Infective (Septic and Osteomyelitis) Flashcards
What is Septic Arthritis (EMERGENCY)
Bacterial infection of joints by direct access or haeamatogenous spread
How does a septic arthritis patient present
Acutely inflamed joint w/fever
Extreme Pain
Can destroy joint in 24 hrs
What are the causative organisms for Septic Arthritis
S Aureus (MC) H Influenzae (Children) N Gonorrhea E Coli and Pseudomonas in IVDU
Why is H Influenzae now an uncommon cause for Septic arthritis in Children
Vaccine available
A patient has septic arthritis of a prosthetic joint, what is the most likely causative
S Epidermidis
-Negative Staph
What are the RF for Septic Arthritis
IVDU
Immunosuppressed
Recent surgery/ trauma
Prosthetic joints
How is septic arthritis investigated
Urgent Joint Aspirate w/ MC+S and polarised light MS
Raised ESR/CRP
Blood culture (Gonococcal cause?)
Sexual health review (Gonorrhea cause?)
How is Septic arthritis managed
Joint aspirate/drain w/ ABx
Stop Methotrexate/Anti TFN
Double Prednisolone (If taking)
Analgesia w/ NSAIDs
If Septic arthritis is caused by Gram Negative bacteria, what must be given to the patient alongside joint aspirate
Flucloxacillin
If Septic arthritis is caused by MRSA/ Gram Positive bacteria, what must be given to the patient alongside joint aspirate
Vancomycin
If Septic arthritis is caused by Gonorrhea, what must be given to the patient alongside joint aspirate
IM Ceftriaxone and Azithromycin
What drugs must be stopped when treating Septic arthritis
Methotrexate
Anti TFN
What is Osteomyelitis
Acutely Inflamed Bone Marrow due to haematogenous/ local spread from infection/trauma
Who is most prone to osteomyelitis
Children via haematogenous spread
What are the causative organisms of Osteomyelitis
S Aureus
Salmonella in SCD
Why is SCD a RF for Osteomyelitis
Salmonella typically affects them more in Osteomyelitis
What are the RF for Osteomyelitis
IVDU Immunosupressed PVD/DM/SCD Inflammatory arthritis Trauma and infection
What is the Pathology of Osteomyelitis
Direct/ Local/ Haematogeous spread of infection = Inflammation and Bone OEDEMA
What can severe inflammation and bone oedema in osteomylytis lead to
Sequestra (Necrotic bone in pus)
Involucrum (Thick sclerotic bone around sequestra to compensate)
What is Sequestra
necrotic bone found in pus and can be surrounded by Involucrum
What is Involucrum
Thick sclerotic bone compensating sequestra
What are the presentations of Osteomyelitis
Dull Bony Pain that is Hot and Swollen
Worse with moving
Deep ulcers (Sequestra Sx)
What is a differential for Osteomyelitis
Charcot joint
- Diabetic foot as a result of nerve loss to diabetic neuropathy
- Weight bearing joint degradation
- Bony Destruction
How is Osteomyelitis Investigated
BM Biopsy w/ Culture and MC+S
Xray = Osteopenia
MRI = BM Oedema
Raised ESR/CRP
Why is MC+S done for Osteomyelitis
To Identify the causative organism
How is Osteomyelitis managed
Immobilise and ABx
What ABx should be given to an Osteomyelitis patient suffering from MRSA/S Aureus
Vancomycin
What ABx should be given to an Osteomyelitis patient suffering from S Aureus
Flusidic acid
What ABx should be given to an Osteomyelitis patient suffering from Salmonella
Flucloxacillin
