Osteomyelitis/Diabetic Foot infections

Question 1

What is osteomyelitis

Answer 1

Inflammation of the bone due to an infection

Question 2

What are the three types of osteomyelitis, what causes them

Answer 2

Hematogenous Osteomyelitis: bacteria in the blood, Osteomyelitis due to contiguous infection focus: breaks in the bone exposed to bacteria, Osteomyeltitis due to vascular insufficiency: Low blood flow leads to less immune response to wounds

Question 3

T/F: Hematogenous osteomyelitis is usually polymicrobial, while osteomyelitis due to contiguous infection or vasucular insufficiency is usually monomicrobial

Answer 3

False: Hemtagounous osteomyeltis is usually monocrobial, while osteomyelitis due to contigous infection or vascular insufficiency is usually polymicrobial

Question 4

What is the difference between acute osteomyelitis and chronic osteomyelitis

Answer 4

acute osteomyelitis has no bone necrosis while chronic has bone necrosis signifying the infection may have been present for 3 months

Question 5

What organism is the most common cause of osteomyelitis, what are other organisms that cause osteomyelitis

Answer 5

S. aureus/ Streptococcus spp., gram negative bacilli, P. aeruginosa, anaerobes

Question 6

When patients have osteomyelitis how long does it take for them to have symptoms that are shown

Answer 6

several days to weeks

Question 7

What is the gold standard for finding osteomyelitis

Answer 7

Bone biopsy with bacterial growth and histological findings of inflammation and necrosis

Question 8

How long are patients given antibiotics to treat their osteomyelitis

Answer 8

6 weeks

Question 9

When would a patient need surgery for their osteomyelitis, why

Answer 9

Chronic osteomyelitis, remove the necrotic tissue and possibly restore blood flow

Question 10

What is the best way to pick antibiotics to treat osteomyelitis

Answer 10

For stable patients wait for bone biopsy culture and sensitivity results before beginning treatment

Question 11

T/F: Aminoglycosides should not be used for osteomyeltis

Answer 11

True

Question 12

What drugs should not be considered switiching to by mouth with good bioavailability

Answer 12

Beta-lactams

Question 13

Though Linezolid has good bone penetration why is it not first line in treating osteomyelitis

Answer 13

anemia and thrombocytopenia seen with long term use

Question 14

When would waiting for a bone biopsy not be the best option, what must be covered for, what empiric treatment would be given

Answer 14

If the patient is hemodynamically unstable/ MRSA, streptococci, gram-negative bacilli/ Vancomycin PLUS Cefipme

Question 15

What is given empirically if the patient has an anaphlactic penicillin alergy

Answer 15

Vancomycin PLUS ciprofloxacin or aztreonam

Question 16

If the pathogen causing osteomyelitis is MSSA with is the first option, what are the alternative options

Answer 16

Naficillin OR Oxacillin OR Cefazolin/ Vancomycin OR Bactrim PLUS Rifampin

Question 17

If the pathogen causing osteomyelitis is MRSA and/or coagulase-negative streptococci what are the first line options, what are the alternative options

Answer 17

Vancomycin/ Daptomycin OR Bactrim PLUS Rifampin

Question 18

What organism does Rifampin have proven success against, when it should be strongly considered

Answer 18

Staphyloccocal, prosthetic joints or is by mouth is required

Question 19

If the pathogen causing osteomyelitis is stretococcus (S. agalacticae, S. pyrogenes, S. pneumoniae) what is the first line if the patient can take penicllin, alternative options

Answer 19

Ceftriaxone OR Penicillin G/ Vancomyin

Question 20

If the pathogens causing osteomelitis is streptococcus (S. agalacticae, S. pyrogenes, S. pneumoniae) what are the treatment options if the patient has a penicillin allergy

Answer 20

Ceftriaxone or Vancomycin

Question 21

If the pathogens causing osteomyelitis is gram negatives that are enterobacteriacaea (E. coli, K. pneumoniae, enterobacter, Citrabacter) what are the first choice options, alternative options

Answer 21

Cefepime OR Ertapenem/ Ciprofloxacin

Question 22

If the pathogen causing ostemyelitis is the gram negative P. aeruginosa what are the first choice options, alternative options

Answer 22

Cefepime OR Meropenem/ Ciprofloxacin

Question 23

If the pathogen causing osteomyelitis is the gram negative salmonella what are the first choice options, alternative options, in what patient population does Salmonella most likely cause osteomyelitis

Answer 23

Ciprofloxacin, Ceftriaxone, patients with sickle cell anemia

Question 24

How do patients get vertebral ostemylelitis, what usually causes it , what are risk factors for getting this type of osteomylelitis

Answer 24

Hematogenous spread (bactermia)/S. aureus/ IVDA, Hemodialysis, and immunocompromised

Question 25

What are the organisms that are more likely to cause infections due to open fractures

Answer 25

Staphylococcus and Gram negative Bacilli

Question 26

What is the recommendations to reduce the risk of osteomyelitis due to an open fracture, what is the prophylaxis, what antibiotic class should be avoided

Answer 26

Irrigation, debridement, and prophylaxis within 6 hours of open trauma to reduce osteomyelitis risk, Vancomycin PLUS Cefepime for 1-3 days post-trauma, Flouroquinolones=impair fracture healing

Question 27

How long is osteomyeltis treatment, when would it be longer and what is this new duration

Answer 27

6 weeks, vertebral osteomyelitis AND high risk of recurrence (MRSA infection OR Paravertebral abscess), greater than 8 weeks

Question 28

What patients are at high risk for diabetic foot infections, what should people with diabetes do for their feet

Answer 28

Patients with neuropathy, peripheral artery disease, impaired immunity, check their feet daily

Question 29

T/F: Gram postive cocci, particularly Staph are the most common causes of Diabetic foot infections

Answer 29

True

Question 30

If a patient has a mild Diabetic foot infection how should the antibiotics be taken, what are the targets, what organisms will be covered if the patient has certain risk factors

Answer 30

Oral, MSSA and Streptococcus, MRSA or P. aeruginosa

Question 31

What are the MRSA risk factors that would require MRSA coverage for treating diabetic foot infections, P. aeruginosa

Answer 31

Prior history of MRSA infection and High local prevalence of MRSA/High local prevalence of P. aeruginosa and a macerated wound

Question 32

If a patient has a moderate Diabetic foot infection how should the antibiotics be taken, what are the targets, what organisms will be covered if the patient has certain risk factors

Answer 32

Oral or IV/ MSSA, Streptococcus, Enterobacteriae, anaerobes/ MRSA or P. aeruginosa

Question 33

If a patient has severe Diabetic foot infection how should the antibiotics be taken, what are the targests

Answer 33

IV/ MRSA, Steptococcus, Enterobacteriae,anaerobes, P. aeruginosa

Question 34

If a patient has a mild Diabetic foot infection what are the first line choices, covering for MRSA, covering for P. aeruginosa

Answer 34

Cephaxelin OR Augmentin OR Clindamycin/Cephaxelin AND Bactrim/Cephaxelin AND Ciprofloxacin

Question 35

If a patient has a moderate Diabetic foot infection what are the first line choices, covering for MRSA, covering for P. aeruginosa

Answer 35

Augmentin OR Ampicillin/Sulbactam OR Piperacillin/Tazobactam/ Ampicillin/Sulbactam AND Vancomycin/ Piperacillin/Tazobactam

Question 36

If a patient has a severe Diabetic foot infection what is the regimen

Answer 36

Vancomycin and Cefepme and Metronidazole

Question 37

If a culture is taken for a diabetic foot infection which organism do not need to be treated, why

Answer 37

negative staphylococci and enterococci,low virulence and high likelihood of being a contaminate

Question 38

T/F: If the diabetic foot infection does not have any improvements the therapy should be broadened

Answer 38

True

Question 39

How long should diabetic foot disease treatment be

Answer 39

Greater than or equal to 6 weeks