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YR3S2- clinical therapeutics > wk 10 - bone and soft tissue infections > Flashcards

wk 10 - bone and soft tissue infections Flashcards

1
Q

erysipelas is

A

bacterial infection of the upper half of dermis

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2
Q

cellulitis is

A

bacterial infection of the lower half of dermis into the subcutaneous fat

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3
Q

if someone has systemic symptoms where should you refer to?

A

emergency department

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4
Q

patient characteristics of cellulitis and erysipelas (differences)
Age
How fast does it progress
Line of demarcation
Organism

A

cellulitis
-occurs in middle age/older
-slowly increases
-line of demarcation ill defined
-organism: strep pyogenes 2/3, staph aureus 1/3

erysipelas
-occurs in children
–rapidly
-clear line of demarcation
-can have vesicles
-organism: strep pyogenes

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5
Q

risk factors of skin infection

A

impaired barrier function
weakened immune system
iV drug use

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6
Q

complications of cellulitis

A

progression to

lymphangitis
abscess formation
gangenous cellulitis
necrotising fascitis
sepsis
death

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7
Q

treatment guidelines for erysipelas without systemic features

A

referral for IV:

  1. phenoxymethylpenicllin
    OR
  2. brocaine benzylpenicillin

if delayed nonserve hypersensitivity
2. cefalexin

if immediate nonsevere/severe or delayed severe
2. clindamycin

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8
Q

signs in cellulitis to be concerned about

A

soft, fluctuant areas - abscess formation

red streak from area of cellulitis or fast spreading of redness

significant pain not aleviating by medications

inability to move joint because of pain

patients with diabetes, cancer, immunosuppressant

systemically unwell

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9
Q

main role of podiatrist in management /prevention of these infections?

A

maintain barrier function of the skin

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10
Q

spetic arthritis organisms involved and how many joints affected?

A

presents usually as single joint infection

organisms:
1. staph aureus or
2. gonorrhoeae (recent STI?)

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11
Q

how to diagnose septic arthritis/investigations

A

joint aspiration for:
- cell count
- crystals
-MC and S

blood culture

radiograph

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12
Q

what monoarthritis presenting condition should be considered in ATSI populations

A

acute rheumatic fever

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13
Q

management of septic arthritis in hospital

A

-drainge of pus and joint irrigation

-synvoectomy to remove pathogens and help with diffusion of antibiotic into joint

-early treat will reduce joint damage

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14
Q

osteomyelitis

A

inflammation/ infection of the bone or bone marrow

organism: staph aureus can also by fungi

red fag: probe to bone in ulcers

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15
Q

signs and symptoms of osteomyelitis (acute v chronic)

A

acute
-pain at site
fevers

chronic
-weight loss
-prolonged systemic signs

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16
Q

radiographic signs of osteomyelitis

A

deep soft tissue swelling

periosteal reaction

cortical irregularity

bone demineralisation

17
Q

how does infection get to bone

A

20% of people dont carry staph aureus

60% are intermittent carriers

20% of people always carry staph aureus (reservoirs) (1/5)

opportunistic infections- typically staph present in nose, is same as skin infection and osteomyelitic infections

18
Q

how does bacteria reach bone?

A
  1. spread via blood (haematogenous)- infection in somewhere else in body
  2. contiguous spread- overlying wound (common in podiatry- ulcers)
  3. direct implantation secondary to trauma or surgery
19
Q

how can staph in the nose get to a distal site ?

A

doesnt have to be through contact but can be via blood

bacteria that cna remain undetected and not raising and inflammatory response can do this

they can also convert to SCV cells to tolerate antimicrobials

20
Q

can staph aureus enter osteophytes?

A

yes as a SCV cell, which acts as a resivoir for pressitent infection. often when the host is compromised is when they revert back to staph aureus

21
Q

if someone is immunocompromised what does that mean for infections

A

they are at high risk and their body is unlikely to provide large signs to show that there is an infection, more discrete signs

22
Q

IV antibiotics is necessary when?

A

adults with two or more of the follow systemic symptoms of infection

-temp more than 38deg or less than 36 deg

-heart rate more than 90bpm

-respiratory rate more than 20 breaths a min

-white cell count more than 12 x 10^9 L or less than 4 x 10^9L

-contact GP and refer to hospital for IV

23
Q

local signs of infection

A

tenderness
warmth
redness - erythema
swelling

probe to bone-osteomyelitis

24
Q

if someone has an infected diabetic foot and youre deciding what antibiotics to use where would you go?

A

IWGDF guidelines

25
Q

process of diabetic foot infection and antibiotic treatment

A

swab and send for MC and S

refer to gp for renal function, BGLs

consider medical history (allergies, drug interactions)

IWGDF guidelines based off degree of infection
-empiracal therapy
-directed therapy

refer to hospital if there is
-systemic signs of infection
-unresolving infection
-osteomyelitis

26
Q

diagnosing osteomyelitis and monitoring

A

probe to bone test

bone biopsy- gold standard but rarely done

radiograph

blood tests
elevated:
-ESR
-CRP
-WCC

culture

monitoring -blood tests and renal function tests

27
Q

IWGDF guidelines on determining if there is an infection

A

needs to have two of the following features

-local swelling/induration
-erythema extending more than 0.5
-local tenderness/pain
-local warmth
-purulent discharge

28
Q

IWDGF gudelines on infection classification (mild, mod, sev)

A

mild- only the skin/subcutaneous tissue
erythema extends no more than 2cm
no systemic features

mod- involves structures deeper than skin/subcutaneous tissue (muscle, bone, tendon, joint) or erythema extends more than 2cm. no systemic features

sev- systemic inflammtory response syndrome

29
Q

how long should antibiotic treatment take for mild/mod infection

A

duration: 1-2 weeks for mild/mod
-infection should be reolsved by this time but not wound

pathology results may change antibiotic treatment

30
Q

key steps to assessing and treating an infection

A
  1. rule out serious pathology
    -refer to hospital if theres signs of
    septic arthritis
    ostoemyleities
    unresolving infection
    severe infection that requires IV
    systemic symptoms (2 or more signs)
  2. is there signs of infection (2 or more)
  3. what degree of infection (mild, mod, sev)- wound?no wound?
  4. TG or IWGDF guidelines for treatment
  5. management
    -swab
    -GP blood tests to diagnose/monitor
    -empiracal treatment based of EBP
    -directed therapy
31
Q

what type of antibiotic for mild, mod,sev dibetic foot infections

A

mild-oral
mod-IV
sev-IV

32
Q

antimicrobial resistance types

A
  1. multi-drug resistant- non susceptible to 1 or more agents in 3 or more categories
  2. extensively drug resistant - non susceptible to 1 agent in all but less than 2 categories
  3. pan-drug ressitant - non susceptible to all approved anti microbial agents (eg pseudomonoas)
33
Q

ways that selective pressure has caused evolution of bacteria

A
  1. indiscriminate use of antibiotics
  2. insufficient dosages
  3. insufficient length of courses
34
Q

other ways resistance has occurred

A
  1. broad spectrum
  2. empiracal treatment without switching to narrow
  3. non compliance
  4. inadequate dosage/length
  5. easy access to prescription
  6. hospital/nursing homes allowing spread
  7. over exposure to antibiotics
  8. animal husbandry- antibiotics on farm animals
35
Q

types of antimicrobial resistance in humans

A
  1. innate - species are naturally resistant
  2. acquired- bacteria that was once sensitive to a drug becomes resistant (gene codes for resistance is transferred from one bacterium to another by mutation or transfer genetic material)
36
Q

mechanisms of antimicrobial resistance

A
  1. enzymes produced by bacteria destroy the drug
  2. bacterial cell walls become impermeable to a drug or rapidly removed
  3. drug binding sites within abcteria become altered
  4. alternative metabolic pathway in bacteria using enzymes not affected by the drug
37
Q
A
38
Q

How long do corticosteroids work for

A

Everyone responds differently but usually around a few weeks to just over a month

39
Q

How do you store corticosteroids in clinic

A

S4 med-
Secure location
Room temperature
Only endorsed prescribers can access location
Documentations for purchasing for 2 years

YR3S2- clinical therapeutics (12 decks)

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