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MSK block > Bone and Joint infections > Flashcards

Bone and Joint infections Flashcards

1
Q

How does septic arthritis present?

A

Hot swollen painful joint

Erythema, tenderness, reduced ROM

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2
Q

Investigation and treatment steps for septic arthritis?

A
  1. Aspiration – gram staining, crystal microscopy, culture and antibiotic sensitivities
  2. Emperical Antibiotics - Flucloxacillin + rifampicin
  3. Blood cultures
  4. MRI
  5. Workup for sepsis / severity
  6. Repeat aspiration/ Washout
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3
Q
A
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4
Q

Native joint Septic arthritis most commonly affect which joints?

A

Knee > Hip > shoulder

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5
Q

Native joint Septic arthritis usally occurs due to? (2)

A

Haematogenous and/or Iatrogenic

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6
Q

List 4 causitive organisms in native joint septic arthritis

A
  1. Staphylococcus aureus incl MRSA
  2. Streptococci
  3. Gram negatives in Immune deficiency, urinary or intestinal invasive procedures, elderly people, renal failure, chronic joint disorders and diabetes
  4. Gonococci , Borrelia ( Lyme ) & TB
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7
Q

First line emperical antibiotics for gram positive bacteria?

A

Flucloxacillin + Benzylpenicillin

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8
Q

First line emperical antibiotics if there is an MRSA risk?

A

Vancomycin/ Teicoplanin

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9
Q

Duration of antibiotic treatment in native joint spetic arthritis

A

Upto 6 weeks from last positive culture

2-3 weeks IV followed by oral

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10
Q

What is the first thing we MUST do if we suspect a Prosthetic Joint Infection?

A

ALWAYS SEEK ORTHOPAEDIC OPINION

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11
Q

What defines an ‘early’ Prosthetic Joint Infection?

A

< 30 days

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12
Q

List 4 causitive organisms in Prosthetic Joint Infections

A
  1. Staphylococcus aureus including MRSA
  2. Coagulase negative staphylococci
  3. Streptococci
  4. Gram negatives – enterobacteriaceae

+ Other gram positives… it is rarely fungal

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13
Q

List 3 management steps for prosthetic joint infections?

A

DAIR

Debridement, Antibiotics, Implant Retention (one vs two stage revision)

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14
Q

What does DAIR stand for in management of prosthetic joint infections?

A

Debridement, Antibiotics, and Implant Retention

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15
Q

Compare 2 stage vs 1 stage revision in the management of prosthetic joint infections

A

Two stage revision : Removal of the prosthesis, then delayed reimplantation, typically 6-8 weeks later

One stage revision : Removal of the prosthesis, then immediate reimplantation of a new prosthesis

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16
Q

Emerical antibiotic treatment for PJI?

A

Vancomycin or Teicoplanin + Tazocin/meropenem

17
Q

Following cultures what other antibiotic may be used?

A

Rifampicin if organism is susceptible

18
Q

Duration of antibiotic treatment for PJI?

A

IV antibiotics for 6 weeks followed by oral antibiotics

Oral antibiotics 6 weeks - 4 1/2 months

19
Q
A
20
Q

Acute osteomyelitis is usually aquired via what route

cjeck?

A

haematogenous

21
Q

Subacute osteomyelitis is known as what?

A

Brodie’s abscess

22
Q

Compare the onset and characteristics of acute vs chronic osteomyelitis

A

Acute: typically presents 2 weeks after bone infection, characterised by inflammatory bone changes

Chronic: typically presents 6+ weeks after bone infection, characterised by the presence of bone destruction and formation of sequestra

23
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24
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25
Q

How do we diagnose oteomyelitis? (4)

A
  1. Blood cultures
  2. Sinus track cultures/superficial ulcer swabs (usually do not correlate with cultures obtained at bone biopsy)
  3. Bone biopsy for histology and culture
  4. Imaging
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32
Q

What principals must we address for use of Antibiotics in osteomyelitis?

A
  • Depends on risk factors
  • Gram positive cover essential
  • If not septic wait to get samples
33
Q

Duriation of antibiotic treatment for osteomyelitis?

A

Usually 6 weeks IV antibiotics followed by 6 weeks oral antibiotics

34
Q

Surgical management of osteomyelitis?

A

Drainage of abscess / debridement

Spinal instability : fixation

Amputation in context of diabetic foot infections

35
Q

What is OPAT?

A

Out-patient Parenteral Antibiotic Therapy

Service to manage patients with severe non-life threatening infections requiring parenteral antibiotics in an ambulatory setting. Aims to reduce length of stay for complex infections or avoid admissions in other simpler infections

36
Q

List 3 benefits of OPAT

A
  1. Home treatment - patients can recover in familiar surroundings
  2. Hospital beds and nursing time gained
  3. Indirect benefits - cost savings

e.g. income to the acute trust from further admissions into the bed vacated through the use of OPAT, reduced cancellations of operations, improvements in efficiency of bed use and patient flow

MSK block (30 decks)

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