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bone infection Flashcards

1
Q

Who is more susceptible to bone and/or bone marrow infection?

A

It is more common in children but can also occur in adults.

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2
Q

What are the usual causes of bone and/or bone marrow infection?

A

It’s usually caused by bacteria, occasionally by fungi.

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3
Q

Name some of the risk factors associated with bone and/or bone marrow infection.

A

Immunocompromised patients, individuals with chronic diseases, the elderly, and even the young are at risk.

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4
Q

What are the common causative organisms in newborns (<4 months) with bone infections?

A

S. aureus, Enterobacter sp., and group A and B Strep are common in this age group.

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5
Q

In adults, what is the most common causative organism for bone and/or bone marrow infection?

A

In adults, S. aureus is the most common, occasionally followed by Enterobacter or Streptococcus sp.

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6
Q

What are the primary routes of bone infection?

A

The two primary routes are haematogenous and exogenous.

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7
Q

Describe the difference between haematogenous and exogenous routes of infection for bone infections.

A

Haematogenous infections travel through the blood from another infected site, while exogenous infections result from trauma or contiguous spread.

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8
Q

How does the immune system respond once a bone is infected?

A

Enzymes from leucocytes cause local osteolysis, leading to pus formation and impairing local blood flow, making the infection challenging to eradicate.

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9
Q

What is the formation known as a sequestrum in the context of bone infection?

A

A sequestrum is a dead fragment of bone that forms and, once present, antibiotics alone will not cure the infection.

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10
Q

Define involucrum in the context of bone infections.

A

It’s the new bone formed around the area of necrosis in response to bone infection.

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11
Q

Who primarily experiences acute osteomyelitis in the absence of recent surgery?

A

Acute osteomyelitis usually occurs in children in the absence of recent surgery.

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12
Q

What anatomical features in children’s long bones contribute to the occurrence of acute osteomyelitis?

A

Children’s long bones contain abundant tortuous vessels with sluggish flow, promoting bacterial accumulation and spread towards the epiphysis.

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13
Q

What is the potential consequence of certain metaphyses being intra-articular in neonates and infants?

A

In neonates and infants, intra-articular metaphyses can cause infection to spread into the joint, resulting in co-existent septic arthritis.

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14
Q

How does the periosteum in infants contribute to the spread of abscesses in acute osteomyelitis?

A

In infants, the loosely applied periosteum allows abscesses to extend widely along the subperiosteal space.

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15
Q

What is Brodie’s abscess, and in what way does it differ from typical acute osteomyelitis?

A

Brodie’s abscess is a form of subacute osteomyelitis where the bone reacts by walling off the abscess with a thin rim of sclerotic bone.

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16
Q

How does chronic osteomyelitis typically develop?

A

Chronic osteomyelitis typically develops from untreated acute osteomyelitis and may involve a sequestrum and/or involucrum.

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17
Q

Where is the infection primarily found in adults with chronic osteomyelitis, and how does it often spread?

A

In adults, the infection tends to occur in the axial skeleton, primarily the spine or pelvis, often spreading hematogenously.

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18
Q

Other than typical bacterial causes, what other condition can cause chronic osteomyelitis, and how does it predominantly affect the body?

A

Tuberculosis can cause chronic osteomyelitis, particularly in the spine, through hematogenous spread from primary lung infection.

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19
Q

In what circumstances does sickle cell osteomyelitis commonly occur?

A

Sickle cell osteomyelitis commonly occurs during sickle cell crisis.

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20
Q

What is Gaucher’s disease, and how can it resemble osteomyelitis?

A

Gaucher’s disease, a lysosomal storage disorder, can mimic osteomyelitis.

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21
Q

Which disorders—SAPHO and CRMO—commonly affect specific anatomical areas?

A

SAPHO and CRMO predominantly affect the chest wall.

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22
Q

What are the common symptoms associated with acute osteomyelitis?

A

Acute osteomyelitis presents with gradual onset pain at the site of infection, point tenderness, swelling, redness, warmth, and systemic findings such as malaise, fever, and chills.

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23
Q

What distinguishable symptoms are observed in chronic osteomyelitis?

A

Chronic osteomyelitis exhibits recurrent pain following a prior episode, with swelling and redness. Spinal osteomyelitis presents with constant, unremitting back pain.

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24
Q

How do patients typically present when experiencing spinal osteomyelitis?

A

In spinal OM, patients present with insidious onset of back pain which is constant and unremitting (see notes)

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25
What types of areas should be probed for investigations related to osteomyelitis?
Probe areas include bone or visible bone, non-healing ulcers, and sinuses.
26
Why is CRP useful in the investigation of osteomyelitis, and what other blood test is commonly recommended?
CRP is useful for monitoring response, and blood cultures are commonly recommended.
27
List different imaging techniques used in diagnosing osteomyelitis.
Imaging techniques include X-rays, MRI, CT scans, PET scans, and bone scans.
28
What is the gold standard for confirming osteomyelitis, and why are wound swabs or blood cultures not always diagnostic?
The gold standard for confirming osteomyelitis is a bone biopsy; wound swabs or blood cultures might not always provide a diagnostic result.
29
In case the first biopsy is negative, what should be considered?
If the first biopsy is negative, considering another biopsy is advisable.
30
When is microbiological diagnosis awaited in osteomyelitis management?
Microbiological diagnosis is awaited unless the patient is septic or has soft tissue infection.
31
What is the initial treatment approach for acute osteomyelitis?
The initial treatment approach for acute osteomyelitis involves 'best guess' antibiotics given intravenously, unless there's an abscess requiring drainage.
32
What actions might be taken if the infection fails to resolve in acute osteomyelitis?
If the infection fails to resolve in acute osteomyelitis, second-line antibiotics might be considered, along with surgery to obtain a sample for culture and removal of infected bone or tissue.
33
Can chronic osteomyelitis be entirely cured by antibiotics alone?
Chronic osteomyelitis cannot be entirely cured by antibiotics alone.
34
What surgical interventions are typically recommended for chronic osteomyelitis?
Surgical interventions for chronic osteomyelitis include gaining deep bone tissue cultures, removing sequestrum, and debridement of infected or non-viable bone.
35
If bone debridement causes instability, what further action might be necessary?
If bone debridement causes instability, bone stabilization through internal or external fixation might be necessary.
36
Besides surgical intervention, what other strategies are used in managing chronic osteomyelitis?
Other strategies in managing chronic osteomyelitis include local antibiotic delivery systems, bone grafting, and possibly requiring plastic surgery for skin and soft tissue coverage over the bone.
37
How long are IV antibiotics continued after surgery in chronic osteomyelitis cases?
IV antibiotics are continued for several weeks after surgery in chronic osteomyelitis cases.
38
What is osteomyelitis, and what is the most common mode of infection?
Osteomyelitis refers to bone and bone marrow inflammation caused mainly by bacterial infection. The most common mode of infection is haematogenous osteomyelitis.
39
How does haematogenous osteomyelitis differ from direct contamination in causing bone infection?
Haematogenous osteomyelitis involves pathogens seeded in the bone via the bloodstream, whereas direct contamination occurs at the bone due to factors such as fractures or orthopedic operations.
40
Which bacterium is responsible for most cases of osteomyelitis?
Staphylococcus aureus is responsible for most osteomyelitis cases.
41
What distinguishes acute from chronic osteomyelitis?
Acute osteomyelitis presents as a sudden infection, while chronic osteomyelitis might involve recurring or persistent infections post-treatment of acute osteomyelitis.
42
Name some key risk factors associated with developing osteomyelitis.
Key risk factors for developing osteomyelitis include open fractures, orthopedic operations (especially with prosthetic joints), diabetes (particularly with foot ulcers), peripheral arterial disease, IV drug use, and immunosuppression.
43
In the context of joint replacements, when is infection more likely to occur, and what preventive measures are typically taken?
Infection in prosthetic joints is more likely during revision surgery. Preventive measures like perioperative prophylactic antibiotics are taken to reduce this risk.
44
What are the typical clinical manifestations of osteomyelitis?
Typical clinical manifestations of osteomyelitis include fever, pain, tenderness, erythema, and swelling.
45
How might the presentation of osteomyelitis be described in terms of specificity?
The presentation of osteomyelitis can be nonspecific, with generalized symptoms of infection such as fever, lethargy, nausea, and muscle aches.
46
Why might X-rays not be conclusive for osteomyelitis diagnosis, especially in the early stages?
X-rays might not display changes in early osteomyelitis and can't conclusively rule it out.
47
What are the potential signs of osteomyelitis that might be observed on an X-ray?
Potential signs of osteomyelitis on an X-ray include periosteal reaction, localized osteopenia, and areas of bone destruction.
48
Which imaging investigation is considered the most effective for diagnosing osteomyelitis?
MRI scans are considered the most effective imaging investigation for diagnosing osteomyelitis.
49
What elevated markers are typically found in blood tests for osteomyelitis?
Blood tests often reveal raised inflammatory markers like WBC, CRP, and ESR.
50
What type of culture might be performed to establish the causative organism and antibiotic sensitivities in osteomyelitis cases?
Bone cultures are performed to identify the causative organism and its antibiotic sensitivities in osteomyelitis cases.
51
What are the primary components of osteomyelitis management?
Osteomyelitis management involves a combination of surgical debridement of infected bone and tissues along with antibiotic therapy.
52
How is antibiotic therapy typically combined with surgical procedures in osteomyelitis treatment?
Antibiotic therapy is typically used for an extended period in conjunction with surgical procedures to effectively treat osteomyelitis.
53
According to the BNF recommendation for acute osteomyelitis, what is the suggested duration of flucloxacillin treatment?
According to the BNF recommendation for acute osteomyelitis, the suggested duration of flucloxacillin treatment is 6 weeks.
54
In addition to flucloxacillin, what other antibiotics might be used in acute osteomyelitis management, especially in cases of penicillin allergy or when treating MRSA?
Alternatives to flucloxacillin in cases of penicillin allergy might include clindamycin, while for MRSA, vancomycin or teicoplanin could be used in acute osteomyelitis management.
55
How long is the recommended duration of antibiotic therapy for chronic osteomyelitis?
Chronic osteomyelitis usually requires 3 months or more of antibiotic therapy.
56
What might be necessary in the case of osteomyelitis associated with prosthetic joints, such as a hip replacement?
Osteomyelitis associated with prosthetic joints, such as a hip replacement, might necessitate complete revision surgery to replace the prosthesis for effective treatment.
57
What are the most common causative organisms of joint space infection?
The most common causative organisms of joint space infection are Staphylococcus aureus in adults, followed by Streptococci.
58
How has the prevalence of Haemophilus influenzae as a cause of joint space infection changed in areas where Haemophilus vaccination is practiced?
The prevalence of Haemophilus influenzae as a cause of joint space infection has diminished in areas where Haemophilus vaccination is practiced.
59
What populations are more likely to be affected by Neisseria gonorrhoea and Escherichia coli as causative agents for joint space infections?
Neisseria gonorrhoea is more common in young adults, while Escherichia coli affects the elderly, IV drug users, and the seriously ill.
60
What are the primary modes through which joint space infections are often spread?
Joint space infections are primarily spread through haematogenous spread, but they can also be an extension of local infections.
61
What distinguishes joint space infection as an orthopaedic emergency?
Joint space infection is considered an orthopaedic emergency due to the rapid and irreversible damage to hyaline articular cartilage.
62
How does joint space infection typically present in terms of symptoms?
Joint space infections typically present as an acute monoarthropathy, characterized by a single warm, red, and painful joint with pain upon movement.
63
Which joint is most commonly affected by joint space infections?
The knee is the most commonly affected joint in joint space infections.
64
What can be observed in blood tests in cases of joint space infection, and what is the significance of a positive blood culture?
Blood tests may reveal raised CRP, and a positive blood culture is significant in 30-60% of cases.
65
What is the primary purpose of joint fluid aspiration in suspected joint space infections, and what additional condition is important to exclude during this process?
Joint fluid aspiration is crucial for microscopy, culture, and sensitivity, aiming to exclude crystals, such as those seen in gout.
66
What imaging techniques are considered for diagnosing joint space infections?
X-rays and MRI are considered for diagnosing joint space infections.
67
What is the recommended approach regarding empirical antibiotics if the patient is not septic?
Empirical antibiotics are to be avoided if the patient is not septic.
68
What initial antibiotic treatments are recommended for septic patients, and what adjustment might be made after the organism is confirmed?
For septic patients, the initial treatment is flucloxacillin, with the addition of ceftriaxone if the patient is under 5 years old (for H. influenzae cover), with adjustments made after confirming the organisms.
69
How is the response to treatment monitored in joint space infections?
Response to treatment is based on clinical findings and serial CRP levels.
70
What is septic arthritis, and why is it considered a medical emergency?
Septic arthritis is an infection within a joint and is considered a medical emergency due to its potential to rapidly destroy the joint and cause systemic illness.
71
What joints are commonly affected by septic arthritis?
Septic arthritis usually affects a single joint, often the knee, among others.
72
What is the mortality rate associated with septic arthritis?
Septic arthritis has a mortality rate of approximately 10%.
73
How does septic arthritis typically manifest in terms of joint condition and systemic symptoms?
Septic arthritis typically manifests as a hot, red, swollen, and painful joint with stiffness and reduced range of motion. Systemic symptoms such as fever, lethargy, and sepsis might also occur.
74
Which joint is often affected in septic arthritis presentations?
The knee joint is frequently affected in septic arthritis presentations.
75
What are the systemic symptoms that may accompany septic arthritis?
Systemic symptoms may include fever, lethargy, and sepsis.
76
What is the most common causative organism of septic arthritis?
Staphylococcus aureus is the most common causative organism of septic arthritis.
77
Name other bacteria that can cause septic arthritis.
Other bacteria causing septic arthritis include Neisseria gonorrhoea (gonococcus), Group A Streptococcus (especially Streptococcus pyogenes), Haemophilus influenza, and Escherichia coli (E. coli).
78
How can a gram stain aid in diagnosing gonococcal septic arthritis?
In a young patient presenting with a single acutely swollen joint, a gram stain revealing a gram-negative diplococcus could suggest gonococcal septic arthritis.
79
What are the primary differential diagnoses to consider for a single warm, swollen joint?
The primary differential diagnoses for a single warm, swollen joint include gout, pseudogout, reactive arthritis, and haemarthrosis.
80
How can gout and pseudogout be differentiated based on crystal examination?
Gout exhibits urate crystals that are negatively birefringent, while pseudogout displays rod-shaped calcium pyrophosphate crystals that are positively birefringent.
81
What might trigger reactive arthritis, and what associated symptom might suggest its presence?
Reactive arthritis is typically triggered by urethritis or gastroenteritis and is associated with conjunctivitis.
82
What is haemarthrosis, and what typically precedes its occurrence?
Haemarthrosis refers to bleeding into the joint, usually after trauma.
83
Why is it crucial to have a low threshold for suspecting septic arthritis, particularly in immunosuppressed patients?
Having a low threshold for suspecting septic arthritis is crucial, particularly in immunosuppressed patients, due to the significant consequences of delayed treatment.
84
What essential procedures are usually required to exclude septic arthritis, and why is joint fluid examination important in suspected cases?
Joint fluid examination is usually required to exclude septic arthritis. It is important because delayed treatment has serious consequences.
85
What components are typically included in joint fluid examination for suspected septic arthritis?
Joint fluid examination involves gram staining, crystal microscopy, culture, and antibiotic sensitivities. The joint fluid may be purulent (full of pus).
86
How are empirical IV antibiotics managed in septic arthritis treatment before obtaining sensitivity results?
Empirical IV antibiotics should be given until sensitivities are known, typically continued for 4-6 weeks (initially IV, then oral).
87
What is the typical duration and transition of antibiotic treatment for septic arthritis?
Empirical IV antibiotics are continued until sensitivities are obtained, and then treatment might transition to oral administration.
88
Name examples of antibiotics commonly used in septic arthritis treatment and their indications.
Examples of antibiotics commonly used in septic arthritis treatment include flucloxacillin (often first-line), clindamycin (for penicillin allergy), vancomycin (if MRSA is suspected), and ceftriaxone (for treating Neisseria gonorrhoea).
89
What are the primary risk factors associated with periprosthetic joint infections?
The primary risk factors for periprosthetic joint infections include comorbidities like rheumatoid arthritis, diabetes, malignancy, prior arthroplasty or infection at the surgical site, prolonged surgery, postoperative complications, and Staph. aureus bacteremia.
90
List the most common causative organisms in periprosthetic joint infections.
The most common causative organisms in periprosthetic joint infections are Staph. aureus, Staph. epidermidis, Cutibacterium acnes, and occasionally Streptococcus sp, Enterococcus sp, Gram-negative bacteria like E. coli, Pseudomonas aeruginosa, and rarely fungi or mycobacteria sp.
91
How does direct inoculation at the time of surgery contribute to periprosthetic joint infections?
Direct inoculation at the time of surgery can introduce bacteria into the joint, leading to infection.
92
What characterizes the classification of periprosthetic joint infections as early, chronic, and hematogenous?
Periprosthetic joint infections are classified as early (within 2-3 weeks), chronic (3 weeks or more), and hematogenous (chronic-late), each associated with distinct microbial profiles and time frames.
93
Distinguish between planktonic and sessile bacteria in the context of periprosthetic joint infections.
Planktonic bacteria are mainly responsible for symptoms and bacteremia, while sessile bacteria are involved in forming biofilms on foreign surfaces, resisting the immune system's attacks in chronic deep infections.
94
In cases of chronic deep infections, why might the removal of infected implants and foreign material be necessary?
In chronic deep infections, the removal of infected implants and foreign material may be necessary because the biofilm formed by sessile bacteria prevents the immune system from attacking the infection.
95
What are the typical clinical features of periprosthetic joint infections?
Typical clinical features of periprosthetic joint infections include fever, joint pain in the affected joint, and minimal swelling.
96
What blood tests and tissue cultures are typically performed in the diagnosis of periprosthetic joint infections?
Blood tests such as CRP and tissue cultures from perioperative tissues are typically performed to diagnose periprosthetic joint infections.
97
What does the management strategy involve for early or hematogenous infections?
For early or hematogenous infections, the management strategy involves debridement, antibiotics for 12 weeks, and implant retention (DAIR).
98
What is involved in the Stage 1 exchange for frail patients with chronic infections?
In the Stage 1 exchange for frail patients with chronic infections, the process involves joint removal and antibiotic therapy.
99
Explain the process of Stage 2 exchange in chronic periprosthetic joint infections.
Stage 2 exchange for chronic infections entails joint removal, aggressive antibiotic therapy for 6 weeks, and, once infection is controlled, a revision joint replacement with more complex components.
100
When and why is rifampicin added to antibiotic therapy in periprosthetic joint infections?
Rifampicin is added to antibiotic therapy if the culture is positive for rifampicin-sensitive Staphylococci.
101
Outline some key measures for prophylaxis during joint replacement surgeries.
Prophylaxis during joint replacement surgeries involves various measures like clean air theatres, 24-hour antibiotic administration, antibiotics in cement, and laminar flow systems.

MSK (21 decks)

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