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Musculoskeletal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

BJI

A

bone &joint infection

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2
Q

PJI

A

prosthetic joint infection

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3
Q

MSSA

A

meticillin sensitive staph aureus

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4
Q

MRSA

A

meticillin resistant staph aureus

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5
Q

common PJI bacteria

A

S. Aureus, coagulase negative staph, strep. spp, propionibacterium acnes

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6
Q

common septic arthritis infections

A

staph aureus, streptococci

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7
Q

common post-traumatic infections

A

staph aureus, polymicrobial coliforms, pseudomonas

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8
Q

common vertebral osteomyelitis infections

A

staph aureus, coliforms, strep spp, mycobacterium tuberculosis

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9
Q

common diabetic foot infections

A

staph aureus, strep spp, coliforms, pseudomonas, anaerobes

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10
Q

less common bacteria species but must be remembered

A

psuedomonas aeruginosa

kingella in children

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11
Q

risk factors for infections

A

sickle cell anaemia
immunocompromised patient
diabetes

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12
Q

clinical presentation of acute BJI in adults

A

Temperature/systemic signs
Pain/swelling/redness over area
Reduced mobility/movement of joint/held in flexed position

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13
Q

clinical presentation of acute BJI in children

A

listless, not feeding/playing, cranky

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14
Q

the category for systemic inflammatory response syndrome (SIRS)

A

two or more of:

  • Temperature >38C or 90 beats/min
  • Respiratory rate >20 breaths/min or PaCO2 12,000 cells/mm3 or
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15
Q

how can organisms be introduced into the joint space in septic arthritis?

A 
Haematogenous spread
Contiguous spread (eg infected bone)
Direct inoculation (injection or trauma)
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16
Q

what tests should be done to diagnose acute septic arthritis?

A

Blood culture if pyrexial (positive in 30-60% cases)
CRP, FBC, U&E, lactate, ESR etc
Joint fluid aspirate/washout for microscopy* & culture
crystals (gout, pseudogout) white cells & gram stain
Ultrasound scan, plain X-ray MRI, CT, bone scan

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17
Q

how would you treat septic arthritis in someone over 5 years old?

A

high dose flucloxacillin for 2-4 weeks
look for source of organisms
adjust with culture results

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18
Q

how would you treat septic arthritis in someone under 5 years old?

A

high does flucloxacillin + ceftriaxone for 2-4 weeks
look for source of organisms
adjust with culture results

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19
Q

why is ceftriaxone added into the treatment of septic arthritis for children under the age of 5?

A

to cover H. influenzae & Kingella

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20
Q

what is osteomyelitis?

A

Inflammation of bone & medullary cavity, usually long bones or vertabrae

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21
Q

what organisms is it likely to be in acute osteomyelitis?

A

MSSA

streptococci

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22
Q

what organisms could it be in chronic osteomyelitis?

A 
mycobacterium tuberculosis 
pseudomonas aeruginosa 
salmonella 
brucella 
coliforms
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23
Q

how can osteomyelitis be spread?

A

Haematogenous
Contiguous
Peripheral vascular disease associated
Prosthesis associated

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24
Q

what is the most likely way of spreading in acute osteomyelitis?

A

haematogenous especially in femur/tibia

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25
Q

what is the risk of osteomyelitis in shoulder/ankle/hip/elbow?

A

metaphysis is intracapsular so may extend into joint space

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26
Q

why are infants more at risk of septic arthritis as well as acute osteomyelitis?

A

due to vessels crossing metaphysis to epiphysis

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27
Q

how does chronic osteomyelitis come about?

A

Delay in treating acute infection leads to higher risk of abscess, permanent damage, septicaemia etc

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28
Q

why should you always try to delay antibiotic treatment in osteomyelitis?

A

until specimens have been obtained for culture

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29
Q

how is osteomyelitis diagnosed?

A

Blood culture if pyrexial

Bone biopsy/washout if possible for microscopy & culture

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30
Q

how is osteomyelitis treated?

A

high dose flucloxacillin (4-8 weeks)

modify treatment after results of culture

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31
Q

what are the risk factors for PJI?

A

RA
Diabetes
Malnutrition
Obesity

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32
Q

what are the three types of implant infection?

A

early postoperative
delayed (low grade)
late

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33
Q

when does early postoperative PJI come on?

A

0-3 months after operation

34
Q

what route of spread is used in early postoperative PJI?

A

perioperatice

35
Q

what signs are present in early postoperative PJI?

A

fever
effusion
warmth drainage

36
Q

what bacteria are likely to be causing early postoperative PJI?

A

staph aureus
streptococci
enterococci

37
Q

when does delayed PJI come on?

A

3-24 months after operation

38
Q

what is the route of spread in delayed PJI?

A

perioperative

39
Q

what signs are present in delayed PJI?

A

persistent pain
device loosening
fistula

40
Q

what bacteria is likely to be causing delayed PJI?

A

coagulase negative staph

P. acnes

41
Q

when does late PJI come on?

A

more than 24 months after operation

42
Q

what is the route of spread in late PJI?

A

haematogenous

43
Q

what signs are present in late PJI?

A

acute or subacute

44
Q

what bacteria is likely to be causing late PJI?

A

staph. aureus

E. coli

45
Q

are coagulase negative staph commensal?

A

yes, part of normal skin flora

46
Q

describe the virulence of coagulase negative staph

A

low virulence

47
Q

do coagulase negative staph create a biofilm

A

yes

48
Q

how is PJI diagnosed?

A

multiple cultures - tissue & bone
blood culture
CRP, WCC etc.
radiological investigations

49
Q

why is PJI often difficult to diagnose?

A

as it’s often caused by organisms that are common contaminants

50
Q

what is the treatment of PJI?

A

Ideally removal of prosthesis & cement.
At least 6 weeks with no joint & on antibiotics.
Then re-implantation of the joint.

51
Q

what is the clinical picture of necrotising fasciitis?

A

Highly painful with some signs of inflammation (pain disproportionate to superficial appearances)
Spread through tissues very rapidly
Systemic toxicity

52
Q

which bacteria is type 1 necrotising fasciitis caused by?

A

anaerobes plus multiple other bacteria “synergistic gangrene”

53
Q

which bacteria is type 2 necrotising fasciitis caused by?

A

“flesh eating bacteria”

group A strep

54
Q

how is necrotising fasciitis diagnosed?

A

swabs & tissue biopsy for microbiology & culture
blood cultures
CRP, FBC, clotting factor, U&Es

55
Q

how is necrotising fascittis treated?

A

surgical debridement

antibiotics

56
Q

which antibiotics would you give for necrotising fasciitis caused by strep pyogenes?

A

penicillin & clinamycin

57
Q

which antibiotics would you give for synergistic necrotising fasciitis?

A

piperacillin-tazobactam
clindamycin
gentamycin

58
Q

which bacteria causes Gas gangrene?

A

clostridium perfringens (part of normal bowel flora)

59
Q

describe the microbiology of clostridium perfringens

A

gram positive strictly anaerobic rods

60
Q

how is gas gangrene spread

A

spores into tissues with germinate and crete an accumulation of gas bubbles in tissues

61
Q

what sign would expect to find on palpation in gas gangrene?

A

crepitus

62
Q

what is the treatment of gas gangrene?

A

urgent debridement in theatre
antibitocs
+/- hyperbaric oxygen

63
Q

what antibiotics are given for gas gangrene?

A

penicillin & metronidazole (either or both)

64
Q

which bacteria causes tetanus?

A

clostridium tetani

65
Q

describe the microbioogy of clostridium tetani

A

gram positve strictly anaerobic rods

66
Q

where are the spores of clostridium tetani found?

A

in soil, gardens, animal bites etc.

67
Q

which toxin is present in tetanus and what does it cause?

A

neurotoxin causes spastic analysis

68
Q

how does neurotoxin cause spastic paralysis?

A

binds to inhibitory neurones, preventing the release of neurotransmitters

69
Q

what is the incubation period of tetanus?

A

4 days - several weeks

70
Q

what symptom is often found in tetatnus?

A

lock jaw due to muscle spasm

71
Q

how is tetanus treated?

A 
surgical debridement 
antitoxin 
supportive measures
antibiotics 
booster vaccination
72
Q

what antibiotics can be used in the treatment of tetanus?

A

penicillin or metronidazole

73
Q

what type of vaccination is the tetanus vaccine?

A

toxoid vaccine

74
Q

which antibiotics can you give for staphs & streps?

A

flucloxacillin (staph. aureus)
vancomycin (if pen. allergic)
clindamycin (antitoxin)

75
Q

which antibiotics can you give for coliforms?

A 
gentamycin 
sometimes ceohalosporins (ceftriaxone) 
sometimes ciprofloxaxin (oral)
76
Q

what physical/chemical environmental factors can increase the risk of infection of implanted devices?

A

low pH
reduced O2
free nucleic acid & other cell products

77
Q

why would you take at least 3 bone samples for culture in PJI?

A

Superficial swabs are a waste of time as they reflect the skin flora rather than deep infection
Bone samples can get contaminated with skin flora in theatre (or in the laboratory)
CoNS are normal part of skin flora

78
Q

is CRP always elevated in infections?

A

no

especially not in chronic infections

79
Q

what can CRP levels be influenced by?

A

underlying diseases

surgery

80
Q

when can you be sure of clinical cure of PJI?

A

until at least 2 years after treatment of PJI

81
Q

what prophylactic antibitotics are give before prosthetic joint or implant surgery?

A

co-amoxiclav 1.2g peri-op & posto-p doses

pen allergy - co-trimoxazole

Musculoskeletal (22 decks)

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