bone and joint infections Flashcards
septic arthritis risk factors (4)
- IV drug use
- diabetes
- immunosuppression
- pre-existing joint disease
septic arthritis most common causes
- s. aureus
- streptococci
septic arthritis most common cause in kids < 5
H. influenzae
septic arthritis most common cause in young adults
gonorrhoea
septic arthritis most common cause in IV drug users and the elderly
E. coli
septic arthritis presentation
extremely painful red, hot, swollen and tender monoarthritis
septic arthritis diagnosis
- bloods (CRP and blood culture)
- x-ray of joint
- joint aspiration (synoviral microscopy and culture)
septic arhtritis management
- antibiotics (flucloxacillin/clindamycin IV for 2 weeks, then oral for 2-4 weeks)
- possible surgical wash out
prosthetic joint infection early post op cause
s. aureus
prosthetic joint infection delayed post op causes
- s. epidermis
- propionibacterium acnes
prosthetic joint infection late post op causes
- s. aureus
- e. coli
prosthetic joint infection early post op time period
0-3 months
prosthetic joint infection delayed post op time period
2-24 months
prosthetic joint infection late post op time period
> 24 months
prosthetic joint infection early post op presentation
- sepsis
- warm joints with signs of effusion
prosthetic joint infection delayed post op presentation
- persistent pain at joint
- loosening of prosthesis
prosthetic joint infection diagnosis
peri-operative tissue, blood and pus culture
prosthetic joint infection management
- prophylaxis (co-amoxiclav/co-trimoxazole)
- debridement and antibiotics (flucloxacillin/vancomycin, ciprofloxacin if gram negative, rifampicin if staph sensitive)
- either implant retention or replacement
osteomyelitis most common site in kids
metaphysis
osteomyelitis acute causes (3)
- s. aureus (most common)
- streptococci
- h. influenzae
osteomyelitis chronic causes (4)
- TB
- pseudomonas aeruginosa
- salmonella (complication of sickle cell anaemia)
- e. coli
osteomyelitis presentation
- pain, swelling and erythema at site of infection
- low grade fever
- fatigue and malaise
osteomyelitis diagnosis
- MRI
- bloods (FBC, CRP, culture)
- joint or abscess culture
- bone biopsy
osteomyelitis acute management
flucloxacillin/clindamycin IV (vancomycin if MRSA)
osteomyelitis chronic management
- flucloxacillin/doxycycline (co-trimoxazole if MRSA)
- debridement
what is necrotising fasciitis
severe infection of subcutaneous soft tissues that most commonly occurs in limbs, abdominal walls and groin
necrotising fasciitis type 1 cause
mixed aerobes and anaerobes
necrotising fasciitis type 2 causes
group A strep (strep. pyogenes)
necrotising fasciitis presentation
- fever and mild inflammation with out of proportion pain and rapid spread of inflammation
- severe pain felt at sight of infection with only mild inflammation
necrotising fasciitis diagnosis
start treatment immediately if suspected
necrotising fasciitis management
debridement and antibiotics (penicillin /clindamycin)
gas gangrene cause
clostridium perfinegens
gas gangrene presentation
- usually follows on form penetrative wound
- skin discolouration and bubbling
gas gangrene management
- debridement
- antibiotics (penicillin and metronidazole)
tetanus cause
clostridium tetani
tetanus presentation
- follows on from penetrative trauma
- spastic paralysis
tetanus management
- surgical debridement
- antibiotics (penicillin and metronidazole)
- anti-toxin
- prophylaxis with vaccination
