Bone and Joint infections - Glew Flashcards

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1
Q

In hematogenous seeding of infection into bone, where does the infection go in:

Children?

Adults?

A

Children - long bones at the metaphyses

Adults - vertebral osteodiscitise

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2
Q

Contiguos inoculation/spread is via?

A

trauma

surgery

vascular insufficiency –> ulcer

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3
Q

What are the most common pathogens in the hematogenous spread of infections to the vertebral column (verterbal osteodiscitis)?

A

S. aureus (skin)

Viridians group Streptococcus (teeth/GI)

GNBs (UTI via Batson plexus)

Pathophysiology - adjeacent vertebrae and intervening discitis

Complications - epideural abscess

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4
Q

What are the clinical symptoms of vertebral osteodiscitis?

How do you diagnose it?

A

Back pain

Redness /swelling

Fever is variable; rare in elderly

Spine tendernes

Dx:

↑C-reactive protein (CRP)
Blood cultures - Increased WBC
Imaging - MRI > CT
IR - needle aspirate/biopsy → cultures

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5
Q

Contiguous spread sources in osteomyelitis and pyarthrosis?

A
  1. Open fracture
  2. Penetrating trauma
  3. Orthopedic surgery
  • Complication of
    • Open Reduction/Internal Fixation
    • Total Joint Prostheses
  1. Diabetes mellitus → ulcer
  2. Decubitus ulcer
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6
Q

Contiguous/traumatic pyarthrosis and osteomyelitis diagnostic features

Clinical

Lab

Imaging

Cultures

A

1.Clinical
Source - trauma, surgery, wound
Pain
Redness/swelling

  1. Lab
    ↑CRP
    ↑WBC

3.Imaging - MRI > CT

4.Cultures
Blood
Bone (surgical biopsy)/Joint fluid (aspirate)

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7
Q

What are the pathogens involved in contiguos/traumatic osteomyelitis/pyarthrosis?

A

Mixed flora:

Staph. aureus
Coagulase-negative Staph.
Streptococcus species
GNBs
Anaerobes

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8
Q

Which pathogens do you get from these methods of infection and their specific treatments

Clenched fist injury/human bite

Animal bites

Foot - puncture wound

A

Clenched fist injury/Human bite
Staph., Strep, anaerobes, Eikenella

Tx: vancomycin plus Carbapenem

Animal bites
Cat - P. multocida
Dog - Pasteurella spp., S. aureus, anaerobes

Tx: Ceftriaxone (plus vancomycin if dog bite)

Foot - puncture wound
Pseudomonas aeruginosa

Tx: Ciprofloxacin if bone divot

Vancomycin if no bone injury

Surgery can also be done with debridement and soft tissue coverage

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9
Q

What antibiotics do you use for:

Staph aureus

Coagulase negative staphylococcus

Streptococcus species

Gram-negative Bacilli

A
  • Staphylococcus aureus
    • MSSA - Cefazolin (or Nafcillin) IV
    • MRSA - Vancomycin IV (or Linezolid or Daptomycin)
  • Coagulase-negative Staphylococcus
    • Vancomycin IV (or Linezolid)
  • Streptococcus species
    • Ceftriaxone IV (or Ampicillin)
  • Gram-negative Bacilli (per susceptibilities)
    • Fluoroquinolone IV/PO (or 3rd Cephalosporin)
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10
Q

What are the two big infectious agents in total joint arthroplasties?

A

Coag-neg Staph

Staph aureus

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11
Q

What are the three options in management of total joint arthroplasty?

A

Two stage removal

Debridment and retention

Resection arthroplasty

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12
Q

What are the total joint arthroplasty infectious agents and what antibiotics would you treat them with?

A

Coagulase-negative Staphylococcus
Vancomycin* (or Linezolid)

Staph. aureus
MSSA - Cefazolin* (or Nafcillin)
MRSA - Vancomycin*
(or Linezolid or Daptomycin)

Streptococcus species
Ceftriaxone (or Ampicillin)

Gram-negative Bacilli
Fluoroquinolone (or 3rd gen Cephalosporin)

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13
Q

There are three categories of hematogenous pyarthosis. What are they and what are the infectious agents?

A

General - S. aureus

Elderly (vertebral) - S. aureus > GNB

Sexually-transmitted disease-related - Neisseria gonorrhea

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14
Q

What is the pathophysiology of pyarthosis

A

The synovium has no basement membrane and is highly vascula - therefore it is easily seeded

PMNs are also present - they release osteolytic enzymes that destroy cartilage and bone

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15
Q

What are the etiologies of pyarthrosis?

A

Pyarthrosis can be bacterial or microcrystalline

BACTERIAL

  • Gonococcal
    • As part of disseminated Gonococcal infection
  • Non-Gonococcal
    • S. aureus/Streptococcus species
  • Lyme Borreliosis
    • Uncommon
    • Chronic
    • Monoarticular - knee
    • With or without antecedent systemic Lyme Disease

MICROCRYSTALLINE
Gout (urate)
Pseudogout (Ca++ pyrophosphate)

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16
Q

What are the non-infectious etiologies of pyarthrosis?

A

REACTIVE POST-INFECTIOUS ARTHRITIS (REITER’S SYNDROME)

Enterititis:

  • Shigella/Salmonella
  • Campylobacter/Yersinia

Urethritis:

  • Chlamydia trachomatis

CONNECTIVE TISSUE DISORDERS
Rheumatoid Arthritis
Juvenile Rheumatoid Arthritis

17
Q

What is Reiter’s syndrome?

A

This is a reactive post infectious arthritis

18
Q

Where can a patient get pyarthrosis from and what infectious agent would it be?

A

BACTEREMIA (normal host/normal joints)

  • Staph. aureus
  • Streptococcus species

INJECTION DRUG USE (including fibrocartilaginous joints)

  • Staph. aureus
  • GNB

SEXUALLY-TRANSMITTED DISEASES

  • N. gonorrhoeae
  • Chlamydia → Reiter’s Syndrome
19
Q

What is the clinical presentation of pyarthrosis?

A
  1. Fever & chills
  2. Malaise
  3. Affected joint
  • Large, weight-bearing
  • Hot
  • Swollen/effusion
  • ↓Mobility
20
Q

What is important in the diagnosis of pyarthrosis

A

Look at the joint aspirate for - PMNs. gram stain/culture, rule out crystals

Blood cultures - although they are positive in less than 50% of cases

21
Q

How do you treat pyarthrosis?

A

Antibiotics

Aspiration

Arthroscopy - debridement, irrigation