Serious Infections Flashcards
What is osteomyelitis?
Inflammation of the bone and/or bone marrow related to microbial infection
What are the bones often affected by osteomyelitis in pediatric populations?
Femur
Fibula
Radius
Tibia
Is osteomyelitis often acute or chronic?
Acute
Is osteomyelitis typically single or polymicrobial?
Single
Does osteomyelitis typically become a chronic infection?
No
What are the classifications of osteomyelitis
Acute
Subacute
Chronic
What is acute osteomyelitis?
1-2 weeks after exposure
Mostly children
What is subacute osteomyelitis?
Few weeks to < 1 month
Mostly adults
What is chronic osteomyelitis?
> 1 month
Mostly adults
Leads to necrosis
What is hematogenous spread of infection?
Via blood stream
What group of patients is hematogenous spread most common?
Pediatric patients
Rich supply of blood and vasculature
What is continguous spread of infection?
Direct inocculation (stepping on a nail) Through close proximity of soft tissue
What does the presence of organisms in the venous sinusoids recruit?
Inflammatory mediators
Phagocytic cells
Toxins
What do the presence of prostaglandins in osteomyolitis cause?
Bone destruction
Decreases organism load to cause infection
What happens when an organisms sets into the bone?
Microabscess
Localized inflammation
What are the steps for osteomyeltis infections?
Reactive bone formed around infection site
Inflamed membrane (periosteum) lifts from bone
Organism enters subperiosteal space
More abscesses form
Abscesses independent of blood supply
Process continues traversing the bone to adjacent growth plates and epiphysis
What is the most common organism in osteomyelitis?
S aureus
What are the most common organisms in a neonate (<1 month)?
S aureus
GBS
G-enteric organisms
Candida
What are the most common organisms in 1 month to 5 year olds?
S aureus
S pyogenes
S pneumoniae
Kingella kingae
What are the most common organisms in > 5 year olds?
S aureus
S pyogenes
What are the s/sx of a local infection in osteomyelitis?
Inflammation Pain Pseudoparalysis Refusal to bear weight Swelling
What are the s/sx of a systemic infection in osteomyelitis?
Fever
Irritability
Lethargy
What are the lab markers in osteomyelitis?
Elevated WBC
Increased ESR
Increased CRP
Bacterial growth in obtained cultures
What is the presentation of the osteomyelitis?
Pain and tenderness
What are options for radiographical exams in osteomyelitis?
MRI is best for bone infections
CT detects soft tissue inflammation
Bone scan shows bone inflammation (source undeterminable)
What is the typical duration of treatment for osteomyelitis?
4-6 weeks
When can IV abx be d/c’d in osteomyelitis?
Decreasing inflammatory markers
Improving PE
Normalizing Temp
What is the empiric therapy for patients with osteomyelitis that are > 5 years of age w/ RFs?
Antistaphylococcal agent AND 3rd generation ceph
What are the empiric therapies for patients with osteomyelitis that are > 5 years of age w/o RFs?
IV penicillinase-resistant PCN (Nafcillin, oxacillin)
1st gen ceph (cefazolin)
Vanc
Clinda
What is the dosing for vanc in patients with osteomyelitis?
60mg/kg/d
Divided into 3 or 4 doses
What are the goal troughs for vancomycin?
10-20
Mild: 10-15
Severe: 15-20
When should clindamycin not be used in osteomyelitis?
> 10% resistance in general
> 15% resistance to clinda
What is the dosing strategy for clinda in osteomyelitis?
40mg/kg/d
12.5 mg/kg/dose q8h
10 mg/kg/dose q6h
What are RF that change the empiric abx choice?
Immunocompromised
Sickle cell
What is the empiric therapy for neonates and infants?
Antistaphylococcal
3rd gen ceph OR AG
What are RFs for CAP?
Age under 5 years
H/o wheezing
AOM before age 2 years
Recurrent UTI
What are the common organisms for CAP in < 3 weeks old?
E coli
GBS
Listeria
H flu
What are the common organisms for CAP in 3wks-3months of age?
Viruses
Chlamydia trachomatis
S pneumo
H flu
What are the common organisms for CAP in 4 months-4 years of age?
Viruses
Chlamydia pneumo
Mycoplasma pneumo
S pneumo pneumo
What are the common organisms for CAP in >/= 5 years of age?
Chlamydia pneumo
Mycoplasma pneumo
S pneumo
What are viruses that can cause CAP?
Adenovirus Coronavirus Human bocavirus Influenza A and B Parainfluenza Rhinoviruses
What are the presentations for CAP?
Cough Crackles Difficulty breathing Fever Grunting Retractions Tachypnea Wheezing
What are the ages and ranges for tachypnea?
2-12 months > 50 bpm
1-5 years > 40 bpm
> 6 years > 20 bpm
What is the gold standard for diagnosing CAP?
Infiltration on chest radiograph
What is used for diagnosis of CAP?
Infiltration on chest radiograph Lab markers (WBC, CRP)
What patients with CAP require inpatient treatment?
Age under 6 months Dehydrated Patients not tolerating oral liquids Patient w/highly virulent organisms Patients w/persistent hypoxia Patients w/respiratory distress Patients w/unreliable caregivers
What are the treatment options for CAP?
3rd gen ceph Amox (HD) Amp and Gent (Not ceftriaxone under 30 days) Azith Clinda Doxy FQ Oseltamivir Vanc
