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Microbiology Flashcards

1
Q

what are some risk factors of bone and joint infections?

A

Implants
Immunosuppression
Diabetes
IVDUs

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2
Q

Why is it important to look for other sites of infection?

A

It can be easy to mistake the pain of bone infection for something else. E.g. a patient presenting with back pain who is also bacteraemic may have a discitis but can also be endocarditis.

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3
Q

What are common organisms causing prosthetic joint infection?

A

S. aureus
Coagulase negative Staph
Proprionobacterium acnes

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4
Q

Septic arthritis is caused by streptococci but not staph. aureus. -true/false

A

False - both staph aureus and streptococci can cause septic arthritis

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5
Q

Vertebral osteomyelitis is a common presentation of infection with S. aureus, coliforms, strep spp and mycobacterium tuberculosis - true/false

A

True

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6
Q

What are the most likely causative organisms of diabetic foot infection?

A

S. Aureus, streptococcus spp. Coliforms, pseudomonas and anaerobes

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7
Q

Streptococcus pyogenes is the most common causative organism of all bone and joint infections - true/false

A

False - S. aureus is the most common.

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8
Q

Three most common organisms to cause bone and joint infections are…

A

Staph aureus, streptococci and coliforms

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9
Q

it is very common for MRSA to infect bones and joint - true/false

A

False - it is rare

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10
Q

PVL producing staph often/rarely infect bones and joints

A

Rarely

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11
Q

In prostethic joints it is very common/uncommon to get a staphylococcus and propionibacterium infection.

A

Common

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12
Q

Typical symptoms of bone infection include

A 
temperature
Systemic signs
Pain/swelling
Redness over the pain area
Reduced mobility of the joint.
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13
Q

Give four symptoms that children may elicit if they have a bone/joint infection

A

Listlessness
Not feeding
Not playing
Very cranky

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14
Q

What is SIRS?

A

Temp >38 or 90
Resp rate >20 or paCO2 less than 4.3kPa
WBC >12,000 or

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15
Q

What is the difference between SIRS and sepsis, severe sepsis and septic shock?

A

sepsis must have signs of SIRS and a suspected or proven infection, severe sepsis must have SIRS + suspected or proven infection + SBP

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16
Q

What is septic arthritis?

A

Septic arthritis is an infection of the joint space

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17
Q

There are two ways organisms may be introduced in septic arthritis; haematogenous spread and direct inoculation - true/false

A

False - three ways
haematogenous spread
Contiguous spread
direct inoculation

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18
Q

MRSA is more common in septic arthritis than MSSA - true/false

A

False - MSSA is more common than MRSA

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19
Q

What are the common causes of septic arthritis?

A

MSSA and streptococcus

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20
Q

What are the less common causes of septic arthritis?

A

Haemophilus influenza

Neisseria gonorrhoea

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21
Q

Describe the sepsis 6 protocol

A

“Take 3 give 3”
Take - blood cultures, blood for FBCs and lactate, measure urine output
Give - fluids, antibiotics and oxygen

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22
Q

In septic arthritis, you should always take blood cultures regardless of whether the patient is pyrexic or not - true/false

A

False - only take bloods if there are clinical evidence (pyrexia) of infection

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23
Q

You should carry out a number of blood tests including…?

A

CRP, FBC, U&Es, Lactate and ESR

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24
Q

A patient has suspected septic arthritis and you decide to ask the orthopaedic registrar to consider doing a joint fluid aspirate or washout for testing. What are you looking for in the lab?

A

Carry out a culture to test for microbes.
Under microscopy you are looking for needle shaped uric acid crystals indicating gout or rhomboid shaped calcium pyrophosphate crystals indicating pseudo gout.

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25
Empirical treatment for septic arthritis is targeted at streptococci because it is the most likely causative organism - true/false
False - targeted at staphylococcus aureus because it is the most likely causative organism
26
What is the antibiotic used empirically for septic arthritis?
High dose, IV Flucloxacillin
27
Why is high dose flucloxacillin given intravenously?
it is poorly tolerated/poorly absorbed
28
Why should a patient under 5 with septic arthritis be given a second antibiotic? What should they be given?
they have a higher risk of kingella or H. Influenza infection. Ceftriaxone covers gram negative organisms
29
Osteomyelitis is inflammation of the cortical bone usually in flat bones
False - inflammation of the medullary cavity usually in long bones and vertebrae
30
Acute osteomyelitis is caused by MRSA often/rarely
Rarely
31
Acute osteomyelitis is caused by MSSA often/rarely
Often
32
Chronic osteomyelitis is caused by MTB often/rarely
Often
33
Chronic osteomyelitis is caused by pseudomonas often/rarely
often
34
Chronic osteomyelitis is caused by Salmonella, brucella and coliforms often/rarely
Often
35
Osteomyelitis spreads by contiguous spread but not by haematogenous spread - true/false
False - spreads by both
36
osteomyelitis is often associated with peripheral vascular disease and prosthesis - true/false
True
37
What is the time frame for acute osteomyelitis?
few days to less than 2 weeks
38
Contiguous spread is more likely than haematogenous spread in osteomyelitis - true/false
true
39
Why is infection likely to spread to the joint in osteomyelitis?
The metaphysis is intracapsular.
40
SIRS is often present in osteomyelitis and rapid, empirical antibiotic therapy is warranted - true/false
False - SIRS is usually absent and in the absence of SIRS there is no need for treatment before tests come back unless the clinical picture deteriorates.
41
If SIRS is present in osteomyelitis, what is the empirical treatment
High dose IV flucloxacillin
42
What are the risk factors for a prosthetic joint infection?
``` prosthesis diabetes obesity rheumatoid, malnutrition ```
43
What is the timeframe and route for an early postop prosthetic infection?
0-3months | Perioperative
44
What is the timeframe and route for a delayed postop prosthetic infection?
3-24months | perioperative
45
What is the timeframe and route for a late postop prosthetic infection
>24months - haematogenous spread
46
What are the three most likely causes of an early post op prosthetic infection?
S. Aureus, streps and enterococci
47
What are the two most likely causes of a delayed post op prosthetic infection?
CoNS | P. acnes
48
What are the two most likely causes of a late post op prosthetic infection?
S. Aureus | E. Coli
49
Coagulase negative staphylococci are not a normal part of the skin flora - true/false
False
50
Antibiotics in bone infection should be low dose, long term and bacteriostatic - true/false
False - high dose, long term and bactericidal
51
For staphs and streps you should give erythromycin - true/false
False - flucloxacillin
52
Vancomycin can be used to cover diphtheroids, CoNS and MRSA or if the person is pen allergic - true/false
True
53
What antibiotic would you give for anti-toxin properties?
Clindamycin
54
Which antibiotic should be given for PVL? Gentamicin or clindamycin?
Clindamycin
55
Gentamicin can be ___toxic and ____toxic
Ototoxic and nephrotoxic
56
Ciprofloxacin can be exceptionally useful in ________ ________ infections.
Pseudomonas aeruginosa
57
Ciprofloxacin must be used very carefully as it can precipitate ______ _____ ______
Clostridium Difficile infection
58
What is biofilm?
A slow growing bacterial colony covered in a slime
59
What is the problem with biofilm?
The slime protects the bacteria from the immune system and the antibiotics
60
How does biofilm protect bacteria?
it protects them by lowering pH to 5, reducing oxygen and freeing nucleic acids and other cell products.
61
In chronic infections SIRS is very common/uncommon
Uncommon
62
In the absence of SIRS, immediate antibiotic therapy is not warranted and you should wait until the specimen for culture has been obtained - true/false
true
63
Give the two types of surgery for prosthetic joint infections
1 stage - remove prosthesis, clean out the joint, give antibiotic cement and place new prosthesis in 2 - stage - remove prosthesis, clean it out, 6-8 weeks of antibiotics, replace the joint.
64
What are the advantages and disadvantages of one stage surgery for PJIs
Patient only has to be put under once and has a shorter hospital stay/recovery time There is a higher risk of recontamination of the prosthesis
65
What are the advantages and disadvantages of two stage surgery for PJIs
less likely to be contaminated again longer recovery time patient has to have two surgeries

MSK (7 decks)

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