MSK Microbiology Flashcards
Acute BJI organisms and management
- Staph aureus, Strep
- Empirical Abx: flucloxacillin
Chronic BJI management
- Take samples and only start empirical if SIRS
- Coagulase negative strep
PJI
- Min of 3 bones/tissue/pus samples for culture
- Min 6 weeks Abx before cleaning
Abx in PJI
- Flucloxacillin for gram positive strep
- Vancomycin if allergic
- Co-trimoxazole and Amoxicillin for gram negative strep
PJI: Retention of prothesis (DAIR) antibiotic regime
4 weeks IV + 8 weeks oral
PJI: 1 stage antibiotic regime
4 weeks IV + 8 weeks oral
PJI: 2 stageantibiotic regime
6 weeks IV + 6 weeks oral
PJI: hip and knee antibiotic regime
- Hip 3 months
- Knee 6 months
Early post op (0-3months)
- Route of infection
- Cause
- Perioperative with fever, effusion, warmth and drainage
- Staph aureus, Strep, Enterococci
Delayed post op (3-24months)
- Route of infection
- Cause
- Perioperative with persistent pain, device loosening, fistula
- Coagulase negative staph, p.acnes
Late infection (>24mnths)
- Route of infection
- Cause
- Haematogenous with acute or subacute signs
- Staph aureus or ecoli
Risk factors for PJI
RA, diabetes, obesity, malnutrition
Septic Arthritis
- Route
- Organisms
- Treatment
- Haematogenous or trauma
- MSSA, Strep
- Flucloxacillin for Staph Aureus
- Ceftrixone
Osteomyelitis
- Cause
- Spread
- Inflammation of bone and medullary cavity
- Acute or chronic
- Haematogenous, Continguous, Prosthesis and Peripheral vascular associated
Acute Osteomyelitis
-time frame
Few days-2weeks
Chronic Osteomyelitis
-time frame
- Delay in treating acute infection
- Delay Abx until culture is obtain if no SIRS
- Empiral is flucloxacillin
Necrotising Fasciitis
- Type 1
- Type 2
Type 1: anaerobes and multiple bacteria
Type 2: flesh eating group A strep
Treatment for Necrotising Fasciitis
- Debridement
- Penicillin and Clindamycin
Gas gangrene
- Cause
- Treatment
- Spores into tissue from Clostridium Perfringes
- Spores germinate and accumulation of gas bubble in tissue leads to gas “crepitus”
- Urgent debridement and high dose penicillin and metronidazole
Tetanus
- Intubation period
- Clinical features
- Treatment
- 4 days-several weeks
- Locked jaw, muscle spasm, neurotoxin release
- Surgical debridement, Abx and booster vaccination
