noninvasive procedure , however it may be blocked by body tissues, or scarring
  • TEE is much less common and much more invasive. Usually only occurs when good visualization can not be obtained with TTE
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24
Q

Tech 99

A

-binds directly to calcium hydroxyapatite to form soluble salts via osteoblasts

  • High sensitivity for low specificity:
  • –osteomyelitis
  • –recent surgery
  • –arthritis
  • –bone tumors
  • –fracture
  • – ischemic necrosis of bone
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25
Q

Gallium-67-

A

-identifies acute inflammation and infection
through:
—direct bacterial uptake
—phagocytosis of bacterial cells by phagocytes
—direct leukocyte labelling

Sensitive but not specific for acute osteo will also pick up:

  • -infection
  • -fractures
    • inflammation
  • -trauma
  • -neoplasms
  • -gout
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26
Q

Indium-111

A
  • WBC are isolated from patient’s blood and labelled with Indium-111 and reinjected into patient
  • Highly sensitive and specific for acute soft tissue and osseous infections
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27
Q

Ceretec Scan

A

Tc-99 labelled WBC

  • High sensitivity for acute soft tissue and osseous infections
  • Higher specificity for acute osteomyelitis than in In-111
  • easier and less radiation than Indium-111, which allows more radioactive material to be used and increased anatomical contrast
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28
Q

SPECT/CT

A
  • single photon emisssion CT
  • Detects radio-labelled markers and creates an image
  • Shows level of biological activity as well
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29
Q

What will acute osteomyelitis show on:

  • Tc-99m Scan
  • Ga-67 scan
  • Indium scan
  • Ceretec scan
A
  • Tc 99:
  • –Phase 1: +
  • –Phase II:++
  • –Phase III:+++
  • Ga-67 scan: positive focal uptake
  • Indium Scan: Positive
  • Ceretec scan: Positive
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30
Q

What will Inactive Chronic osteo show on:

  • Tc-99m Scan
  • Ga-67 scan
  • Indium scan
  • Ceretec scan
A
  • Tc-99m Scan
  • –Phase I: +/-
  • –Phase II: +
  • –Phase III: +++
  • Ga-67: negative
  • Indium: Negative
  • Ceretec scan: Negative
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31
Q

What will acute cellulitis show on:

  • Tc-99m Scan
  • Ga-67 scan
  • Indium scan
  • Ceretec scan
A

Tc-99m Scan:

  • –Phase I:+++
  • –Phase II: ++
  • –Phase III: +
  • Ga-67: Positive diffuse uptake
  • Indium: Positibe

Ceretec Scan: Negative

32
Q

Charcot joint:

  • Tc-99m Scan
  • Ga-67 scan
  • Indium scan
  • Ceretec scan
A

Tc-99m Scan:

  • –Phase I: +/-
  • –Phase II: +/-
  • –Phase III: +++
  • –Phase IV: ++/+++
  • Ga-67: Negative
  • Indium scan: Negative
  • Ceretec scan: Negative
33
Q

Positive Ceretec signifies?

A

acute osteomyelitis

34
Q

Positive Indium indicates?

A

either acute osteomyelitis or acute cellulitis

35
Q

Positive Ga-67 scan signifies?

A
  • Positive focal uptake signifies: acute osteomyelitis

- Positive diffuse uptake signifies: acute cellulitis

36
Q

Identifying the incidence and risk factors for reamputation among patients who underwent foot amputation article:

-Risks associated with reamputation

A
  • Higher level amputations
  • Longer hospitalization
  • Insulin-dependent diabetes
  • Gangrene on admission
37
Q

Acute Kidney Injury definition

A
  • abrupt and usually reversible decline in the GFR or decreased urine output within 7 days
  • increase in creatinine of .3mg/dL within 48 hours
  • 50 percent increase in creatinine within 7 days
  • decrease in urine volume to <3mL/kg over six hours

Will result in an elevation of BUN, creatinine

38
Q

AKI diagnosis: How to make it

A
  • UA w/ microscopy
  • BMP
  • Serum and urine protein electrophoresis
  • renal ultrasound
39
Q

AKI treatment (4) things

A
  • determine the cause
  • remove any active insults
  • minimize new injury
  • identify the complications
40
Q

Probing to bone in infected pedal ulcers article conclusion

A

-in hospitalized diabetic patients with limb-threatening infection, palpable bone at the ulcer base by Probe to bone test was significantly associated with underlying osteo.

41
Q

Probe to bone test in a diaetic foot osteo in a clinical setting

A
  • in a clinical setting the PTB test is better used to exclude osteo
  • in a hospital setting the PTB test is more helpful in diagnosing osteo
42
Q

Efficacy of MRI in diagnosing diabetic foot osteo in the presence of ischemia

A
  • preoperative MRI effective in diagnosis of neuropathic ulcers
  • Preoperative MRI less effective in diagnosis of ischemic ulcers
43
Q

Statistical reliability of bone biopsy for the diagnosis of diabetic foot osteomyelitis article

A
  • results suggest limited reliability of the histopathologic analysis of bone
  • histopathologic bone biopsy should not be sonsidered the “standard” of diabetic foot osteo
44
Q

Does this patient with diabetes have osteo of the lower extremity article

A
  • osteo of the foot causes significant morbidity in patients with diabetes
  • using the criteria of an ulcer that measures more than 2cm, positive PTB, an ESR greater than 70mm/h, an abnormal x-ray and MRI, along with a detailed history can help improve diagnostic accuracy and improve patient outcomes
45
Q

Primary non surgical management of osteo of the foot in diabetics article

A

-urgent surgery is indicated in some patients, however non-surgical management of those without limb-threatening infection is associated with a high rate of apparent remission

46
Q

Outcome of diabetic foot osteo treated non-surgically

A
  • Bone culture based antibiotic therapy is an independent factor predictive of remission in diabetic patients with osteo of the foot
  • there is also a possible negative effect of nonbone-based antibiotic therapy for osteo of the diabetic foot
47
Q

Rate of residual osteo after partial amp in diabetic patients

A
  • after debridement and irrigation it is recommended to routinely obtain bone margin cultures
  • residual osteo has a statistical significant association with poor outcomes
48
Q

Reasons for prophylactic use of antibiotics

A
  • Following wounds
  • For surgery
  • For prophylaxis against bacterial endocarditis in patient with compromised heart valve
  • Dental patients
49
Q

Antibiotics used for prophylaxis (8)

A
  • cefazolin
  • cefuroxime
  • Ceftriaxone
  • Vancomycin
  • Clindamycin
  • Ciprofloxacin
  • Levofloxacin
  • Teicoplanin
50
Q

Cefazolin

  • use in Lower extremity
  • Half life
  • coverage
  • Doseage
A
  • most frequently used for lower extremity
  • longest half-life of any 1st generation cephalosporin
  • spectrum: anti-staphylococcal and gram negative

Dosing: 1-2g IV or IM before surgery

51
Q

Cefuroxime

  • what type of surgery is it used
  • comparison to ancef
A
  • usually used in cardiothoracic surgery

- may have better anti-staph than Cefazolin

52
Q

Ceftriaxone

  • half life
  • spectrum
A
  • longest half life of any cephalosporin

- relative lack of anti-staph activity

53
Q

Vancomycin

  • when is it used
  • dosing
A
  • used in penicillin or cephalosporin allergic patients or high MRSA expected areas
  • 1g IV 12hours…. slow infusion over 1 hour
54
Q

Clindamycin

Use?

Dose:

A
  • useful in implant surgery
  • great substitute for vancomcin in beta-lactam allergic patients
  • dosing 600-900 mg IV
55
Q

Ciprofloxacin

use:

activity:

A

very versatile but not used as likely in prophylaxis for lower extremity surgery

-mediocre anti-staphylococcal activity

56
Q

Levofloxacin

coverage:

half life:

Oral vs. IV

A
  • better staph and strep coverage than Cipro
  • longer half life
  • oral dosing achievable levels are similar as parenteral
57
Q

Joint aspiration:

Uses
—-diagnosis vs therapy

A

Diagnostic:
-used in the evaluation for septic joint

-also used in the confirmation of gouty arthritis

Therapeutic
-injection with steroids for inflammatory condition

-drain effusion to relieve pressure

58
Q

Aspiration of the ankle:

-approaches

A

Medial approach:

  • more common
  • leg kept at 90 degrees, insert needle between TA and medial malleolus.

Lateral approach: less common
-between lateral to EDL

59
Q

Aspiration of the MTPJ

steps:

A
  • distract the toe with gentle plantarflexion
  • insert needle perpendicularly and into joint space medially
  • avoid extensors
60
Q

Synovial fluid analysis

WBC count to keep in mind

A

<2000WBC/mm3 is noninflammatory

> 2000 WBC/mm3 is inflammatory or septic

61
Q

Synovial fluid analysis table

A

LOOK AT STEVEN’s tables

62
Q

Late hematogenous infection of the 1 MTPJ

A
  • It is more common for late hematogenous infections to come from knee and hip replacements.
  • This case occured in 1st MTPJ due to misdiagnosis and the administration of steroids
63
Q

Acute hematogenous osteo

-Labs to receive

A

CBC

ESR and CRP

Blood cultures

64
Q

Acute Hematogenous osteo

Unique infecting organisms in:

  • newborns
  • children
A

Newborns: Group B strep

Children: H. influenzae

65
Q

Acute hematogenous osteo treatment options (3)

A
  • Incision and drainage
  • cultures
  • antibiotics that are tailored toward the infection
66
Q

Pathogens isolated from deep soft tissue and bone in patients with diabetic foot infections

-main finding

A

Most of the time bone and soft tissue cultures differed

67
Q

Minimum Inhibitory Concentration

-definition

A

Is the lowest concentration of a chemical which prevents visible growth of a bacterium overnight

68
Q

Minimum Inhibitory Concentration

-Clinical use

A

used to confirm resistance and to determine in vitro activity of new antimicrobials

69
Q

Minimum Inhibitory concentration

-Interpretation

A

-antimicrobials with the smallest MIC are the most effective

70
Q

Minimum Inhibitory concentrations

-Breakpoint

A
  • chosen concentration of an antibiotic which defines whether a species of bacteria is susceptible or resistant
  • If the MIC is smaller than the susceptibility breakpoint then the bacteria is considered to be susceptible to the antibiotic
71
Q

The role of polymethylmethacrylate antibiotic loaded cement-article

A
  • Three big antibiotics are:
  • tobramycin
  • gentamycin
  • vancomycin

-PMMA provides local delivery of high concentrations that do not depend on vascular support or have systemic toxicity complications

72
Q

Infection control issues

  • active surveillance cultures: definition
  • Decolonization: definition
A

Active surveillance cultures:

  • universal or targeted microbiological screening cultures for patients admitted to a hospital
  • used to try and help control infections

Decolonization:
-a process used in infection control that destroys a resistant organism before it can cause infection and spread by using topical antibiotics and antiseptics

73
Q

C. difficile

Diagnosis

Treatment:

A

Diagnosis:
-C. difficile infection requires demonstration of C.dif toxins or detection of toxigenic C.dif organisms

-Findings of pseudomembranous colitis are highly suggestive of C.diff

Treatment:
-discontinuation of inciting antibiotic

  • Vanc: 125 mg QID PO
  • Metronidazole: 500mg QID PO
74
Q

Hospital acquired MRSA

-Buzzwords:

Treatment:

A
  • Older patients
  • In a care facility
  • With chronic wounds
  • Multiple recent antibiotic exposure

-treated: Vanco, Zyvox and Cubicin

75
Q

Community acquired MRSA

-Buzzwords:

Treatment

A
  • Younger patients
  • Contain genes: USA300, PVL, SCC mec IV, and cycolytic peptides

Treatment:

  • TMP/SMX (bactrim)
  • Minocycline and doxycycline
76
Q

How to differentiate between community and hospital aquired MRSA

A

Clindamycin induced susceptibility

Dr. Freschi antibiotics (3 decks)

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