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Host and Defense - Exam 1 > Quiz 3 - Spivak - Bone and Joint > Flashcards

Quiz 3 - Spivak - Bone and Joint Flashcards

1
Q

Osteomyelitis - How is it caused?

A

Result of trauma or surgery

Contiguous spread

Hematogenous - S aureus - thru blood

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2
Q

What happens in osteomyelitis?

A

Inflammatory exudate leads to increased intramedullary pressure and extension to cortex and periosteum

Blood supply interrupted which leads to necrosis - sequestra is separated dead bone

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3
Q

What is the development of osteomyelitis?

A

Initial infection -> Blood supply blocked -> Subperiosteal abscess -> Dead bone -> pus escape

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4
Q

Stage I - Osteomyelitis - ?

Stage II - “ - ?

Stage III - “ - ?

Stage IV - “ - ?

A

I - Medulla of bone

II - Superficial

III - Localized (cortical and medullary bone, but not entire diameter of bone)

IV - Diffuse - Entire bone and loss of stability

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5
Q

Acute vs chronic classification

A

Acute

  • Infection prior to development of sequestra
  • Usually less than 2 weeks

Chronic

  • Infection after sequestra have formed
  • Other hallmarks include formation of involucrum (new bone), bone loss, and sinus tract formation
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6
Q

Clinical presentation of acute osteomyelitis?

A
  • Gradual onset over several days
  • Dull pain/local tenderness
  • Warm, erythemous, swelling, fevers may occur
  • Can present as septic arthritis
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7
Q

Clinical presentation of chronic osteomyelitis?

A
  • Mild pain over several weeks
  • May have localized swelling or erythema
  • Draining sinus tract
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8
Q

Diagnosis of osteomyelitis?

A

Clinical presentation may or may not bacteremia with typical organisms - bone pain with other symptoms

  • Imaging, poorly healing wounds, diabetes mellitus, vascular disease, decubitus ulcers
  • Need an MRI
  • Blood tests
  • Definitive diagnosis based on culture of bacteria from bone biopsy and pathology with inflammation and osteonecrosis
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9
Q

Acute osteomyelitis treatment?

A

3-6 weeks antibiotics may or may not need to debride abscess or due to instability

Difference b/t IV vs. oral antibiotic therapy not well established

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10
Q

Chronic osteomyelitis treatment?

A

3-6 weeks antibiotics, may or may not need surgery, but is common

Greater role for surgery due to necrotic bone and lack of drug penetration to devascularized bone (usually means an amputation)

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11
Q

T/F - Oral antibiotics are acceptable and actually more data in support of them than IV.

A

TRUE

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12
Q

T/F - Better cure rates of osteomyelitis with adjunctive surgical debridement.

A

TRUE

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13
Q

Osteomyelitis of the jaw - tell me about it.

A

Odontogenic infections can spread continuously to the jaw (oral aerobes and anaerobes)

Rare

Mandible more susceptible than maxilla due to thinner cortical plates and poorer vascular supply

What happens? Periosteum penetrated with chronic infection w/ formation of mucosal or cutaneous abscesses and fistulae- lingual aspect of posterior mandible at greatest risk

Risks: Dental infection, fractures, radiation, diabetes mellitus, steroid use

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14
Q

What are some symptoms of osteomyelitis of the jaw?

A

Mandibular pain, anesthesia/ paresthesia on affected side, lymphadenopathy and can progress to trismus

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15
Q

Treatment of osteomyelitis of the jaw?

A

Combo of surgery and antibiotics targeting oral flora

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16
Q

Definitive diagnosis of osteomyelitis of the jaw is helped by what?

A

Medication related osteonecrosis of the jaw

Antiresorptive (bisphosphonates) and antiangiogenic

17
Q

In general, how does hematogenous osteomyelitis come about?

A

Bacteria in blood

Spinal cord injuries

Trauma

Surgery

  • In adults - seen in spine
  • In kids - seen in long bones
18
Q

T/F - Joint replacements (arthroplasty) are highly effective and improve patients’ quality of life, mobility, and independence.

A

TRUE

19
Q

What is the leading cause of arthroplasty failure?

A

Prosthetic joint infections (PJIs) - This leads to more surgery, prolonged antimicrobials - Difficult to treat with failure rates of 10-20%

20
Q

What are some risk factors for PJIs?

A

Surgical site infection not involving joint prosthesis

Prior surgery at site of prosthesis

Extended operative times

Diabetes mellitus, immunosuppression

21
Q

Microbiology of PJIs?

A

65% - Gram + cocci

-Coagulase-negative staph
—Aureus
-Streptococcus species
-Enterococcus species

22
Q

6% of the microbiology of BJIs is from what bugs?

A

Aerobic gram - bacilli

  • Enterobacteriacae
  • Psuedomonas aeruginosa
23
Q

Anaerobes account for what % of osteomyelitis?

A

4%

Propionibacterium species (shoulder arthroplasty)

Peptostreptococcus

Finegoldia magna

24
Q

About _________% of osteomyelitis has been found to be polymicrobial.

A

20

25
Q

How do bugs colonize on a prosthesis?

A

Using a biofilm that allows them to adhere to the surface

26
Q

What is the definition of early PJI?

What are the clinical presentations of early PJI?

A

W/in 1-3 months, acquired during prosthesis implantation, virulent organisms (S aureus, gram negative)

Local erythema
Swelling
Pain
Drainage
Delayed healing
May or may not have a fever
27
Q

What is the definition of delayed PJI?

How is this presented clinically?

A

3 months - 2 yrs
Acquired during prosthesis implantation
Less virulent organisms (CoNS, P acnes)

Chronic pain
Draining sinus

28
Q

What is the definition of late PJI?

How is this presented clinically?

A

> 1-2 yrs
Hematogenous seeding or late manifestation of surgical infection

Chronic pain
Draining sinus or acute septic arthritis with sudden pain (hematogenous)

29
Q

Treatment = ? + ?

A

Treatment = surgery + antimicrobials

30
Q

What are surgical options to cure osteomyelitis?

A 
Debridement and retention
Two stage exchange
One stage exchange
Resection arthroplasty w/ arthrodesis
Amputation
31
Q

T/F - In general, for patients with prosthetic joint implants, prophylactic antibiotics are NOT recommended prior to dental procedures to prevent prosthetic joint infection

A

TRUE

*Randy does this, probably as a CYA.

32
Q

What is the antibiotic therapy associated with debridement and retention?

A

Staph Infection

  • 2-6 wks of IV therapy + rifampin
  • Follow by oral therapy + rifampin (Tetracycline, levofloxacin)
  • Duration (IV + oral): THA - 3 months, TKA - 6 months
33
Q

What is the antibiotic therapy for 1 stage exchange surgery?

A

Staph Infection

  • 2-6 wks of IV therapy + rifampin
  • Follow with oral therapy + rifampin (Tetracycline, levoloxacin)
  • Duration (IV + oral): 3 months
34
Q

What is the antibiotic therapy for 2 stage exchange surgery?

A

4-6 wks IV therapy or highly bioavailable oral therapy

  • Rifampin NOT recommended b/c prosthesis removed
  • Antibiotic-impregnated cement spacer used to maintain limb length (May decrease infection recurrence)
  • Re-implantation (stage 2): 6 wks - 3 months
35
Q

How is osteomyelitis classified?

A

Based on chronicity and whether hematogenous or contiguous

36
Q

Conclusions about bone and joint infections?

A
  • Treatment for bone and joint infection involve antibiotics and surgical debridement
  • NO role for antibiotic prophylaxis prior to dental procedures to prevent orthopedic implant infection in most patients

Host and Defense - Exam 1 (14 decks)

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