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Musculoskeletal > Antimicrobial Therapy > Flashcards

Antimicrobial Therapy Flashcards

1
Q

What is the other name for skeletal tuberculosis?

A

Pott’s disease

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2
Q

What is unusual about skeletal tuberculosis?

A

Often has no systemic manifestations and is not infectious

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3
Q

What are some features of skeletal tuberculosis?

A

50% have skin and soft tissue infections, <50% have pulmonary TB, travel history is important, crushes bone and causes wedge-compressions that lead to kyphosis

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4
Q

What should be checked in children when considering skeletal TB?

A

Check reduced receptors for IFN-gamma RI and IL-12 beta 1

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5
Q

What should adults with suspected skeletal TB always be check for?

A

HIV

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6
Q

What are the risk factors for prosthetic limb infections?

A

Obesity, diabetes, malnutrition, rheumatoid arthritis

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7
Q

How can bacteria spread in prosthetic limb infections?

A

Direct inoculation during surgery, limb manipulation during surgery, seeding of joint at later time

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8
Q

What are features of early and late prosthetic limb infections?

A

Early (within a month) = haematoma, wound sepsis

Late (>month) = contamination at time of operation

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9
Q

What type of infections do planktonic bacteria cause?

A

Bacteraemia = presence of bacteria in blood

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10
Q

What are some features of sessile bacteria?

A

Phenotypic transformation of planktonic bacteria, form biofilm, extracellular matrix, need surgical removal

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11
Q

What drug is used to remove biofilms form prosthetic limb infections?

A

Rifampicin

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12
Q

What are some gram positive organisms that can cause prosthetic limb infections?

A

Staph. aureus, staph. epidermidis, Propionibacterium acnes (upper limb), rarely strep. sp and enterococcus sp

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13
Q

What are some gram negative organisms that cause prosthetic joint infections?

A

E.coli, pseudomonas aeruginosa

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14
Q

What are some non-bacterial causes of prosthetic limb infections?

A

Fungi, myobacteria sp

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15
Q

How can prosthetic limb infections be diagnosed?

A

Culture samples taken from perioperative tissue (multiple), blood culture, CRP, radiology (x-rays)

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16
Q

What are some features of staph. epidermidis prosthetic limb infections?

A

Coagulase negative staph, forms slime, treated with vancomycin initially, usually swap to doxycycline or clindamycin orally as out-patient

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17
Q

How should prosthetic limb infections be treated?

A

Remove prosthesis and cement, treat with antibiotics for at least 6 weeks, re-implantation of joint after aggressive antibiotic therapy

18
Q

What are some ways to reduce risk of infection in orthopaedics?

A

Anti-infective implants and cement, antibiotic prophylaxis, laminar flow, hydrogels, surgical aftercare

19
Q

How can bacteria spread in septic arthritis?

A

Direct invasion, haematogenous spread, rarely spread from adjacent osteomyelitis

20
Q

What is septic arthritis?

A

Inflammation of joint space caused by infection

21
Q

What bacteria cause septic arthritis?

A

Staph. aureus (most common), strep, coagulase negative staph. in prosthetics, Neisseria gonorrhoeae in sexually active, h.influenzae in pre-schoolers (rare)

22
Q

What are some features of PVL producing staph. aureus?

A

Both MSSA and MRSA, rare, skin infections, necrotising pneumonia, invasive infections (e.g. septic arthritis)

23
Q

How can PVL producing staph. aureus be treated?

A

Flucloxacillin, clindamycin, linezolid

24
Q

How is septic arthritis diagnosed?

A

Joint fluid for microscopy, culture and sensitivity, blood culture if pyrexial, exclude crystals

25
Q

How is septic arthritis treated?

A

High dose flucloxacillin for staph. aureus, add ceftriaxone in children <5 to cover haemophilis influenzae

26
Q

What are some causes of viral arthritis?

A

Hep B, parovirus B19, rubella, alphavirus = all treated supportively

27
Q

What is pyomyositis?

A

Muscle inflammation with pus

28
Q

What are some causes of bacterial pyomyositis?

A

90% are staph. aureus, some site specific (e.g GNB perineum), treated with surgery
Tropical variant = MSSA (immune competent)
Temperate variant = pseudomonas, beta haemolytic strep, enterococcus (immunosuppressed)
Clostridial infections = contaminated wounds

29
Q

What are some causes of diffuse viral pyomyositis?

A

HIV, HTLV, influenza, CMV, rabies, Chikungunya and other arboviruses (travel history important)

30
Q

What are some features of fungal pyomyositis?

A

Often focal

31
Q

What parasites can cause pyomyositis?

A

Schistosoma, taenia, trichinella, echinococcus (travel history important)

32
Q

What can pyomyositis lead to?

A

Myonecrosis = treated by surgery

33
Q

What bacteria causes tetanus-toxin mediated illness?

A

Clostridium tetani

34
Q

What are some features of clostridium tetani?

A

Gram positive, strictly anaerobic rods, forms spores, found in soil, non-invasive, all toxin related

35
Q

How does clostridium tetani cause illness?

A

Produces neurotoxin = causes spastic paralysis by preventing muscle relaxation

36
Q

What is the incubation period for tetanus?

A

4 days to several weeks

37
Q

What is the classic symptom of tetanus?

A

Lock jaw

38
Q

How is tetanus diagnosed?

A

Culture = difficult, anaerobic gram positive, terminal spore
Serum and urine toxin assays exist

39
Q

How is tetanus treated?

A

Surgical debridement, antitoxin

Antibiotics = 7-10 days, penicillin, metronidazole

40
Q

What are some supportive treatments for tetanus?

A

Early initiation, beta blockers, benzodiazepines for reflex spasms, need some neuromuscular blockade

41
Q

What are some features of the tetanus vaccine?

A

Survivors not immune so need booster vaccination

Routine vaccination = toxoid vaccine (2,3,4 months)

Musculoskeletal (57 decks)

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