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Infectious Diseases (4th year) > Infectious Arthritis and Osteomyelitis > Flashcards

Infectious Arthritis and Osteomyelitis Flashcards

1
Q

SEE TABLE FOR TREATMENT - patients without implants

A

slide 2

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2
Q

Classification -> According to mechanisms of spread:

A
  • hematogenous spread
  • spread from contiguous site following surgery
  • secondary infection in the setting ofvascular insufficiency or concomitant neuropathy (e.g. in diabetes)
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3
Q

Classification -> According to the duration of infection:

A
  • acute: can be treated with antibiotics alone

- chronic: antibiotics should be combined with debridement surgery

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4
Q

Classification -> According to location:

A
  • in the long bones
  • the vertebral column
  • periarticular bones
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5
Q

What is the most common manifestation of hematogenous bone infection in adults?

A

vertebral osteomyelitis

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6
Q

What is the most common cause of acute vertebral osteomyelitis?

A
  • 40-50% s. aureus
  • 20% gram negative bacilli (mainly e.coli and p. aeruginosa)
  • 12% streptococci
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7
Q

What is the most common cause of subacute vertebral osteomyelitis?

A
  • mycobacterium tuberculosis or brucella

- and in patients with endocarditis by s. viridans

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8
Q

Is implant-associated spinal osteomyelitis usually acute or chronic?

A

chronic

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9
Q

What causes implant-associated spinal osteomyelitis?

A
  • coagulase-negative staph and P. acnes
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10
Q

What is the most common cause of spinal osteomyelitis in cases of prolonged bacteremia (e.g in patients with infected pacemaker)?

A
  • coagulase-negative staph
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11
Q

Candida species in…..

A

IV drug users (vertebral osteomyelitis)

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12
Q

What is the most leading initial symptom in vertebral osteomyelitis?

A

back pain

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13
Q

What are the clinical manifestation in vertebral osteomyelitis?
(SLIDE 7 - read more)

A
  • back pain
  • fever >38 (degrees celcius)
  • neurologic deficits (radiculopathy, weakness or sensory loss)
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14
Q

What is the diagnosis for vertebral osteomyelitis?

A
  • ↑ Erythrocyte sedimentation rate
  • ↑ CRP lever
  • blood culture
  • *plain radiography can be useful in patients with subacute or chronic vertebral osteomyelitis WITHOUT neurologic symptoms
  • *MRI is the gold standard in patients with neurologic impairment
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15
Q

When it comes to the diagnosis of vertebral osteomyelitis, what should we do if the blood culture is negative?

A
  • in patients with negative blood cultures, CT-guided or open biopsy is needed.
  • bone samples should be cultures for aerobic, anaerobic and fungal agents with a portion if the sample sent to histopathologic study.
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16
Q

What is the gold standard in patients with neurologic impairment?

A

MRI is the gold standard in patients with neurologic impairment

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17
Q

When is plain radiography can be useful in diagnosis of vertebral osteomyelitis?

A

plain radiography can be useful in patients with subacute or chronic vertebral osteomyelitis WITHOUT neurologic symptom

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18
Q

What is the treatment of vertebral osteomyelitis in patients without sepsis syndrome?

A

in patients without sepsis syndrome, antibiotics should not be administered until the pathogen is identified in a blood culture, a bone biopsy or aspirated pus collection

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19
Q

What is the treatment of vertebral osteomyelitis for those with bone infection?

A

bone infections are least initially treated by the IV route

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20
Q

Other things to take notice from when it comes to duration of the treatment of vertebral osteomyelitis?

A
  • no data on the optimal duration of therapy

- most suggest 6 weeks for patients who have acute osteomyelitis without an impairment

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21
Q

When is prolonged antibiotic therapy recommended in vertebral osteomyelitis?

A

prolonged antibiotic therapy recommended for patients with abscesses that have not been drained and patients with spinal implants

22
Q

What is the treatment necessary in implant-associated spinal infection?

A

surgical treatment

23
Q

SEE TABLE FOR TREATMENT

A

slide 11-15, 19

24
Q

What is the osteomyelitis in long bones a consequence of?

A
  • hematogenous seeding
  • contamination during trauma (open fracture)
  • perioperative contamination during orthopedic repairs
25
Q

Who developed chronic osteomyelitis in long bones in the preantibiotic era?

A

more common in elderly patients

26
Q

What is the most common cause of osteomyelitis in long bones in adults?

A
  • posttrauma

- postsurgery

27
Q

Which organism is most commonly isolated from adult patients?

A
  • s.aureus.

- after open fracture, infection is typically caused by gram-negative bacilli or mixed bacteria

28
Q

What are the clinical manifestation of hematogenous osteomyelitis?

A
  • pain
  • low-grade fever
  • occasionally sepsis and local signs of inflammation (erythema and swelling)
    SLIDE 17
29
Q

Diagnosis in osteomyelitis in long bones:

A
  • similar to that of vertebral osteomyelitis
  • CT is required in order to estimate the extent of inflamed tissue and to detect bone necrosis (sequestres)
  • the three-phase bone scan does not differentiate bone remodeling from infection and is not useful during at least the first year after implantatio
30
Q

What is the treatment from acute hematogenous infection in long bones?

A
  • identical to that for acute vertebral osteomyelitis

- it should last 4-6 weeks

31
Q

What are the causes of PJI (periprosthetic joint infection)?

A
  • 70% staph (s.aureus and coagulase-negative staph)
  • 10% strep
  • 10% gram-negative bacilli
32
Q

PJI =

A

periprosthetic joint infection

33
Q

What are the clinical manifestations of exogenous PJI (periprosthetic joint infection)?

A

exogenous PIJ with local signs of infections

34
Q

What are the clinical manifestations of acute hematogenous PJI (periprosthetic joint infection)?

A

acute hematogenous PJI causes new-onset pain that initially is not accompanied by local inflammatory signs

35
Q

What are the clinical manifestations of chronic PJI (periprosthetic joint infection)?

A

chronic PJI presents with join effusion, local pain, implant loosening, occasionally sinus tract

36
Q

Diagnosis of PJI:

A
  • blood tests (CRP, erythrocyte sedimentation)
  • during debridement surgery (at least 3 samples obtained)
  • CT or MRI
37
Q

What is the treatment of PJI?

A
  • antimicrobial treatment should be accompanied with surgical intervention (go back to the slide: “treatment - patient with orthopedic device”)
38
Q

When does sternal osteomyelitis occur?

A

sternal osteomyelitis occurs primarily after sternal surgery with the entry of exogenous organisms

39
Q

What is poststernotomy osteomyelitis caused by?

A
  • s. aureus (40-50%)
  • gram-negative bacilli (15-25%)
  • enterococci (5-12%)
  • sometimes fungi (candida ssp)
  • M. tuberculosis in patients from endemic areas (as reactivation)
40
Q

What is the clinical manifestation of sternal osteomyelitis?

A
  • fever, increased local pain, erythema, wound idscharge
  • sternal instability
  • contiguous mediastinitis may occur as a complication of sternal osteomyelitis (in 10-30% of cases)
41
Q

Diagnosis - sternal osteomyelitis:

A
  • in secondary sternal osteomyelitis, leukocyte counts may be normal but the CRP level is >100mg/l in most cases
  • samples from at least three deep biopsies should be taken for microbiologic examination
42
Q

Treatment - sternal osteomyelitis:

A
  • antibiotic treatment right after the samples have been obtained
  • primary sternal osteomyelitis can be treated without surgical intervension
  • secondary sternal osteomyelitis debridement is required
43
Q

Who usually gets osteomyelitis of the foot?

A
  • patients with DIABETES
  • peripheral arterial insufficiency
  • peripheral neuropathy
  • after foot surgery
44
Q

What is the incidence of diabetic foot infection?

A

incidence of diabetic foot infection is 30-40cases/1000 persons with diabetes per year. It increases the risk of amputation.

45
Q

Pathogens - foot osteomyelitis:

A
  • s. aureus (30-40%)
  • gram-negative bacilli (30-40%)
  • anaerobes (10-20%)

pretreatment selects for P.aeruginosa or enterococci

46
Q

Diagnosis - foot osteomyelitis:

A
  • in many cases foot osteomyelitis can be diagnosed clinically with the “probe-to-bone” test: diagnosis is highly probable if bone can be directly touched with a metal instrument
  • in a patient with lower pretest probability, MRI should be performed
47
Q

Treatment - foot osteomyelitis:

A
  • correlation between cultures of bone and those of wound swabs is poor so antimicrobial therapy should be based on bone culture
  • treatment consists of wound debridement combined with a 4-6 weeks course of antibiotics
48
Q

Acute bacterial arthritis:

A
  • bacteria enter the joint:
    • from the blood stream
    • from a contiguous site of infection in bone or soft tissue
    • by direct inoculation during surgery, injection, animal or human bite, or trauma
49
Q

What is the most common route of infection in acute bacterial arthritis?

A

the hematogenous route of infection is the most common route in all age groups

50
Q

Microbiology - acute bacterial arthritis:

A
  • NEISSERIA GONORRHEA is the most common pathogen of bacterial arthritis
  • S. AUREUS is the most common nongonococcal pathogen of bacterial arthritis
51
Q

SLIDE 30

A

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Infectious Diseases (4th year) (19 decks)

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