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Therapeutics IV > Bone Infection - Block 1 > Flashcards

Bone Infection - Block 1 Flashcards

1
Q

RF of bone infection?

A
  1. Diabetes (DFI)
  2. Peripheral vascular disease
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2
Q

Complications of bone infection?

A
  1. Amputation
  2. Bone deformity
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3
Q

What is the difference between OM and infectious arthritis?

A

OM: infection of bone
Infectious/septic arthritis: inflammation of the joint cavity

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4
Q

Acute vs chronic OM?

A

Acute: <1week
Chronic: >1 month

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5
Q

What are the types of OM?

A
  1. Hematogenous
  2. Contiguous
  3. Vascular insufficiency
  4. Direct inoculation
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6
Q

What is hematogenous OM?

A

Spread via bloodstream to the bone:
* Lumbar and thoracic vertebrae -> vertebral osteomyelitis
* Common in >50YO
* Staphylococci spp.

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7
Q

What is contiguous OM?

A

Shares a common border/adjacent infection reach to the bone (untreated DFI wound):
* Polymicrobial infections
* Staphylococci spp.

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8
Q

What is vascular insufficiency OM?

A

Polymicrobial infection (e.g. sacrum wounds, DFI)

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9
Q

What is direct inoculation OM?

A

Trauma, puncture wound, surgery:
* Step, S. epidermis, E.coli, P. aeruginosa

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10
Q

Sites of hematogenous OM?

A
  1. Long bones and joints
  2. Vertebrae
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11
Q

Sites of contiguous OM?

A

Foot in DMF, femur, tibia, and mandible

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12
Q

Sites of direct inoculation?

A

Foot

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13
Q

Sites of vascular insufficiency?

A

Sacrum wound, feet, and toes

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14
Q

Common pathogens of OM in adults? Children

A

Adults: S. aureus

less than 4 YO: Kingella kingae
>4 YO: S. aureus

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14
Q

Presentations of vertebral OM?

A
  1. Constant back pain
  2. Nuerological complication if infection compressess spinal cord
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15
Q

Clinical presentation of direct inoculation OM?

A

S/swithin 1 month from surgery or bone trauma

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16
Q

Clinical presentation of contiguous spread OM?

A
  1. Localized tenderness, warmth, edema, erythema
  2. In patients with vascular insufficiency
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17
Q

GOld standard of OM diagnosis?

A

MRI: as early as 1 day after onset of infection

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18
Q

Lab abnormalities of OM?

A
  1. Elevated WBC
  2. Elevate ESR and CRP (more sensitive)
  3. Bone cultures
  4. Blood culture is + in hematogenous
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19
Q

What location is most common for contiguous osteomyelitis to occur in adults?

A

Foot

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20
Q

Consideration to treat S. aureus OM?

A
  • 10% -> MRSA -> vancomycin and daptomycin (alt)
  • MSSA -> 1st gen cephalosporin (cefazolin)
  • Pediatric -> Clindamycin
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21
Q

How do you get adequate drug into the bone?

A
  • High doses with adj of weight and renal/hepatic function
  • Empiric therapy
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22
Q

Tx for adult OM?

A

S. aureus: Vanc TDM or Daptomycil 6-10 mg/kg/day
OR
Cefazolin (no risk for MRSA)

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23
Q

Vascular insufficiency tx?

A

G-: Vancomycin + ceftriaxone 2 g IV Q24H

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24
Q

IV drug use OM tx?

A

MRSA and P. aeruginosa: Vancomycin + ciprofloxacin, ceftazidime, or cefepime

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25
Q

Postop/trauma OM Tx?

A

MRSA and Pseudomonas: Vanc + Cefepime

26
Q

Necrotic OM Tx?

A

MRSA, Pseudomonas, anaerobes:
* Vancomycin + Cefepime or ceftazidime or cefepime PLUS metronidazole 500 mg IV Q8 or clindamycin 900 IV Q8
OR
* Vancomycin + zosyn or merrem (meripenum)

27
Q

Newborn OM tx?

A

S. aureus, S. pyogenes, E. coli: Cefazolin

28
Q

Children ≤ 3 years old OM tx?

A

K. kingae: cefazolin, cefuroxime, ceftriaxone, or augmentin

29
Q

Children ≥ 4 years old OM tx?

A

S. aureus: Vancomycin, clindamycin, cefazolin

30
Q

When is definitive therapy used?

A
  • Should be delayed until bone cultures can be obtained (surgical debridement, chronic OM)
  • Discontinue antibiotics for at least two weeks prior to debridement
  • Antibiotic therapy should be tailored to culture and susceptibility data when available.
31
Q

Staph MSSA Tx?

A

Nafacillin, oxacillin, cefazolin: Q4-8H (inpatient)
Ceftriaxone: QD (outpatient)

32
Q

Staph MSRA OM tx?

A

Vancomycin
Alt: Daptomycin
* Hold statin, check baseline CPK -> rhabdomylysis

33
Q

Strep-pen sensitive OM?

A

Penicillin G and Ampicillin: 6 divided doses)
Ceftriaxone: high dose -> not as strong

34
Q

E. coli OM tx?

A

Ceftriaxone

35
Q

Pseudomonas OM tx?

A
  1. Ceftazidime
  2. Cefepime
  3. Meropenem
  4. Ciprofloxacin/Levofloxacin
36
Q

Duration of OM therapy in adults?

37
Q

Duration of MRSA OM?

38
Q

Duration of therapy GNB OM?

A

≥8 weeks

39
Q

Duration of OM in children?

A

min 3 weeks

40
Q

What is OPAT?

A

IV antibiotics administered at home or infusion clinic

41
Q

Criteria for at-home admin of IV ABX?

A
  1. Patients receiving stable treatment
  2. Interested/motivated to receive treatment at home
  3. Good venous access
  4. Support from family or caregivers
  5. Safe, stable housing situation, including refrigerated drug storage capability
42
Q

Exclusion criteria for at-home administration of IV antibiotics

A
  1. Vision or dexterity
  2. Recent IV drug use
43
Q

What do you need to monitor dialy in OM/

A
  1. Inflammation
  2. Fever
  3. Redness
  4. Tenderness
  5. WBC
44
Q

What do you need to monitor Weekly in OM?

A
  1. WBC and CRP: Reduction of inflammatory markers
  2. MRI to rule out abscess
  3. Vanc levels are collected aat least weekly after stabilization
45
Q

Describe follow up of OM?

A
  1. Follow up cultures not typically indicated
  2. Suppressive therapy:
    * Patients who fail surgery + antibiotics or chronic Osteomyelitis -> long-term oral suppressive therapy, month
    * Recurrent with prosthetic -> life long
46
Q

Suppression OM of methicillin susceptible?

A
  1. Cefadroxil
  2. Cephalexin
  3. Dicloxacillin
  4. FLucloxacillin
47
Q

Suppression OM of MRSA?

A
  1. BActrim
  2. Doxycycline
  3. Minocycline
  4. Clindamycin
48
Q

Suppression OM of G-?

A
  1. Bactrim
  2. Ciprofloxacin
  3. Levofloxacin
49
Q

Suppression OM of penicillin sensitive strep and entero?

A
  1. Amoxicillin
  2. Penicillin VK
50
Q

Suppression OM of Cutibacterium?

A
  1. Amoxicillin
  2. Penicillin VK
51
Q

Who are more susceptible to joint infections?

A

Children and oldre adults

52
Q

Types of septic arthritis?

A

Acquired via adjacent bone infection, or trauma/surgery: monoarticular
Hematogenous via blood: 2 or more joints

53
Q

What are the different causes of septic arthritis?

A

Native: S. aureus, strep; E. coli
* Pseudomonas If IV drug user or nosocomial
* N. gonorrhea from GUT

Prosthetic: S. aureus, strep, enterococcus, GNRs

54
Q

What is the septic arthritis triad?

A
  1. Dermatitis
  2. Tenosynovitis
  3. Migratorily polyarthralgia(comes and go)
55
Q

Tx of spetic arthritis?

A

Source:
* Joint drainage
* Remove prosthesis
* Empiric antibiotics cover
* Tailoring ABX

Joint rest:
* Avoid weight-bearing initially
* Passive ROM exercises

56
Q

IA empiric therapy?

A

MRSA + ceftriaxone 2 gram IV Q12

57
Q

IV drug user IA tx?

A

MRSA + pseudomonas

58
Q

PCN allergy IA tx?

A

MRSA + Aztreonam or cephalosporin

59
Q

N. gonorrhea tx of IA?

A

Ceftriaxone

60
Q

IA from bite wound tx?

A

Ampicillin/Sulbactam 3 g IV Q6
Or
Clindamycin 600 mg IV Q8 + Cipro 400 mg IV Q12 if PCN allergy

61
Q

Hardware retention in prosthetic joint IA tx?

A

If staph isolated, add rifampin 600 (breaking down the slime layer produce by s.ar)mg po Q24

62
Q

How long is IA duration of therapy?

A

4-6 weeks IV therapy
If prosthesis retained, most patients will require at least 3 months of oral abx +/- rifampin

Therapeutics IV (39 decks)

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