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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
how long do you treat osteomyelitis for
6 weeks
26
what microbials does gentamicin cover
gram negative bacilli not not anaerobes
27
what antibiotics for gram positive cover
flucloxacillin IV or vancomycin if penicillin allergic oral switch doxycyline
28
what antibiotics for gram negative cover
gentamicin/ aztreonam IV if severe oral cotrimoxazole/ doxycyline
29
what antibiotic for anaerobes
metronidazole
30
what organisms commonly cause osteomylitis
staph aureus group A,B,C or G streptococcus milleri group anaerobes
31
name 7 likely red herring colonisers
``` pseudomonas aeruginosa escherichia coli proteus enterobacter bacillus sp coagulase negative straphylcocci ```
32
why do you not switch IV vancomycin to oral in osteomyelitis
as not absorbed
33
how long is endocarditis treated for
6 weeks injectable therapy
34
who gets haematogeneous osteomyelitis
prepubertal children, PWIDs, central lines/dialysis/elderly
35
when does the first day of treatment 914 days IV antibiotics) start for people with haematogeneous osteomyelitis
first day of negative blood culture results
36
what organisms commonly cause PWID haematogeneous osteomyelitis
staphylococcus, streptococci
37
what organisms commonly cause dialysis patients HO infections
staph aureus (most common), aerobic gram negatives
38
what pathogens cause sickle cell osteomyelitis
salmonella | staph aureus
39
what is gauchers disease and its clinical features
lysosomal storage disorder may mimic bone crisis (if sterile) often affects tibia if infected= staph aureus
40
what is seen clinically in SAPHO and CRMO
raised inflammatory marker, lytic lesions on x-rays, pus cultures exclude osteomyelitis
41
who most gets SAPHO and CRMO
SAPHO adults CRMO kids (mostly chest wall, plevis or spine)
42
what organisms cause vertebral osteomyelitis
staph aureus gram neg aerobic bacilli streptococcus spp mycobacterium tuberculosis
43
is vertebral osteomyelitis contiguous or haematogenous
mostly haematogeneous
44
what are the clinical presentations of vertebral osteomyelitis
50% have fever 90% have insidious pain and tenderness 90% raise inflam markers
45
what is the bets way to diagnose vertebral osteomyelitis
biopsy and MRI
46
how do you treat vertebral osteo
drain large paravetebral/ epidural adbscesses | antimicrobials for 6 weeks
47
do you get systemic symptoms with skeletal tuberculosis
not usually, confined to spine
48
what are the risk factors for infection in prosthetic joints
rheumatoid arthritis diabetes malnutrition obesity
49
what is the mechanisms of prosthetic joint infection
direct inoculation during surgery manipulation of joint during surgery seeding of joint at later date
50
what is the difference between planktonic vs sessile bacteria
planktonic- bacteraemia sessile- grow into bio film which has protective extracellular matrix making it hard to abscess with antibiotics
51
what pathogens cause prosthetic joint infection
gram +ve - staph aureus - staph epidermis gram -ve - escherichia coli - pseudomonas aeruginosa fungi mycobacteria sp
52
what is the treatment for infection of prosthetic joint infection
ideally remove prosthesis and cement- re-implantation after aggressive antibiotic therapy
53
how do you treat coagulase negative staph epidermis
vancomycin
54
what is the oral switch for vancomycin
doxycycline
55
what are the sources of infection for septic arthritis
penetrating wound hematogenous spread adjacent infected soft tissues/ bone
56
what bacteria cause septic arthitis
``` staph aureus streptococci coag neg strep (prosthetic joints) neisseria gonorrheae haemophilus influenzae ```
57
what infections does PVL producing staph aureus cause
skin infections peumonia bacteraemia septic arthritis
58
what is septic arthritis
inflammation of the joint space caused by infection
59
what are the symptoms of septic arthitis
severe pain, red, hot swollen, pus limited movement
60
what is the treatment for septic arthiritis
presumptive treatment for staph aureus- flucloxacillin
61
what is bursitis
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
what is pyomyositis
bacterial infection of the skeletal muscles
63
what are 90% of bacterial pyomyositis caused by
staphylococcal
64
what else can cause myosisitis
viral, protozoa, parasites, fungal
65
what causes myonecrosis
'flesh eating bugs'
66
what bug causes teanus- describe it
clostridium tetani- gram +ve, strictly anaerobic rods, produces spores (drumstick shaped) found in soil, gardens etc
67
what does the tetanus neurotoxin do
causes spastic paralysis- binds to inhibitory neurones preventing the release of neurotransmitters- lock jaw, muscle spasm
68
what is the treatment for tetanus
surgical debridement antitoxin supportive measures antibiotics booster vaccination (survivors are not immune)
69
how long does debrided bone take to be covered by vascularised soft tissue
6 weeks

MSK (71 decks)

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