Osteo/Endo/skin i Flashcards
how does acute bacterial endocarditis present?
abrupt lasting a few days/ a week-high fever, rigors, skin lesions, embolic phenomenon
how does subacute bacterial endocarditis present?
insidious lasting weeks to months-fever, sweats, weakness, myalgias, arthralgias, malaise, anorexia, fatigue. Presenting sx may arise from sites other than the heart
presenting signs of IE?
- MURMUR
- mylagia/arthralgia
- splenomegaly
- emboli
- roth spot
how to dx IE?
- 3 blood cultures at diff sites
- CBC, ESR, C-reactive protein, RF
- TEE
duke criteria
2 major (two + cultures, evidence on TEE, new murmur) 3 minor + 1 major 5 minor (temp, predisposing heart disease, embolic disease/hemorrhage, roth spots/janeway lesions, + culture, + echo)
MC organisms for native valve IE
Strep Viridans 35%
Staph Aureus 25%
gram - bacilli (hospital)
MC organism for prosthetic valve
coag - staph
how to tx IE?
- PCN G/Ceftriaxone
- Vancomycin for PCN resistance
- PCN G + gentamycin for native valve uncomplicated IE with susceptible strep viridans
MSSA tx
MRSA tx
nafcillin or oxacillin (add rifampin for prosthetic valve)
vanco (add genta if you cultures don’t confirm)
indications for sx for IE
Moderate to severe heart failure
Vegetations > 1.0 cm that obstruct valves
Perivalvular invasion/abscess formation
Uncontrolled bacteremia despite adequate antibiotics
Fungal endocarditis
Prosthetic Valve Endocarditis (PVE) caused by Staph aureus or other hard to treat bugs
when to use prophylaxis in pts with valvular disease
Dental procedures that involve manipulation of gingival tissue or periapical region of the teeth
Incision or biopsy of the respiratory tract mucosa (bronchoscopy)
Procedures on infected skin or mucous membrane structures
use amox
if pcn allergic, use clinda/azithro/clarithro
organisms involved in osteomyelitis
prosthetic devices-staph epi
heel puncture-pseudomonas
decubitus ulcer-anaerobes
Occurs in older patients with diabetes or vascular impairment
Skin breakdown and foot ulcers develop over weight bearing areas
Osteomyelitis develops by contiguous spread of infection and may lead to gangrene
vascular osteomyelitis
how to dx osteomyelitis
Clinical: fever, localized bone pain, + blood/tissue cultures, ESR, CRP
X-ray: may be normal up to 2 weeks after onset of sx.
Repeat X-ray: Look for tissue swelling, periostial elevation, bone destruction, sequestra (dead bone
osteomyelitis tx
Abx. 6-8 weeks
(pipercillin/tazobactam, ampicillin/sulbactam or ticarcillin/clavulante)
PCN allergic-clinda or metro + cipro or levo
