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MSK > Microbiology > Flashcards

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
Q

Empirical treatment for septic arthritis is targeted at streptococci because it is the most likely causative organism - true/false

A

False - targeted at staphylococcus aureus because it is the most likely causative organism

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26
Q

What is the antibiotic used empirically for septic arthritis?

A

High dose, IV Flucloxacillin

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27
Q

Why is high dose flucloxacillin given intravenously?

A

it is poorly tolerated/poorly absorbed

28
Q

Why should a patient under 5 with septic arthritis be given a second antibiotic? What should they be given?

A

they have a higher risk of kingella or H. Influenza infection. Ceftriaxone covers gram negative organisms

29
Q

Osteomyelitis is inflammation of the cortical bone usually in flat bones

A

False - inflammation of the medullary cavity usually in long bones and vertebrae

30
Q

Acute osteomyelitis is caused by MRSA often/rarely

A

Rarely

31
Q

Acute osteomyelitis is caused by MSSA often/rarely

A

Often

32
Q

Chronic osteomyelitis is caused by MTB often/rarely

A

Often

33
Q

Chronic osteomyelitis is caused by pseudomonas often/rarely

A

often

34
Q

Chronic osteomyelitis is caused by Salmonella, brucella and coliforms often/rarely

A

Often

35
Q

Osteomyelitis spreads by contiguous spread but not by haematogenous spread - true/false

A

False - spreads by both

36
Q

osteomyelitis is often associated with peripheral vascular disease and prosthesis - true/false

A

True

37
Q

What is the time frame for acute osteomyelitis?

A

few days to less than 2 weeks

38
Q

Contiguous spread is more likely than haematogenous spread in osteomyelitis - true/false

A

true

39
Q

Why is infection likely to spread to the joint in osteomyelitis?

A

The metaphysis is intracapsular.

40
Q

SIRS is often present in osteomyelitis and rapid, empirical antibiotic therapy is warranted - true/false

A

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
Q

If SIRS is present in osteomyelitis, what is the empirical treatment

A

High dose IV flucloxacillin

42
Q

What are the risk factors for a prosthetic joint infection?

A 
prosthesis
diabetes
obesity
rheumatoid, 
malnutrition
43
Q

What is the timeframe and route for an early postop prosthetic infection?

A

0-3months

Perioperative

44
Q

What is the timeframe and route for a delayed postop prosthetic infection?

A

3-24months

perioperative

45
Q

What is the timeframe and route for a late postop prosthetic infection

A

> 24months - haematogenous spread

46
Q

What are the three most likely causes of an early post op prosthetic infection?

A

S. Aureus, streps and enterococci

47
Q

What are the two most likely causes of a delayed post op prosthetic infection?

A

CoNS

P. acnes

48
Q

What are the two most likely causes of a late post op prosthetic infection?

A

S. Aureus

E. Coli

49
Q

Coagulase negative staphylococci are not a normal part of the skin flora - true/false

A

False

50
Q

Antibiotics in bone infection should be low dose, long term and bacteriostatic - true/false

A

False - high dose, long term and bactericidal

51
Q

For staphs and streps you should give erythromycin - true/false

A

False - flucloxacillin

52
Q

Vancomycin can be used to cover diphtheroids, CoNS and MRSA or if the person is pen allergic - true/false

A

True

53
Q

What antibiotic would you give for anti-toxin properties?

A

Clindamycin

54
Q

Which antibiotic should be given for PVL? Gentamicin or clindamycin?

A

Clindamycin

55
Q

Gentamicin can be ___toxic and ____toxic

A

Ototoxic and nephrotoxic

56
Q

Ciprofloxacin can be exceptionally useful in ________ ________ infections.

A

Pseudomonas aeruginosa

57
Q

Ciprofloxacin must be used very carefully as it can precipitate ______ _____ ______

A

Clostridium Difficile infection

58
Q

What is biofilm?

A

A slow growing bacterial colony covered in a slime

59
Q

What is the problem with biofilm?

A

The slime protects the bacteria from the immune system and the antibiotics

60
Q

How does biofilm protect bacteria?

A

it protects them by lowering pH to 5, reducing oxygen and freeing nucleic acids and other cell products.

61
Q

In chronic infections SIRS is very common/uncommon

A

Uncommon

62
Q

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

A

true

63
Q

Give the two types of surgery for prosthetic joint infections

A

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
Q

What are the advantages and disadvantages of one stage surgery for PJIs

A

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
Q

What are the advantages and disadvantages of two stage surgery for PJIs

A

less likely to be contaminated again
longer recovery time
patient has to have two surgeries

MSK (7 decks)

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