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MSK > Infections > Flashcards

Infections Flashcards

1
Q

where in MSK system can you get infection

A

bone infections
joint and synovial fluid
muscle infections

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2
Q

what is osteomyelitis

A

inflammation of the bone and medullary cavity- usually located in one of the long bones

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3
Q

how can you classify osteomyelitis

A

acute/chronic

by spread: contiguous (adjacent to where infection started)/ haematogenous (PWIDs, bacteriaemia)

host status (vascualr insufficiency, host susceptibility)

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4
Q

what is the risk of using clindamycin

A

c diff infection

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5
Q

how do you treat bone infection

A

surgical debridement- remove pus, dead/ infected bone and drain pus

antimicrobials

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6
Q

what localised symptoms suggest bone infection

A

if you can probe to the bone or see the bone

calorm rubor, tumour, dolor, function laesa

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7
Q

how do you confirm bone infection

A

gold standard= bone biopsy

cross secotional imaging

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8
Q

when do you give antibiotics

A

when you get microbial diagnosis (unless patient septic)

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9
Q

when does a bone infection occur

A

bone highly resistant to infection, only occurs with necrosis +/- high innoculum

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10
Q

how long does osteomyelitis take to recover

A

6 weeks of therapy

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11
Q

what cultures can be done

A

percutaneous aspirate, deep surgical cultures

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12
Q

when do coagulase negative organisms cause infections

A

usually commensals, cause infection in patients with metal/ plastic inside bodies (e.g. prosthetic)

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13
Q

what can cause osteomyelitis

A

open fractures

diabetes/ vascular insufficiency

haematogenous osteomyelitis (PWIDs, disseminate infection)

vertebral osteomyelitis (form of HO above)

prosthetic joint infection

specific hosts and pathogens

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14
Q

how is staph aureus treated

A

flucloxacillin

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15
Q

is staph aureus coagulase positive or negative

A

positive

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16
Q

what type of infection does an open fracture cause

A

contiguous

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17
Q

what bug infects open fractures

A

staph aureus and aerobic gram negative bacteria

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18
Q

what is the early management of an open fracture

A

aggressive debridement, fixation and soft tissue cover

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19
Q

what is the clue to an infected open fracture

A

non union and poor wound healing

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20
Q

does diabetes/ venous insufficiency cause contiguous or haematogenous infection

A

contiguous

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21
Q

what bug usually causes diabetic/ vascular insufficiency

A

often polymicrobial but predominantly staph aureus

can also be streptococci, enterobacteria, obligate anaerobes and MRSA

if severe think obligate anaerobes

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22
Q

what scans can be done for osteomylelitis

A

plain radiograph, if no characteristic pathological findings then MRI

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23
Q

how long do you treat skin or skin and soft tissue diabetic/ vascular infection

A

7 days

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24
Q

how long do you treat bacteraemia for

A

14 days

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25
Q

how long do you treat osteomyelitis for

A

6 weeks

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26
Q

what microbials does gentamicin cover

A

gram negative bacilli not not anaerobes

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27
Q

what antibiotics for gram positive cover

A

flucloxacillin IV
or vancomycin if penicillin allergic

oral switch
doxycyline

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28
Q

what antibiotics for gram negative cover

A

gentamicin/ aztreonam IV if severe

oral cotrimoxazole/ doxycyline

29
Q

what antibiotic for anaerobes

A

metronidazole

30
Q

what organisms commonly cause osteomylitis

A

staph aureus
group A,B,C or G streptococcus
milleri group
anaerobes

31
Q

name 7 likely red herring colonisers

A 
pseudomonas aeruginosa 
escherichia coli
proteus
enterobacter
bacillus sp
coagulase negative straphylcocci
32
Q

why do you not switch IV vancomycin to oral in osteomyelitis

A

as not absorbed

33
Q

how long is endocarditis treated for

A

6 weeks injectable therapy

34
Q

who gets haematogeneous osteomyelitis

A

prepubertal children, PWIDs, central lines/dialysis/elderly

35
Q

when does the first day of treatment 914 days IV antibiotics) start for people with haematogeneous osteomyelitis

A

first day of negative blood culture results

36
Q

what organisms commonly cause PWID haematogeneous osteomyelitis

A

staphylococcus, streptococci

37
Q

what organisms commonly cause dialysis patients HO infections

A

staph aureus (most common), aerobic gram negatives

38
Q

what pathogens cause sickle cell osteomyelitis

A

salmonella

staph aureus

39
Q

what is gauchers disease and its clinical features

A

lysosomal storage disorder
may mimic bone crisis (if sterile)
often affects tibia
if infected= staph aureus

40
Q

what is seen clinically in SAPHO and CRMO

A

raised inflammatory marker, lytic lesions on x-rays, pus cultures exclude osteomyelitis

41
Q

who most gets SAPHO and CRMO

A

SAPHO adults

CRMO kids

(mostly chest wall, plevis or spine)

42
Q

what organisms cause vertebral osteomyelitis

A

staph aureus
gram neg aerobic bacilli
streptococcus spp
mycobacterium tuberculosis

43
Q

is vertebral osteomyelitis contiguous or haematogenous

A

mostly haematogeneous

44
Q

what are the clinical presentations of vertebral osteomyelitis

A

50% have fever
90% have insidious pain and tenderness
90% raise inflam markers

45
Q

what is the bets way to diagnose vertebral osteomyelitis

A

biopsy and MRI

46
Q

how do you treat vertebral osteo

A

drain large paravetebral/ epidural adbscesses

antimicrobials for 6 weeks

47
Q

do you get systemic symptoms with skeletal tuberculosis

A

not usually, confined to spine

48
Q

what are the risk factors for infection in prosthetic joints

A

rheumatoid arthritis
diabetes
malnutrition
obesity

49
Q

what is the mechanisms of prosthetic joint infection

A

direct inoculation during surgery

manipulation of joint during surgery

seeding of joint at later date

50
Q

what is the difference between planktonic vs sessile bacteria

A

planktonic- bacteraemia

sessile- grow into bio film which has protective extracellular matrix making it hard to abscess with antibiotics

51
Q

what pathogens cause prosthetic joint infection

A

gram +ve

  • staph aureus
  • staph epidermis

gram -ve

  • escherichia coli
  • pseudomonas aeruginosa

fungi

mycobacteria sp

52
Q

what is the treatment for infection of prosthetic joint infection

A

ideally remove prosthesis and cement- re-implantation after aggressive antibiotic therapy

53
Q

how do you treat coagulase negative staph epidermis

A

vancomycin

54
Q

what is the oral switch for vancomycin

A

doxycycline

55
Q

what are the sources of infection for septic arthritis

A

penetrating wound
hematogenous spread
adjacent infected soft tissues/ bone

56
Q

what bacteria cause septic arthitis

A 
staph aureus 
streptococci 
coag neg strep (prosthetic joints)
neisseria gonorrheae
haemophilus influenzae
57
Q

what infections does PVL producing staph aureus cause

A

skin infections
peumonia
bacteraemia
septic arthritis

58
Q

what is septic arthritis

A

inflammation of the joint space caused by infection

59
Q

what are the symptoms of septic arthitis

A

severe pain, red, hot swollen, pus limited movement

60
Q

what is the treatment for septic arthiritis

A

presumptive treatment for staph aureus- flucloxacillin

61
Q

what is bursitis

A

is inflammation and swelling of a bursa. A bursa is a fluid-filled sac which forms under the skin, usually over the joints, and acts as a cushion between the tendons and bones.

62
Q

what is pyomyositis

A

bacterial infection of the skeletal muscles

63
Q

what are 90% of bacterial pyomyositis caused by

A

staphylococcal

64
Q

what else can cause myosisitis

A

viral, protozoa, parasites, fungal

65
Q

what causes myonecrosis

A

‘flesh eating bugs’

66
Q

what bug causes teanus- describe it

A

clostridium tetani- gram +ve, strictly anaerobic rods, produces spores (drumstick shaped) found in soil, gardens etc

67
Q

what does the tetanus neurotoxin do

A

causes spastic paralysis- binds to inhibitory neurones preventing the release of neurotransmitters- lock jaw, muscle spasm

68
Q

what is the treatment for tetanus

A

surgical debridement
antitoxin
supportive measures antibiotics
booster vaccination (survivors are not immune)

69
Q

how long does debrided bone take to be covered by vascularised soft tissue

A

6 weeks

MSK (71 decks)

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