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Clinical Microbiology > Bone and Joint Infections > Flashcards

Bone and Joint Infections Flashcards

1
Q

What is arthroplasty?

A

Putting in an artificial joint

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2
Q

What is resection arthroplasty?

A

Taking a disease joint out and replacing this with an artificial joint

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3
Q

What is a revision arthroplasty?

A

Re-operating on an artificial joint

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4
Q

What is arthrodesis?

A

Fusing two bones together

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5
Q

What is pseudo-arthrosis?

A

Allowing two bones to articulate against one another but without a joint

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6
Q

Septic arthritis is a medical emergency. T/F?

A

True

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7
Q

Why should septic arthritis be treated as a medical emergency?

A

Untreated joint infection can result in loss of cartilage leading to OA in later life and can cause severe sepsis

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8
Q

How does septic arthritis present?

A

Fever, single hot joint (commonly knee or hip), loss of movement, pain

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9
Q

What investigations should be done in septic arthritis?

A

Blood cultures, joint aspirate, FBC, CRP, imaging

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10
Q

What pathogens commonly cause septic arthritis?

A

S.aureus (MSSA, MRSA)

Streptococci (S.pyogenes)

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11
Q

What pathogens are less common causes of septic arthritis?

A 
H.influenzzae
Kingella
N.meningitidis
N.gonorrhoeae
E.coli
P.auruginosa
Salmonella species
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12
Q

What is the minimum length of time that septic arthritis should be treated with IV antibiotics?

A

2 weeks

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13
Q

What are the risk factors for the development of prosthetic joint infections in primary arthroplasty?

A 
RA
Diabetes
Obesity
Poor nutritional status
Concurrent UTI
Steroids
Malignancy
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14
Q

What are the risk factors for the development of prosthetic joint infections in revision arthroplasty?

A

Prolonged operating room time

Pre-op infection (teeth, skin, UTI)

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15
Q

Local spread is more common than haematogenous spread for prosthetic joint infections. T/F?

A

True

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16
Q

Which organisms causing prosthetic joint infections commonly spread locally?

A

Organisms from the skin surface

17
Q

When does prosthetic joint infection which has local spread usually manifest?

A

Immediate post-op period

18
Q

Why does a prosthesis require fewer bacteria to establish sepsis than in soft tissue?

A

Avascular surface allows survival of bacteria as it protects bacteria from circulating and immunological defences and most antibiotics
Cement can inhibit phagocytosis and lymphocyte/complement function

19
Q

What is the presentation of a prosthetic joint infection?

A 
Pain
Effusion
Warm joint
Fever
Systemic symptoms
Loosening of joint on X-Ray
Discharging sinus
Mechanical dysfunction
20
Q

Which antibiotic is given as prophylaxis to prevent prosthetic joint infection?

A

Cephalosporin

21
Q

How long before skin incision should cephalosporin be given to prevent prosthetic joint infection?

A

30-60 minutes

22
Q

Explain the DAIR method of treating prosthesis infection?

A

Debride, antibiotics, implant retained
Can be used if prosthesis infection is acute <30 days since insertion, is still mechanical function
Joint washed out to reduce burden of infection, then IV antibiotics started for 4-6 weeks

23
Q

When would an infected prosthetic joint need to be removed?

A

If infection occurs >30 days after surgery

24
Q

What procedures can be used to remove/replace an infected prosthetic joint?

A

Girdlestone procedure
One stage revision
Two stage revision

25
Q

Why do the chances of success and cure of infection reduce with each revision surgery to replace am infected prosthetic joint?

A

Anatomical distortion

Infection becomes harder to suppress

26
Q

What samples are preferred over a surface swab when trying to culture the causative organism of a prosthetic joint infection?

A

Tissue
Pus
Fluid

27
Q

Combination therapies including which antibiotic have the greatest success of treating prosthetic joint infection?

A

Rifampicin

28
Q

Antibiotics should be started pre-operatively when treating a patient with prosthetic joint infection. T/F?

A

False - unless the patient has life-threatening infection

29
Q

What is osteomyelitis?

A

Progressive infection of the bone characterised by the death of the bone and the formation fo sequestra

30
Q

Osteomyelitis can spread via contiguous spread due to…?

A

Overlyign infection e.g. cellulitis ulcer
Trauma
Surgical inoculation

31
Q

Acute osteomyelitis is more common in which age group?

A

Children

32
Q

Anaerobes can cause osteomyelitis. T/F?

A

True

33
Q

How is osteomyelitis treated?

A

Surgery to debulk the infection back to health bone and manage the dead space that remains with muscle flaps
Infected fractures stabilised
Sinuses derided
IV antibiotics 4-6 weeks

34
Q

What tissue does diabetic foot infection normally affect?

A

Bone but can also involve the joints

35
Q

What is vertebral discitis?

A

Infected of a disc space and the adjacent vertebral end plates

36
Q

What are the possible complications of vertebral discitis?

A

Cord compression
Paraplegia
Disability

37
Q

What are the possible causes of vertebral discitis?

A

Septic arthritis
Osteomyelitis
Tuberculosis infection

Clinical Microbiology (17 decks)

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