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MSK > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What are the most likely pathogens responsible for a bone and joint infection?

A

Staph aureus
Strep A
Coliforms

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2
Q

What pathogens may be responsible if it is a prosthetic joint infection?

A

Diphtheroids

Coag neg Staph (CoNS)

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3
Q

How would an acute bone and joint infection present?

A

Pain, swelling, redness
Reduced mobility
Temperature

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4
Q

What is needed to diagnose Systemic Inflammatory Response Syndrome (SIRS)?

A 
TWO OR MORE OF: 
Temperature >38
HR >90
RR> 20 
WBC >12,000
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5
Q

What is septic arthritis?

A

An infection of the joint space

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6
Q

What bacteria causes septic arthritis?

A

MSSA

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7
Q

What investigations are needed if septic arthritis is suspected?

A

Bloods
Joint fluid aspirate
USS
Plain xray

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8
Q

What is the empirical therapy for septic arthritis?

A

Flucloxacillin

24-48 hours for lab to return sensitivities.

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9
Q

What antibiotic should be added if pt is under 5 for septic arthritis?

A

Ceftriaxone

for H flu and Kingella

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10
Q

What is osteomyelitis?

A

Inflammation of bone or medullary cavity

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11
Q

Where does osteomyelitis usually affect?

A

Long bones or vertebrae

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12
Q

What bacteria causes acute osteomyelitis?

A

MSSA

Strep

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13
Q

What bacteria causes chronic osteomyelitis?

A

M. tuberculosis, Pseudomonas, salmonella, coliforms

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14
Q

When is haematogenous spread more likely?

A

Acutely.

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15
Q

If osteomyelitis spreads to the joint what is it called?

A

Septic arthritis

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16
Q

Who is at higher risk of developing septic arthritis from osteomyelitis?

A

Infants

more vessels cross the metaphysis to the epiphysis

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17
Q

What antibiotics should be given for chronic osteomyelitis?

A

Abx should be delayed until cultures are returned.

No immediate danger

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18
Q

What abx are given for acute osteomyeltiis?

A

Flucloxacillin empirically. Tx should be modified after cultures.

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19
Q

What are the risk factors for developing an infection in a prosthetic joint?

A

Diabetes
Malnutrition
Obesity
Rheumatoid arthritis

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20
Q

What are the 3 types of implant infection?

A

Early postoperative, delayed and late.

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21
Q

Describe the time scale, causes and signs of early postoperative infection.

A

0-3 months.
Staph aureus, Strep
fever, warmth

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22
Q

True or False

Coagulase negative staphylococci are skin commensals

A

True

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23
Q

Why is it difficult to diagnose a prosthetic joint infection?

A

Caused by common contaminants

Cultures are rarely positive

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24
Q

What is the treatment for PJI?

A

removal of prosthesis and reimplantation after abx tx.

25
Q

What is necrotising fasciitis?

A

Acute and severe infection of the subcutaneous soft tissues

26
Q

Where is most commonly affected by necrotising fasciitis?

A

Limbs, abdominal wall, groin area, post operative wound.

27
Q

What causes necrotising fasciitis?

A

Anaerobes.

Group A strep.

28
Q

How is necrotising fasciitis diagnosed?

A

Pain is disproportionate to superficial appearances.

Take swabs and tissues biopsy for culture.

29
Q

What is the treatment for necrotising fasciitis?

A

Surgical debridement

Penicillin and clindamycin

30
Q

True or False

There is no need for infection control with necrotising fasciitis.

A

False.

Contact precautions should be taken as well as a risk assessment for droplet precautions.

31
Q

How are clostridium perfringens classified?

A

Gram positive (purple)
Strictly anaerobes
Rods

32
Q

What is gas gangrene?

A

Spores of C. perfringens germinate into tissue and accumulate into gas bubbles.

33
Q

What is the treatment for gas gangrene?

A

Urgent debridement.
penicillin +/- metronizadole
Hyperbaric oxygen

34
Q

What organism causes tetanus?

A

Clostridium tetani

35
Q

How is clostridium tetani classified?

A

Gram positive
Strictly anaerobic
Rods

36
Q

What are the symptoms of tetanus?

A

Spastic paralysis
Lock jaw due to muscle spasm
Stiffness of neck

37
Q

What is the incubation period for tetanus?

A

4 days- several weeks

38
Q

What is the treatment for tetanus?

A

Booster vaccination

Penicillin/ metronizadole

39
Q

What is the antibiotic of choice to treat staph and strep?

A

Flucloxacillin.

Vancomycin

40
Q

What antibiotic could be used for coliforms?

A

Gentamicin

41
Q

How many samples should be taken if PJI is suspected?

A

3.

To exclude contaminated bacteria from the culture.

42
Q

How long is the abx treatment for a hip PJI?

A

3 months

43
Q

How long is the abx treatment for a knee PJI?

A

6 months

44
Q

When should the first prophylactic abx be given?

A

Within 60 minutes of surgery

45
Q

What is the most common bacteria which contaminates in trauma?

A

Staph aureus

46
Q

What kind of patients do PVL commonly affect?

A

Young people with osteo infection.

47
Q

What antibiotic would you use if you suspected PVL?

A

Clindamycin

48
Q

How do CoNS affect prosthesis?

A

They are charged and stick to the plastic of the prosthesis and create a layer of biofilm which makes them harder to treat.

49
Q

What bacteria are the most common found in osteomyelitis in children?

A

Pseudomonas

Kingella

50
Q

True or False

BJIs never cause septic shock

A

False.

51
Q

What do microbiology do with a joint fluid aspirate?

A

Look for crystals for (pseudo)gout
Check for white cells
Gram stain

52
Q

What is the classic link with brucella infection?

A

Goats.

Especially drinking goats unpasteurised milk.

53
Q

What are the downsides of gentamicin?

A

Nephrotoxic.

Need permission to use longer than 3 days

54
Q

What kind of antibiotic is gentamicin?

A

Aminoglycoside

55
Q

What is a DAIR procedure?

A

Debridement and implant retention

56
Q

What blood tests need to be done if infection suspected?

A

CRP
PV
WCC if acute

57
Q

When is acute osteomyelitis most likely to occur?

A

Post-trauma

Open wound

58
Q

If an osteomyelitic patient has pus what is the right thing to do?

A

Drain the abscess

59
Q

What antibiotics can be used for cellulitis?

A

Flucloxacillin to cover staph and strep

MSK (30 decks)

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