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Musculoskeletal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

Name some risk factors for developing bone and joint infections

A

Diabetes, Ulcers, IV drug users

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2
Q

What are the most likely pathogens to cause BIJ?

A

Streptococcus (group A), S.aureus, cloakrooms, Kingella in children

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3
Q

Name a pathogen which can present in children under 5

A

Kingella

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4
Q

What are the two types of bacteria which present in Prosthetic Joint s?

A

Proprionobacteria (Diptherioids)

Coagulase negative staphlococcal

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5
Q

What is the typical presentation in acute bone and joint infections?

A

Temperature, tachycardia, hypertension, pain, swelling and tenderness
-Reduced mobility in joint, signs of cellulitis

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6
Q

What are some of the clinical features which present in children with an acute presentation in BIJ?

A

Listless, not feeding/playing, cranky

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7
Q

Give the criteria as to which a Systemic Inflammatory Response Syndrome can be diagnosed

A

Two or more of the following:

  • HR >90bpm
  • RR >20breaths/min or PaCo2 12,000 cells/mm3
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8
Q

What is the progression from Systemic Inflammatory Response Syndrome?

A

SIRS–> Sepsis–> Septic Shock

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9
Q

What is septic arthritis?

A

Infection of the joint space

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10
Q

How can Septic Arthritis spread?

A
  1. Haemotagenous route (through another septic focus e.g. endocarditis)
  2. Contiguous spread (e.g. infected bone)
  3. Direct inoculation (infection or trauma)
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11
Q

How is Septic Arthritis diagnosed?

A
  • Blood culture if pyrexial
  • CRP (can be used to monitor response to treatment)
  • Joint aspirate washout (best before microbiology)
  • Ultrasound
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12
Q

How is Septic Arthritis treated?

A

Antibiotic treatment:

  • Empiric for Staph Aureus is IV Flucloxacillin (2-4 wk course)
  • Look for source of organism
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13
Q

What other antibiotic should be given in the treatment of Septic Arthritis for children

A

Ceftriazone for Hirfluenza/Kingella

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14
Q

What is Osteomyelitis?

A

Inflammation of bone and medullary cavity, long bones or vertebra

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15
Q

What are the risk factors associated with Osteomyelitis?

A

Diabetes, obesity, malnutrition, rhematoid arthritis

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16
Q

How is Osteomyelitis spread?

A
  1. Haematotogenous
  2. Contiguous spread
  3. Peripheral Vascular Disease
  4. Prosthesis associated
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17
Q

What are the 3 different types of implant infection?

A
  1. Early post op phase, 0-3 months
  2. Delayed (low grade), 3-24months
  3. Late phase, >24months
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18
Q

If an infant has osteomyelitis, why are they at an increased risk of also developing Septic Arthritis?

A

The vessels are crossing the metaphysis to reach the epiphysis

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19
Q

How does chronic Osteomyelitis arise?

A

Due to a delay in treating the acute infection, this causes permanent damage and can lead to septicaemia

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20
Q

What is the management of Osteomyelitis?

A

Still target s.aureus with Flucloxacillin

21
Q

What is the difference between type 1 and type 2 Necrotising Fasciitis?

A

Type 1: more common, anaerobes and a mixture of coliforms and strep
Type 2: Flesh eating group A strep

22
Q

What are the clinical features of Necrotising Fasciitis?

A
  • Highly painful with some signs of inflammation
  • Erodes through all tissue planes
  • Rapidly progressive
23
Q

How is Necrotising Fasciitis diagnosed?

A

Pain disproportional to superficial appearance

24
Q

What is the treatment for Necrotising Fasciitis?

A
  • Surgical debridement down to normal tissue

- Antibiotics: Clindamycin and Penicillin

25
Q

Why should Clindamycin be used in Group A Necrotising Fasciitis in particular?

A

Prevents the production of group A toxins

26
Q

What is the mechanism of entry for Gas Gangrene?

A

Spores into tissue–> spores germinate–> produce gas–> accumulation of gas bubbles in tissues, space gangrene ‘crepitus’

27
Q

What are the infective organisms in Gas Gangrene?

A

Clostridium perfringens, spores

28
Q

What is the treatment for Gas Gangrene?

A
  1. Surgical debridement of dead tissue
  2. Antibiotics in high doses (Penicillin and/or Metronidazole)
  3. Hyperbaric oxygen
29
Q

What is the infective organism in Tetanus?

A

Clostridium Tetani, spore producing

30
Q

What is the treatment of Tetanus?

A

Penicillin/ Metronidazole

31
Q

What happens in Tetanus infections?

A
  • Neurotoxin produced
  • Spastic paralysis
  • Muscle can’t relax
  • Binds to inhibitory neurones, preventing release of neurotransmitters
32
Q

In summary, how should the following be treated:

a) Acute BJI
b) Chronic BJI

A

a) Acute: samples, empirical antibiotics, traget MSSA+ streptococci with flucloxacillin
b) Chronic: take sample, only start empirical if SIRS

33
Q

What is the most common affecting organism in septic arthritis?

A

S aureus

34
Q

What are the infecting organisms in prosthetic joint infections?

A

CoNs, S aureus, streptococcus, propionibacterium

35
Q

What are the infecting organisms in vertebral osteomyelitis?

A

s aureus, coliforms, streptococcus, MTB

36
Q

What are the infecting organisms in post trauma infection?

A

staph aureus, polymicrobial gram -ve bacilli

37
Q

What are the infecting organisms in diabetic foot infection?

A

s aureus, streptococcus, colifomrs, anaerobes

38
Q

Which organism forms a biofilm?

A

staph epidermis

39
Q

What is the treatment of choice in BJI infecting by staphs and streps?

A

Flucloxacillin, Vancomycin (if penicillin allergic), Clindamycin (if antitoxins such as PVL)

40
Q

What is the treatment of choice in BJI infecting by coliforms?

A

Gentamicin (beware, need to monitor)

41
Q

What is biofilm?

A

Slow growing slime which protects from the immune system and antibiotics

42
Q

What is the evolution of slime?

A

Bugs stick–> slime–> can from within 3 days–> patients present after weeks to months–> grows silently but extensively

43
Q

How is PJI treated?

A

Surgical and antibiotics

44
Q

What are the two surgical options for the treatment of PJI?

A

1 stage procedure: fit new prosthesis. Risk of leaving residual if not cleaned properly

2 stage: put in spacer in 1st op, give antibiotics for 6 weeks, fit new prosthesis on 2nd op

45
Q

What is the NHS protocol for PJI?

A
  1. No antibiotic preoperatively
  2. Minimum 3 bone/tissue/pus samples
  3. Minimum 6 weeks antibiotics before clean surgery
46
Q

What are 3 bone samples taken from a patient with PJI?

A
  1. Superficial swabs are a waste of time as they reflect the skin flora rather than deep infection
  2. Bone samples can get contaminated with skin flora in the theatre, or in the lab
  3. CoNs are part of the normal skin flora
47
Q

What is the Tayside protocol for PJI in regards to antibiotics?

A

Gram +ve= Flucloxacillin
Penicillin allergic/Meticillin resistant= Vancomycin, Teicoplanin (outpatient)

Gram -ve: Cotrimaxamole, Amoxicillin, Ciprofloxacin, Ceftriaxone

48
Q

What is Teicoplanin?

A

An antibiotic similar to Vancomycin but can be taken once a day orally as an outpatient

49
Q

What is the protocol for prophylaxis with a prosthetic joint or implant?

A

First dose should be within 30mins of the start of surgery and should not continue >24hrs after surgery

Musculoskeletal (13 decks)

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