Other Soft tissue infections

Question 1

Define Pyomyositis?

Answer 1

Infection deep in the striated muscle, often as an abscess.

Its often 2* to another infection

Question 2

What causes pyomyositis?

Answer 2

Mostly Staph Aureus

Other bacteria, TB an fungi can cause it.

Question 3

What factors can predispose you to pyomyositis?

Answer 3

Any immunocompromising disease:

• HIV
• Malignancy
• DM
• Liver Cirrhosis
• IVDA

As well as Rheumatological Disease

Question 4

How does Pyomyositis present?

Answer 4

Fever, Pain and a woody induration of the muscle

Eventually septicaemia and shock

Question 5

How do you test for pyomyositis?

Answer 5

If you get a patient with fever, pain in muscles and stiffening of muscles think infection.
Do a CT or MRI looking for muscle loss & abscesses as well as culture/gram staining for systemic infection

Question 6

How do you treat pyomyositis?

Answer 6

Drain the abscess and give Abx

Question 7

What is Septic Bursitis?

Answer 7

Infection of the cavities within synovial joints, mostly patellar or elbow joints
Often 2* to an adjacent skin infection

Question 8

What causes septic bursitis?

Answer 8

Staph Aureus

Question 9

What are the risk factors for septic bursitis?

Answer 9

Immunosuppression
DM
IVDA

Renal Disease
Alcoholism
Rheumatoid Arthritis

Question 10

How does Septic Bursitis present?

Answer 10

Cellulitis, infection of adjacent deep dermis & subcutaneous fat.

Swelling & Warmth

Fever

Pain in the joint on movement

Question 11

How do we test for septic bursitis?

Answer 11

Aspirate the synovial fluid for culture

Most are treated empirically with Abx

Question 12

Define Infectious Tenosynovitis?

Answer 12

An infection of synovial sheats around tendons, generally in the flexor muscles and the hands

Question 13

What causes infectious tenosynovitis?

Answer 13

Staph Aureus & Streptococci

A chronic infection can be due to mycobacteria or fungi

Question 14

How is Infectious Tenosynovitis spread?

Answer 14

Penetrating trauma

Question 15

How would Infectious Tenosynovitis present?

Answer 15

Mostly in the hands:

• Semiflexed position
• Erythematous Fusiform swelling (of a finger)
• Tender tendon
• Pain on extension

Question 16

How do we treat Infectious Tenosynovitis?

Answer 16

Empirical Abx and a surgical review in case it requires surgical cleaning/removal of tissue

Question 17

Whats the main organism behind IV catheter infections>

Answer 17

Staph Aureus

Question 18

How does an IV catheter infection progress, tested for and treated?

Answer 18

Local SSTI -> Cellulitis -> Necrosis

It can seed into other areas e.g. endocarditis or osteomyelitis

Test with a blood culture after clinical diagnosis

Treat with 14 days Abx course + remove the cannula, express any pus and do an echo for endocarditis

Question 19

How do we prevent IV catheter infections?

Answer 19

Remove unused catheters, otherwise change them every 72 hours.

Monitor patients for thrombophlebitis indicative of SSTI

USe aspetic method when isnerting the canula

Question 20

What are the main organisms behind Surgical Site Infections?

Answer 20

Staph Aureus
E. Coli
Pseudomonas Aeruginosa

Question 21

describe the classes of surgical site infections?

Answer 21

Class 1 = a clean wound that ets infected

Class 2 = Clean-contaminated wound (i.e. minor break in the surgical technique)

Class 3 = Contaminated wound (often a traumatic wound)

Class 4 = A dirty or infected wound of tissue that’s necrotic or devilatised

Question 22

What factors predispose you to surgical site infections?

Answer 22

DM
Smoking
Obesity
Malnutrition
Steroids
Staph Aureus Colonisation

Question 23

How do you manage a surgical site infection?

Answer 23

Culture from the site + Abx

Question 24

What procedural factors can predispose you to a surgical site infection?

Answer 24

• shaving a surgical site
• improper skin prep
• break in sterile technique
• inadequate theatre ventilation
• peri-operative hypoxia