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2MBChB Musculoskeletal > Microbiology > Flashcards

Microbiology Flashcards

1
Q

What is the treatment for a Staphylococcus epidermidis infection?

A

Vancomycin.

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2
Q

What is the treatment for a Staphylococcus aureus infection?

A

Flucloxacillin.

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3
Q

What is the treatment for an infection of gram-negative microorganisms?

A

Doxycycline/clindamycin.

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4
Q

What is osteomyelitis?

A

Inflammation of bone and medullary cavity, usually located in one of the long bones.

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5
Q

How is osteomyelitis in patients classified?

A

By time - acute/chronic.

By spread - contiguous/haematogenous.

Host status - presence of vascular insufficiency, host susceptibility.

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6
Q

What is contiguous spread of an organism?

A

Spread is from a site adjacent to where you think the infection started e.g. diabetic with superficial ulcer and the infection from the ulcer spreads down into the bone.

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7
Q

What is haematogenous spread of an organism?

A

Secondary spread of infection from blood to the bone.

E.g. drugs user gets a bacteraemia and the infection spreads to the bone from elsewhere in the body from the primary infection site.

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8
Q

How can you get indirect and direct confirmation of infection in the bone?

A

Indirect - scan.

Direct - sample from the bone itself.

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9
Q

What is the best clinical indicator that there may be osteomyelitis from an open wound?

A

If you can see tendon/bone or you can probe the bone the open wound.

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10
Q

When is osteomyelitis a medical emergency?

A

If there is sepsis or the patient is clinically unstable.

You also give antimicrobials before culturing if it is a soft tissue infection.

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11
Q

What is the treatment plan for osteomyelitis?

A

No empiric antibiotics (guessing what the infection is and prescribing antibiotics without confirmed cultures).

Culture the bone first, await results and prescribe based on those results.

Acute/chronic osteomyelitis is not a medical emergency.

AND surgical debridement of pus, dead bone.

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12
Q

Why should a patient have 6 weeks of antibiotic therapy for osteomyelitis?

A

It takes 6 weeks for debrided bone to be covered by vascularised soft tissue.

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13
Q

When is coagulase negative staphylococcus (staph. epidermidis) likely to cause infection in the body?

A

If there are metal or plastic prosthesis surgically implanted into the body.

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14
Q

What spread is likely to cause vertebral osteomyelitis?

A

Haematogenous.

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15
Q

How best should you culture for osteomyelitis?

A

Percutaneous aspirate or deep surgical cultures, NOT swabbing top of a sinus.

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16
Q

Who is likely to get osteomyelitis?

A

Open fractures.

Diabetes/vascular insufficiency.

Haematogenous osteomyelitis.

Vertebral osteomyelitis (specific case of haematogenous spread).

Prosthetic joint infection.

Specific hosts and pathogens.

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17
Q

What is the clinical clue that someone has developed osteomyelitis following an open fracture?

A

Non-union and poor wound healing.

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18
Q

What microorganism tends to be causative in open fracture osteomyelitis?

A

Staph. aureus.

Gram-negative bacteria.

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19
Q

What microorganism tends to be causative in diabetic/vascular insufficiency osteomyelitis?

A

Polymicrobial (often staph. aureus).

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20
Q

What is the rule of thumb for when it is likely to get infection from an open wound?

A

If you have a wound >2cm for >2 months, then it is at high risk of infection.

21
Q

If there is osteomyelitis following a diabetic foot ulcer, what is the best treatment?

A

Flucloxacillin (staph. aureus and stept. cover).

Gentamicin (gram-negative cover).

Metronidazole (anaerobic cover).

22
Q

How long would you prescribe antibiotics for a skin and soft tissue infection?

A

7 days.

23
Q

How long would you prescribe antibiotics for a bacteraemia?

A

14 days by IV.

24
Q

How long would you prescribe antibiotics for osteomyelitis?

A

6 weeks.

25
Q

When is oral vancomycin only ever given?

A

To treat C. difficile because orally it is not absorbed by the gut so it becomes a topical treatment in the gut.

26
Q

How long would you prescribe antibiotics for endocarditis?

A

6 weeks IV therapy.

27
Q

Which bacteria when cultured should never be ignored?

A

Staph. aureus.

Group A, B, C, or G strept.

Milleri group.

Anaerobes.

28
Q

Which patients are likely to get haematogenous osteomyelitis?

A

Prepubertal children.

People who inject drugs.

Central lines/dialysis/elderly.

29
Q

When treating osteomyelitis when is day 1 of treatment?

A

The first day you get negative cultures for the organism you are treating for.

30
Q

What organisms can cause osteomyelitis in people who inject drugs?

A

Staphylococcus.

Streptococci.

Pseudomonas.

Candida.

Eikenella corrodens (needle lickers).

Mycobacterium tuberculosis.

31
Q

Which organisms can cause osteomyelitis in dialysis patients?

A

Staphylococcus aureus.

Aerobic gram negatives.

32
Q

Which organisms are likely causative in sickle cell osteomyelitis?

A

Salmonella.

Staphylococcus aureus.

33
Q

What is synovitis acne pustulosis hyperostosis osteitis (SAPHO)?

A

Chronic lytic lesions that when seen on MRI look like osteomyelitis.

Raised inflammatory markers.

Antibiotic and non-antibiotic treatments.

34
Q

What is chronic recurrent multifocal osteomyelitis (CRMO)?

A

Chronic lytic lesions that when seen on MRI look like osteomyelitis.

Raised inflammatory markers.

Antibiotic and non-antibiotic treatments.

35
Q

What abscesses may be associated with vertebral osteomyelitis?

A

Epidural abscess.

Psoas abscess.

36
Q

What conditions are risk factors of infection in prosthetic joints?

A

Rheumatoid arthritis.

Diabetes.

Malnutrition.

Obesity.

37
Q

What is dehiscing of a wound?

A

The wound doesn’t heal properly, instead, there are little punctures of pus seeping from it

38
Q

What type of infection do planktonic bacteria cause?

A

Bacteraemia.

39
Q

What type of infection do sessile bacteria cause?

A

Bacteria form a layer really close to prosthetic material that grows very slowly forming an extracellular matrix of biofilm meaning it can’t be targeted well by antibiotics.

40
Q

What bacteria may cause infection following a shoulder replacement?

A

Propionibacterium acnes.

41
Q

What is the best treatment for infection following a prosthetic joint replacement?

A

Ideally, remove prosthesis and cement.

Antimicrobial therapy for at least 6 weeks.

Re-implantation of the joint after aggressive antibiotic therapy.

42
Q

What is septic arthritis?

A

Inflammation of the joint space caused by infection.

Can be from blood-borne organisms, an extension of local infection (e.g. complication of infection in adjacent bone), or introduced by direct inoculation (e.g. following injection of joint or trauma).

43
Q

What can be the bacterial causes of septic arthritis?

A

Staph. aureus.

Stept.

Coagulase-negative staph.

Neisseria gonorrheae (sexually active, not common).

Haemophilus influenzae (pre-school, not common).

44
Q

What are the symptoms of PVL producing staph. aureus?

A

Skin infections.

Necrotising pneumonia.

Invasive infections, e.g. bacteraemia, septic arthritis.

45
Q

What is the treatment for PVL producing staph. aureus?

A

Flucloxacillin, clindamycin, linezolid, depending on sensitivities.

46
Q

What is pyomyositis?

A

Bacterial infection of the skeletal muscles resulting in pus-filled abscesses.

47
Q

Which patients are more at risk of pyomyositis?

A

Immunocompromised patients.

48
Q

What is the treatment of tetanus infection?

A

Surgical debridement.

Antitoxin.

Supportive measures (early intubation, beta blockers, avoid light, benzodiazepines for reflex spasms).

Antibiotics 7-10 days.

Booster vaccination (toxoid).

Survivors are not immune.

2MBChB Musculoskeletal (17 decks)

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