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MSK > Bone Infections > Flashcards

Bone Infections Flashcards

1
Q

What is the most common infecting agent in acute osteomyelitis?

A

Staph aureus
haemophilus in children
Strep

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2
Q

How does acute osteomyelitis occur?

A

Most post-traumatic/ open fracture

In children or immunosuppressed by haematogenous spread

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3
Q

On x-ray what does acute osteomyelitis look like?

A

Dying necrotic inflammatory tissue

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4
Q

What should you do if there is pus?

A

Let it out!

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5
Q

What is the term used to describe the mass that often grows in chronic osteomyelitis?

A

Involucrum

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6
Q

How does septic arthritis occur?

A

innoculation
metaphyseal spread
Direct haematogenous spread

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7
Q

Describe the clinical picture of a joint with septic arthritis?

A

Severely painful, red, hot, swollen and tender joints with limited movement

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8
Q

What are the most common infecting organisms in septic arthritis?

A
  1. Staph aureus #1
  2. Streptococci
  3. Coagulase negative strep – prosthetic joint
  4. Neisseria gonorrheae – sexually active
  5. Haemophilus influenzae – preschool – uncommon as HIB vaccine
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9
Q

What Ix are required in suspected septic arthritis?

A

History and examination
Joint aspiration M,C and S
Blood culture if pyrexial- organisms may spill into blood causing bacteraemia
Exclude crystal arthropathy

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10
Q

What AB are given for septic arthritis?

A

Flucloxacillin IV high dose and adjust when organisms are confirmed
If <5yo add cefriaxone to cover H. influenzae

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11
Q

What bugs are involved in chronic osteomyelitis?

A

often slow growing – Mycobacterium TB, Pseudomonas aeruginosa, salmonella, brucella and coliforms (E.coli)

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12
Q

What AB should be given for cellulitis?

A

Cover staph and strep

Flucloxacillin and benzylpenicillin

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13
Q

What kinds of surgery can be used for an infected arthroplasty?

A

Two stage revision 80-90% control of infection

One stage revision (rarely done) 70-80%

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14
Q

List some prophylactic measures that can be used to decrease the risk of an arthroplasty becoming infected during surgery.

A 
Laminar flow
24 hours antibiotics starting with induction
Antibiotics in cement
Good hand washing 
Good surgical technique
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15
Q

How do prosthetic joints become infected?

A

Early – within a month – with haematoma/ wound sepsis

Late – after one month – contamination at time of operation

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16
Q

LIst some risk factors for an arthroplasty becoming infected.

A

Rheumatoid arthritis
obesity
diabetes
malnutrition

17
Q

If the arthroplasty is infected with staph epidermidis, which antibiotic should be given?

A

Vancomycin initially

18
Q

What actually is osteomyelitis?

A

Inflammation of bone and medullary acvity, usually located in long bones.

19
Q

What antibiotic is given initially in osteomyelitis?

A

High dose flucloxacillin

20
Q

What is necrotizing fasciitis?

A

Uncommon severe infection of the subcutaneous soft tissue – spreads through fascial planes - medical emergency

21
Q

What are the two types of necrotizinf fasciitis?

A

Type 1 - anaerobes plus multiple other bacteria “synergistic gangrene”
Type 2 - “flesh eating bacteria”

22
Q

What is the immediate treatment for necrotizing fasciitis?

A

Surgical debridement and Penicillin (Vanco if pen allergic) and Clindamycin

23
Q

What organism causes gas gangrene?

A

Clostridium perfringens

24
Q

How do the spores of C. perfringens cause gas gangrene?

A

Get into tissue by dirt getting in to open wound - normally trauma

25
Q

What is the pathogenic process involved in gas gangrene?

A

myonecrosis – accumulation of gas bubbles in subcutaneous spaces  gas gangrene

26
Q

What Tx is required for gas gangrene?

A

Urgent debridement

High dose Penicillin +/- Metronidazole +/- hyperbaric O2

27
Q

What organism causes tetanus?

A

Clostridium tetani

28
Q

What is the pathogenic process involved in tetanus?

A

C. tetani produces a neurotoxin –> spastic paralysis (lock jaw)

29
Q

What Tx is required for tetanus?

A

Surgical debridement #1
Antitoxin
Supportive measures – respiratory intubation and ventilation
Antibiotics – Penicillin and Metronidazole
Booster vaccination (toxoid)

30
Q

What is PVL producing staph aureus?

A

Toxin that destroys white blood cells

31
Q

What Tx is required for an infection caused by PVL producing staph aureus?

A

Flucloxacillin, clindamycin, linezolid, depending on sensitivities

MSK (19 decks)

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