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Pediatrics > Serious Infections > Flashcards

Serious Infections Flashcards

1
Q

What is osteomyelitis?

A

Inflammation of the bone and/or bone marrow related to microbial infection

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2
Q

What are the bones often affected by osteomyelitis in pediatric populations?

A

Femur
Fibula
Radius
Tibia

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3
Q

Is osteomyelitis often acute or chronic?

A

Acute

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4
Q

Is osteomyelitis typically single or polymicrobial?

A

Single

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5
Q

Does osteomyelitis typically become a chronic infection?

A

No

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6
Q

What are the classifications of osteomyelitis

A

Acute
Subacute
Chronic

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7
Q

What is acute osteomyelitis?

A

1-2 weeks after exposure

Mostly children

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8
Q

What is subacute osteomyelitis?

A

Few weeks to < 1 month

Mostly adults

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9
Q

What is chronic osteomyelitis?

A

> 1 month
Mostly adults
Leads to necrosis

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10
Q

What is hematogenous spread of infection?

A

Via blood stream

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11
Q

What group of patients is hematogenous spread most common?

A

Pediatric patients

Rich supply of blood and vasculature

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12
Q

What is continguous spread of infection?

A 
Direct inocculation (stepping on a nail)
Through close proximity of soft tissue
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13
Q

What does the presence of organisms in the venous sinusoids recruit?

A

Inflammatory mediators
Phagocytic cells
Toxins

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14
Q

What do the presence of prostaglandins in osteomyolitis cause?

A

Bone destruction

Decreases organism load to cause infection

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15
Q

What happens when an organisms sets into the bone?

A

Microabscess

Localized inflammation

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16
Q

What are the steps for osteomyeltis infections?

A

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

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17
Q

What is the most common organism in osteomyelitis?

A

S aureus

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18
Q

What are the most common organisms in a neonate (<1 month)?

A

S aureus
GBS
G-enteric organisms
Candida

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19
Q

What are the most common organisms in 1 month to 5 year olds?

A

S aureus
S pyogenes
S pneumoniae
Kingella kingae

20
Q

What are the most common organisms in > 5 year olds?

A

S aureus

S pyogenes

21
Q

What are the s/sx of a local infection in osteomyelitis?

A 
Inflammation
Pain
Pseudoparalysis
Refusal to bear weight
Swelling
22
Q

What are the s/sx of a systemic infection in osteomyelitis?

A

Fever
Irritability
Lethargy

23
Q

What are the lab markers in osteomyelitis?

A

Elevated WBC
Increased ESR
Increased CRP
Bacterial growth in obtained cultures

24
Q

What is the presentation of the osteomyelitis?

A

Pain and tenderness

25
Q

What are options for radiographical exams in osteomyelitis?

A

MRI is best for bone infections
CT detects soft tissue inflammation
Bone scan shows bone inflammation (source undeterminable)

26
Q

What is the typical duration of treatment for osteomyelitis?

A

4-6 weeks

27
Q

When can IV abx be d/c’d in osteomyelitis?

A

Decreasing inflammatory markers
Improving PE
Normalizing Temp

28
Q

What is the empiric therapy for patients with osteomyelitis that are > 5 years of age w/ RFs?

A

Antistaphylococcal agent AND 3rd generation ceph

29
Q

What are the empiric therapies for patients with osteomyelitis that are > 5 years of age w/o RFs?

A

IV penicillinase-resistant PCN (Nafcillin, oxacillin)
1st gen ceph (cefazolin)
Vanc
Clinda

30
Q

What is the dosing for vanc in patients with osteomyelitis?

A

60mg/kg/d

Divided into 3 or 4 doses

31
Q

What are the goal troughs for vancomycin?

A

10-20
Mild: 10-15
Severe: 15-20

32
Q

When should clindamycin not be used in osteomyelitis?

A

> 10% resistance in general

> 15% resistance to clinda

33
Q

What is the dosing strategy for clinda in osteomyelitis?

A

40mg/kg/d
12.5 mg/kg/dose q8h
10 mg/kg/dose q6h

34
Q

What are RF that change the empiric abx choice?

A

Immunocompromised

Sickle cell

35
Q

What is the empiric therapy for neonates and infants?

A

Antistaphylococcal

3rd gen ceph OR AG

36
Q

What are RFs for CAP?

A

Age under 5 years
H/o wheezing
AOM before age 2 years
Recurrent UTI

37
Q

What are the common organisms for CAP in < 3 weeks old?

A

E coli
GBS
Listeria
H flu

38
Q

What are the common organisms for CAP in 3wks-3months of age?

A

Viruses
Chlamydia trachomatis
S pneumo
H flu

39
Q

What are the common organisms for CAP in 4 months-4 years of age?

A

Viruses
Chlamydia pneumo
Mycoplasma pneumo
S pneumo pneumo

40
Q

What are the common organisms for CAP in >/= 5 years of age?

A

Chlamydia pneumo
Mycoplasma pneumo
S pneumo

41
Q

What are viruses that can cause CAP?

A 
Adenovirus
Coronavirus
Human bocavirus
Influenza A and B
Parainfluenza
Rhinoviruses
42
Q

What are the presentations for CAP?

A 
Cough
Crackles
Difficulty breathing
Fever
Grunting
Retractions
Tachypnea
Wheezing
43
Q

What are the ages and ranges for tachypnea?

A

2-12 months > 50 bpm
1-5 years > 40 bpm
> 6 years > 20 bpm

44
Q

What is the gold standard for diagnosing CAP?

A

Infiltration on chest radiograph

45
Q

What is used for diagnosis of CAP?

A 
Infiltration on chest radiograph
Lab markers (WBC, CRP)
46
Q

What patients with CAP require inpatient treatment?

A 
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
47
Q

What are the treatment options for CAP?

A 
3rd gen ceph
Amox (HD)
Amp and Gent (Not ceftriaxone under 30 days)
Azith
Clinda 
Doxy
FQ
Oseltamivir
Vanc

Pediatrics (9 decks)

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