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PHRM 865 > Exam 3 - Endocarditis and bone/joint infections > Flashcards

Exam 3 - Endocarditis and bone/joint infections Flashcards

1
Q

what is the most common bug that causes osteomyelitis

A

staph aureus

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2
Q

what type of bone/joint infection is life threatening

A

septic arthritis

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3
Q

standard duration of abx treatment for bone/joint infections?

A

4 - 6 weeks

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4
Q

For bone/joint infections: when can oral antibiotic therapy be given?

A

oral only used for osteomyelitis and to COMPLETE parenteral regimen

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5
Q

Able to give oral abx to kids when?

A

they have had a good clinical response to IV abx

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6
Q

Able to give oral abx to adults when?

A

if pt does NOT have diabetes or does NO have peripheral vascular disease

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7
Q

3 main therapeutic approaches to managing septic arthritis

A

appropriate abx
joint drainage
joint rest

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8
Q

what does PJI stand for

A

prosthetic joint infetion

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9
Q

PJIs: almost always necessitate the need for _________ and __________ of IV and/or oral abx therapy

A

need surgical intervention and prolonged courses

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10
Q

T or F: bone has poor perfusion

A

false!! great perfusion (lots of venous capillaries)

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11
Q

what are the 3 differ sections of the bone

A

epiphysis
metaphysis
diaphysis

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12
Q

what part of the bone is the epiphysis

A

it is the part at the END of the bone

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13
Q

what is the periosteum

A

fibrous/cellular envelope surrounding the bone

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14
Q

blood vessels supplying bone tissue are predominantly located in what parts of the bone

A

epiphysis and metaphysis

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15
Q

Epiphysis and diaphysis are separated by the _______ which is rapidly growing area of the bone with lots of blood vessels (aka infection can get here super easily)

A

epiphyseal growth plate

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16
Q

When blood flow is ________ an infection is possible with bacterial colonization

A

blood flow is SLOWED considerably

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17
Q

Definition of Osteomyelitis

A

purulent inflammation of the bone marrow and surrounding bone associated with an infection

18
Q

Osteomyelitis is classified by what?

A

the route that the infecting organism reaches the bone

19
Q

what are the 3 different routes that osteomyelitis can occur

A

hematogenous spread
contiguous spread
vascular insufficiency

20
Q

Osteomyelitis: Hematogenous Spread

Risk factors?

A

sickle cell
or
transient/persistent bacteremia!!

21
Q

Osteomyelitis: Hematogenous Spread
Typically involves metaphysis of RAPIDLY growing _____ bones in kids
examples of these bones?

A

rapidly growing LONG bones

ex: femur, tibia, humerus, fibula

22
Q

Osteomyelitis: Hematogenous Spread

Typically involves _____ bones in adults

A

vertebrae (lumbar or thoracic)

23
Q

Osteomyelitis: Hematogenous Spread Pathogenesis

the acute infectious process will increase _______ -> compromises ______ -> leads to _____

A

increase bone pressure; compromises blood flow; leads to necrosis

24
Q

Osteomyelitis: Hematogenous Spread Pathogenesis

Cytokine release by the infection will cause promotion of ______ activity which will decrease bone integrity

A

promote osteoCLASTs

25
Q

Osteomyelitis: Hematogenous Spread Pathogenesis with elevated bone pressure and necrosis will cause _______ of diseased bone from healthy bone (called ________)

A

cause FRAGMENTATION

called SEQUESTRUM

26
Q

Osteomyelitis: Hematogenous Spread Pathogenesis

continued spread of infection leads to outer layers of bone and soft tissue which leads to abscess and draining _______

A

sinus tracts

27
Q

Osteomyelitis: Contiguous Spread Pathogenesis

how does the pathogen get to the bone?

A

gets to the bone from an ADJACENT soft tissue infection or direct inoculation during trauma/puncture wounds or surgery

28
Q

Osteomyelitis: Vascular insufficiency Pathogenesis

is a subset of ________

A

contiguous spread

29
Q

Osteomyelitis: Vascular insufficiency Pathogenesis

Risk factors are who?

A

pts with diabetes or peripheral vascular disease

30
Q

What bug are worried about for Osteomyelitis in sickle cell pts

A

salmonella

31
Q

what is the best radiologic thing to diagnose osetomyelitis

A

MRI (more sensitive)

32
Q

Is it best to get a culture for osteomyelitis - yes or no? and why?

A

yes - get a freaking culture

do not want to do empiric therapy for 4 - 6 weeks…

33
Q

Empiric therapy for Osteomyelitis:

Adults

A

nafcillin or cefazolin (MSSA)

34
Q

Empiric therapy for Osteomyelitis:

Post-Op/Post trauma pts

A

pip/tazo, or cefepime, or meropenem(add vanc if MRSA worried)

*these drugs bc want to cover pseudomonas (the hospital bug..)

35
Q

Empiric therapy for Osteomyelitis:

IV Drug user

A

pip/tazo, cefepime, or meropenem (vanc if suspected MRSA)

want pseudomonas coverage for IV drug users..

36
Q

Directed therapy for Osteomyelitis:

S.Aureus?

A

Nafcillin or cefazolin
if severe allergy: vanc or clinda
if MRSA: vanc, dapto, linezolid

37
Q

3 routes that Septic arthritis can occur

A

hematogenous spread
direct inoculation
contiguous spread from infected soft tissue or bone

38
Q

The most common pathogen for septic arthritis is _______

oddly tho – for adults in age range 15 - 40 the bug _______ is oddly common

A

most common = s.aureus

oddly common bug is Neisseria gonorrhoeae

39
Q

what bug is know to come from cat/dog bites

A

pasterurella multocida

40
Q

Most septic arthritis cases are mono or poly articular

A

usually mono!!

41
Q

Gonococcal arthritis:
4 times more common in men or women?

and why?

A

more common in women

more common in women because there is a higher risk of dissemination during menstruation/pregnancy or postpartum

42
Q

the gram stain of gonococcal arthritis (synovial fluid should be checked!!) will be what?

A

gram negative diplococci

PHRM 865 (59 decks)

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