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PT2 ID 1-6 > bone, joint, MRSA, and more therapeutics > Flashcards

bone, joint, MRSA, and more therapeutics Flashcards

1
Q

how does osteomyelitis develop

A
  • in epiphysis of bones blood flow is slow allowing bacteria to accumulate
  • multiplication leads to increased bone pressure and eventually necrosis of bone
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2
Q

types of osteomyelitis

A
  • hematogenous
  • contiguous spread
  • contiguous w/ vascular insufficiency
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3
Q

hematogenous osteomyelitis age range

A

-ages 1-20; >50

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4
Q

hematogenous osteomyelitis location

A

long bones

vertebrae

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5
Q

hematogenous osteomyelitis symptoms

A 
fever
tenderness
swelling
reduced ROM
drainage
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6
Q

hematogenous osteomyelitis source

A 
pharyngitis
lacerations
cellulitis
sickle cell
respiratory infections
IV catheters
hemodialysis
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7
Q

hematogenous osteomyelitis most common pathogen

A

Staph aureus

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8
Q

contiguous spread osteomyelitis age range

A

> 50

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9
Q

contiguous spread osteomyelitis location

A

femur
tibia
skull
mandible

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10
Q

contiguous spread osteomyelitis symptoms

A 
fever
erythema
swelling
sinus tracts
drainage
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11
Q

contiguous spread osteomyelitis source

A
  • penetrating trauma
  • open reductions of fractures
  • gunshot wounds
  • orthopedic procedures
  • animal bites
  • puncture wounds
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12
Q

contiguous spread osteomyelitis pathogens

A
  • mostly Staph aureas
  • proteus
  • pseudomonas
  • anaerboes
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13
Q

contiguous w/ vascular insufficiency age range

A

> 50

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14
Q

contiguous w/ vascular insufficiency location

A

feet

toes

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15
Q

contiguous w/ vascular insufficiency symptoms

A 
pain
swelling
erythema
ulcerations
drainage
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16
Q

contiguous w/ vascular insufficiency source

A
  • DM
  • peripheral vascular disease
  • bed sores
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17
Q

contiguous w/ vascular insufficiency pathogens

A

mixed infections of:

  • S.aureus
  • proteus
  • pseudomonas
  • GNB anaerobes
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18
Q

types of cultures for identifying osteomyelitis infections

A
  • blood
  • wound swab
  • bone aspirate
  • bone biopsy
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19
Q

preferred culture technique

A

bone biopsy

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20
Q

why are wound cultures not very effective

A

high amounts of S.aureus on skin can contaminate the sample very easily

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21
Q

most common pathogens in osteomyelitis

A
  • s.aureus

- coagulase-negative staph

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22
Q

occasionally seen pathogens in osteomyelitis

A

strep
enterococci
pseudomonas
GNB

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23
Q

when can x-ray detect osteomyelitis

A

at least 50% of matrix is damaged, usually 10-14 days after illness starts

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24
Q

when to use bone scans

A

when x-ray is not helpful

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25
Q

labs to get in osteomyelitis

A
  • WBC w/ diff
  • CBC
  • ESR
  • CRP
  • MRSA nasal screen
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26
Q

lab indicators that infection is healing

A

decreasing ESR and CRP

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27
Q

what to do before selecting most appropriate antibiotic for osteomyelitis

A
  • bone biopsy
  • culture
  • determine if its acute or chronic
28
Q

treatment plan for chronic osteomyelitis

A

at least 6 weeks of IV antibiotics; may extend w/ oral therapy for 2-4 more weeks

29
Q

empiric therapy of hematogenous osteomyelitis

A
  • if possible wait for blood/bone cultures
  • if MRSA use vanco + Ceftriaxone/cefepime/levofloxacin
  • if no MRSA use cetriaxone, cefepime, or levofloxacin
30
Q

D-test

A
  • used to detect possible MRSA
  • uses erythromycin and clindamycin discs
  • flattened growth area near clindamycin disc looks like a D indicating resistance
31
Q

gene that may be present in MRSA that induces glindamycin resistance

A

erm gene (macrolide resistance)

32
Q

risk factors for MRSA

A
  • IV drug abuse
  • serious underlying illness
  • previous antibiotics
  • previous hospitalization, hemodialysis
  • emerging in community
33
Q

treatment options for MRSA

A
  • TMP/SMZ, 1 po bid
  • doxycycline or minocycline 100 mg bid
  • IV vancomycin, daptomycine, linezolid, ceftaroline
34
Q

empiric strategy for contiguous osteomyelitis without vascular insufficiency

A
  • get blood and bone culture
  • IV vanco + cefepime/ceftriazoxone/Amp-sulbactam
  • adjust regimen once culture results known
35
Q

empiric strategy for contiguous osteomyelitis with vascular insufficiency

A
  • debride ulcers
  • get bone culture
  • IV vanco + cefepime/ceftriaxone/pip-tazo/amp-sulbactam/ertapenem
36
Q

specific antibiotics for osteomyelitis from S.aureus after blood culture is back

A 
nafcillin
cefazoline
clindamycin
vancomycin (MRSA)
linezolid (refractory MRSA)
37
Q

antibiotics for pseudomonas

A

ceftazidime
cefepime
pip-tazo
cipro

38
Q

most common bacteria to cause osteomyelitis from IV drug use

A
  • S.aureus

- P.aeruginosa

39
Q

treatment for osteomyelitis after a trauma

A
  • vanco IV + ceftriaxone/ceftazidime/cefepime/amp-sulbactam

- linezolid IV + ceftazidime/cefepime

40
Q

antibiotics for osteomyelitis in patients with peripheral vascular disease

A

Vanco IV +

  • amp/sulbactam
  • pip/tazo
  • ertapenem
41
Q

PO therapy for pseudomonas

A

ciprofloxacin

42
Q

when to add PO rifampin

A

when bone penetration is critical and when an infected prosthetic device is present

43
Q

PO drugs for s.aureus

A 
dicloxacillin
clindamycin
tmp/smz
levofloxacin
linezolid
44
Q

PO drugs for mixed culture

A

tmp/smuz

ciprofloxacin

45
Q

PO drugs for anerobes

A

clindamycin

metronidazole

46
Q

signs of septic arthritis

A
  • erythema
  • warm to touch
  • pain
  • possible cellulitis
  • difficulty with ambulation
47
Q

it is important to rule out when when checking for septic arthritis

48
Q

baseline labs for septic arthritis

A 
ESR
CRP
CBC w/ diff
BMP
joint fluid analysis
49
Q

most common bacteria in septic arthritis

A
  • s.aureus
  • N.gonorrhoeae (75% of sexually active)
  • streptococcus
50
Q

empiric strategy for treating septic arthritis

A 
vanco with or without
-ceftriazxone
-ciprofloxacin
-levofloxacin
for 2-4 weeks
51
Q

most common pathogens in prosthetic joint infections

A
  • coagulase negative Staph

- staph aureus

52
Q

biofilm

A

.commonly found on foreign material in prosthetics such as screws
-makes it difficult for antibiotics to kill bacteria

53
Q

clinical presentations of PJI

A
  • acute joint pain, erythema, warthm

- eventually implant loosening, persistent joint pain

54
Q

baseline labs for PJI

A 
ESR
CRP
CBC w/ diff
BMP
joint aspirate
*avoid antibiotics if possible before surgery*
55
Q

one stage revision in PJI

A
  • remove old hardware and replace with new HW during same surgery OR space w/ Abx implant
  • treat with IV abx for 6 weeks
56
Q

two stage exchange in PJI

A
  • complete one stage, if ESR ,30 and CRP <1 during wek 5 and 6 stop abx
  • begin 6 weeks of abx free
  • if no new infection occurs and ESR.CRP remain at goal then implant new joint
57
Q

antibiotics for MRSA in knee joints in debridement and retention

A

rifampin +

  • levofloxacin
  • doxycycline
  • minocycline
  • tmp/smz DS
58
Q

drug of choice for anaerobes

A

metronidazole

59
Q

pathogenesis of MRSA infections

A
  • colonization can be latent for months-years

- transmission is person to person

60
Q

core prevention strategies for MRSA

A
  • hand hygiene
  • contact precautions
  • recognize previously colonized pts.
  • rapidly reporting MRSA lab results
  • MRSA education
61
Q

bacteria that requires soap and water to remove

62
Q

contact precautions to prevent MRSA

A
  • use gown and gloves
  • don equipment prior to entering room
  • remove before leaving
  • single patient rooms
  • dedicated equipment in room
63
Q

MRSA skin infection treatment

A
  • topical mupirocin
  • incision and drain of abscesses
  • heat furuncles to promote drainage
64
Q

MRSA skin infection treatment drugs

A
  • tmp/smz
  • doxycycline
  • minocycline
  • linezolid
  • clindamycin
  • add rifampin for replasing cases
65
Q

decolonization procedures

A
  • mupirocin 2% ointment in nares BID
  • topical body w/ chlorhexidine as shower soap qd
  • OR
  • dilute bleach bath
  • oral abx if active infection

PT2 ID 1-6 (7 decks)

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