Bone and Joint Infections Flashcards


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1

Hematogenous osteomyelitis:

Infection from the bloodstream

Affects one bone

<16 years old

2

Contiguous osteomyelitis:

SSTI

Affects multiple bones

>50 years old

Fractures, orthopedic procedures

3

Direct Inoculation:

Penetrating wound, open fractures, trauma

4

What is the most common organism in osteomyelitis?

Staph. aureus

5

What labs are associated with osteomyelitis?

Elevated ESR

Elevated CRP

Elevated WBC

6

What is the gold standard test for OM?

MRI

7

VO is a hematogenous osteomyelitis? T/F

True

8

When is VO suspected?

Persistent back pain despite conservative

9

Who is at risk for VO?

IV drug users

Immunocompromised

Elderly

10

VO is monomicrobial? T/F

True- Staph. aureus

11

Treatment for VO should be withheld until diagnostic testing is done? T/F

True

12

When should treatment NOT be withheld in VO?

1. Patients with sepsis

2. Acute neurologic compromise (seizures, altered mental status)

13

Surgery in VO:

Progressive neurologic deficits

Deformity

Spinal instability

14

Surgical debridement in VO:

Persistent/recurrent bloodstream infections

15

Targeted treatment in VO:

Fluoroquinolones

Bactrim

Doxycycline

Linezolid

Flagyl

16

What WBC level in synovial fluid would be indicative of septic/ infectious arthritis?

WBC >200 x 103 cells/mm3

17

Some risk factors for septic/ infectious arthritis?

1. CCS use

2. Arthritis

3. DM

4. Trauma

5. IV drug users

18

Who is most affected by septic/ infectious arthritis?

Children <2 years old

19

Treatment modality for septic/ infectious arthritis?

1. Joint drainage

2. Appropriate antimicrobial (always initiate)

3. Joint rest (avoid weight bearing exercises)

20

Gram + cocci in clusters:

Staphylococcus

Treat with Vancomycin 15 mg/kg IV q 12

21

Gram + cocci in chains:

Streptococci

Treat with Penicillin or Ampicillin

22

Gram - diplococci:

N. Gonorrhea: Have to treat for Gonorrhea and Chlamydia

Ceftriaxone or Cefotamine

+

Azithromycin 1g x 1 dose

23

Therapy without organisms: No MRSA

MSSA Coverage:

Cefazolin 2 g IV q4h

Nafcillin/oxacillin 2 g IV q 8h

24

Therapy without organisms: MRSA/Gram -

Di-therapy: MRSA coverage and gram - ( pseudomonas)

1. Vancomycin 15 mg/kg IV q12

2.

Ceftazidime

Cefepime

Zosyn

25

ADE of Rifampin:

1. CYP INDUCER- decrease concentrations of some medications

2. Transaminitis

3. Body fluid discoloration

26

What is the range of activity of Rifampin?

Staphylococci in all stages of metabolic growth including dormant bacteria and can penetrate biofilm in indwelling devices

27

Dose of Rifampin?

300 mg PO BID x 2-4 weeks

28

Bugs to be expected in adults:

Staphylococcus aureus

Cefazolin

Nafcillin/oxacillin

29

Bugs to be expected in IV drug users:

P. aeruginosa

Ciprofloxacin

Ceftazidime

Cefepime

Zosym

30

Bugs to be expected in post-op and trauma patients:

Gram + and Gram -

Ceftazidime

Cefepime

Zosyn

(no cipro)

31

What modalities will cover anaerobes?

1. Zosyn

or

2. Clindamycin PLUS ceftazidime or cefepime