E3 bone+joint infections

Question 1

3 types of bone and joint infections

Answer 1

• osteomyelitis
• septic arthritis
• prosthetic joint infection

Question 2

most common bacteria for bone and joint infections

Answer 2

staph aureus

Question 3

T or F:
antibiotic therapy is often more intense for CF than other infections

Answer 3

true

Question 4

how long is the standard duration of tx for CF?

Answer 4

2-8 weeks depending on type of infection

Question 5

bottom line for osteomyelitis

Answer 5

blood flow is slowed significantly in the bones

Question 6

3 main pathways for pathogenesis of osteomyelitis

Answer 6

• hematogenous spread
• contiguous spread
• vascular insufficiency

Question 7

Microbe reaches bone via bloodstream

A. hematogenous
B. contiguous
C. Vascular insufficiency

Answer 7

A

Question 8

Microbe reaches bone from soft tissue infection or direct inoculation
A. hematogenous
B. contiguous
C. Vascular insufficiency

Answer 8

B

Question 9

Microbe reaches bone from soft tissue infection

A. hematogenous
B. contiguous
C. Vascular insufficiency

Answer 9

C

Question 10

3 acute symptoms for osteomyelitis

Answer 10

• fever, localized pain/tenderness/swelling, dec range of motion

Question 11

3 chronic symptoms for CF

Answer 11

pain, drainag/sinus tract, dec range of motion

Question 12

3 lab findings for diagnostic considerations in CF

Answer 12

• elevated WBC
• ESR
  -CSR

Question 13

standard of care for diagnostic considerations in CF

Answer 13

MRI**

Question 14

empiric antibiotic selection for osteomyelitis:

Answer 14

typically a b-lactam w/ MSSA, strepto, and GN coverage (cefazolin, ceftriaxone, cefepime, piper/tazo, amp/sulb, meropenem

Question 15

if MRSA coverage is needed what can you add on for osteomyelitis

Answer 15

vanc
dapto
linezolid

Question 16

what is a weird adjunct med you can use with oral antibiotic options in osteomyelitis

Answer 16

rifampin to prevent biofilm formation

Question 17

osteomyelitis oral antibiotic options:
streptococci (3)

Answer 17

amox, cephalexin, clinda

Question 18

osteomyelitis oral antibiotic options:
MSSA

Answer 18

diclox, cephalexin, cefadroxil, bactrim, linezolid

Question 19

osteomyelitis oral antibiotic options:
MRSA

Answer 19

linezolid, bactrim, clinda

Question 20

osteomyelitis oral antibiotic options:
GNRs

Answer 20

bactrim
FQs

Question 21

3 main pathways for septic arthritis development

Answer 21

• hematogenous
• direct inoculation
• contiguous

Question 22

1 most common pathogen for septic arthritis

Answer 22

s. aureus

Question 23

1 unique diagnostic consideration for septic arthritis

Answer 23

arthrocentesis - purulent, low synovial fluid -> look at neutrophil count

Question 24

Prosthetic Joint Infection involves development of biofilm -> impedes _______ ________

Answer 24

antibiotic penetration

Question 25

T or F: rifampin is an adjunct therapy choice in Prosthetic Joint Infection s

Answer 25

true dose: 300-450mg po bid

Question 26

Prosthetic Joint Infection – Approach to Treatment: Debridement and retention of prosthesis

Answer 26

- Pathogen-directed treatment + rifampin x 2-6 weeks - Oral antibiotic treatment + rifampin x 3 months (hip) – 6 months (knee, other joint) - May consider long-term antibiotic suppression after completion of treatment

Question 27

Prosthetic Joint Infection – Approach to Treatment: 1-stage exchange

Answer 27

Pathogen-directed treatment + rifampin x 2-6 weeks Oral antibiotic treatment + rifampin x 3 months

Question 28

Prosthetic Joint Infection – Approach to Treatment: 2-stage exchange

Answer 28

Pathogen-directed treatment x 4-6 weeks

Question 29

last line option for prosthetic joint infection

Answer 29

amputation

Question 30

which of the following options would be most appropriate in a pt that does not want a central line A. Vanc 1.5 q12h B. Dapto 6-12 mg/kg q24h C. Amox 1000 mg TID D. Dalba 1500 day 1 and 8

Answer 30

D, peripheral line

Question 31

JB is a 73-year-old male presenting to the hospital with a 2-week onset of right foot pain, swelling, erythema, and purulent drainage. Patient has deep wound on right heel Below-knee amputation is performed. what is the appropriate antibiotic duration? A. 1-2 weeks B. 2-5 days C. 3 weeks D. 7-14 days

Answer 31

B. 2-5 days