Osteomyelitis/Diabetic Foot infections Flashcards
What is osteomyelitis
Inflammation of the bone due to an infection
What are the three types of osteomyelitis, what causes them
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
T/F: Hematogenous osteomyelitis is usually polymicrobial, while osteomyelitis due to contiguous infection or vasucular insufficiency is usually monomicrobial
False: Hemtagounous osteomyeltis is usually monocrobial, while osteomyelitis due to contigous infection or vascular insufficiency is usually polymicrobial
What is the difference between acute osteomyelitis and chronic osteomyelitis
acute osteomyelitis has no bone necrosis while chronic has bone necrosis signifying the infection may have been present for 3 months
What organism is the most common cause of osteomyelitis, what are other organisms that cause osteomyelitis
S. aureus/ Streptococcus spp., gram negative bacilli, P. aeruginosa, anaerobes
When patients have osteomyelitis how long does it take for them to have symptoms that are shown
several days to weeks
What is the gold standard for finding osteomyelitis
Bone biopsy with bacterial growth and histological findings of inflammation and necrosis
How long are patients given antibiotics to treat their osteomyelitis
6 weeks
When would a patient need surgery for their osteomyelitis, why
Chronic osteomyelitis, remove the necrotic tissue and possibly restore blood flow
What is the best way to pick antibiotics to treat osteomyelitis
For stable patients wait for bone biopsy culture and sensitivity results before beginning treatment
T/F: Aminoglycosides should not be used for osteomyeltis
True
What drugs should not be considered switiching to by mouth with good bioavailability
Beta-lactams
Though Linezolid has good bone penetration why is it not first line in treating osteomyelitis
anemia and thrombocytopenia seen with long term use
When would waiting for a bone biopsy not be the best option, what must be covered for, what empiric treatment would be given
If the patient is hemodynamically unstable/ MRSA, streptococci, gram-negative bacilli/ Vancomycin PLUS Cefipme
What is given empirically if the patient has an anaphlactic penicillin alergy
Vancomycin PLUS ciprofloxacin or aztreonam
If the pathogen causing osteomyelitis is MSSA with is the first option, what are the alternative options
Naficillin OR Oxacillin OR Cefazolin/ Vancomycin OR Bactrim PLUS Rifampin
If the pathogen causing osteomyelitis is MRSA and/or coagulase-negative streptococci what are the first line options, what are the alternative options
Vancomycin/ Daptomycin OR Bactrim PLUS Rifampin
What organism does Rifampin have proven success against, when it should be strongly considered
Staphyloccocal, prosthetic joints or is by mouth is required
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
Ceftriaxone OR Penicillin G/ Vancomyin
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
Ceftriaxone or Vancomycin
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
Cefepime OR Ertapenem/ Ciprofloxacin
If the pathogen causing ostemyelitis is the gram negative P. aeruginosa what are the first choice options, alternative options
Cefepime OR Meropenem/ Ciprofloxacin
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
Ciprofloxacin, Ceftriaxone, patients with sickle cell anemia
How do patients get vertebral ostemylelitis, what usually causes it , what are risk factors for getting this type of osteomylelitis
Hematogenous spread (bactermia)/S. aureus/ IVDA, Hemodialysis, and immunocompromised
What are the organisms that are more likely to cause infections due to open fractures
Staphylococcus and Gram negative Bacilli
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
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
How long is osteomyeltis treatment, when would it be longer and what is this new duration
6 weeks, vertebral osteomyelitis AND high risk of recurrence (MRSA infection OR Paravertebral abscess), greater than 8 weeks
What patients are at high risk for diabetic foot infections, what should people with diabetes do for their feet
Patients with neuropathy, peripheral artery disease, impaired immunity, check their feet daily
T/F: Gram postive cocci, particularly Staph are the most common causes of Diabetic foot infections
True
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
Oral, MSSA and Streptococcus, MRSA or P. aeruginosa
What are the MRSA risk factors that would require MRSA coverage for treating diabetic foot infections, P. aeruginosa
Prior history of MRSA infection and High local prevalence of MRSA/High local prevalence of P. aeruginosa and a macerated wound
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
Oral or IV/ MSSA, Streptococcus, Enterobacteriae, anaerobes/ MRSA or P. aeruginosa
If a patient has severe Diabetic foot infection how should the antibiotics be taken, what are the targests
IV/ MRSA, Steptococcus, Enterobacteriae,anaerobes, P. aeruginosa
If a patient has a mild Diabetic foot infection what are the first line choices, covering for MRSA, covering for P. aeruginosa
Cephaxelin OR Augmentin OR Clindamycin/Cephaxelin AND Bactrim/Cephaxelin AND Ciprofloxacin
If a patient has a moderate Diabetic foot infection what are the first line choices, covering for MRSA, covering for P. aeruginosa
Augmentin OR Ampicillin/Sulbactam OR Piperacillin/Tazobactam/ Ampicillin/Sulbactam AND Vancomycin/ Piperacillin/Tazobactam
If a patient has a severe Diabetic foot infection what is the regimen
Vancomycin and Cefepme and Metronidazole
If a culture is taken for a diabetic foot infection which organism do not need to be treated, why
negative staphylococci and enterococci,low virulence and high likelihood of being a contaminate
T/F: If the diabetic foot infection does not have any improvements the therapy should be broadened
True
How long should diabetic foot disease treatment be
Greater than or equal to 6 weeks
