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Therapeutics V > Bone and Joint Infections > Flashcards

Bone and Joint Infections Flashcards

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1
Q

What are the types of bone and joint infections?

A

-Osteomyelitis
-Septic arthritis
-Prosthetic joint infection

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2
Q

What is osteomyelitis?

A

Infection of the bone causing inflammation of the bone marrow and surrounding bone

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3
Q

What is septic arthritis?

A

Inflammatory reaction within the joint tissue and fluid due to a microorganism

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4
Q

What is prosthetic joint infection?

A

Infection of a prosthetic joint and joint fluid

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5
Q

How is a culture taken for osteomyelitis?

A

Bone sample/biopsy, commonly obtained via surgical intervention

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6
Q

How is culture taken for septic arthritis and prosthetic joint infection?

A

Joint aspiration with examination of synovial fluid to establish diagnosis and/or surgical intervention

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7
Q

What pathogen is most common in bone and joint infections?

A

Staph aureus

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8
Q

Why is antibiotic therapy more intense in bone and joint infections?

A

Antibiotic penetration into infected bone and joints is typically low

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9
Q

How long is treatment for osteomyelitis?

A

4-8 weeks

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10
Q

How long is treatment for septic arthritis?

A

2-4 weeks

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11
Q

How long is treatment for prosthetic joint infection?

A

6-12+ weeks

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12
Q

What are some key considerations when selecting antibiotic therapy for a patient?

A

-Will the patient need long-term IV access for antibiotic therapy?
-If IV antibiotic therapy is selected, where will the patient receive it?
-If oral antibiotic therapy is selected, will the patient adhere to the regimen if it requires multiple antibiotics and doses per day?
-Does the patient have insurance coverage/ability to pay for the treatment plan?

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13
Q

What are the three main sections of the bone?

A

-Epiphysis
-Metaphysis
-Diaphysis

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14
Q

What are the three main pathways in which osteomyelitis develops?

A

-Hematogenous spread
-Contiguous spread
-Vascular insufficiency

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15
Q

How does a microbe cause osteomyelitis through hematogenous spread?

A

Microbe reaches bone via bloodstream

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16
Q

How does a microbe cause osteomyelitis through contiguous spread?

A

-Microbe reaches bone from soft tissue infection or direct inoculation
-Commonly polymicrobial

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17
Q

How does a microbe cause osteomyelitis through vascular insufficiency?

A

-Microbe reaches bone from soft tissue infection
-Commonly polymicrobial

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18
Q

What are risk factors for vascular insufficiency?

A

-Diabetes
-Peripheral vascular disease

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19
Q

What is the most common type of osteomyelitis in adults?

A

Vertebral

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20
Q

Which predisposing factors can result in a pseudomonal infection?

A

-Post-surgical
-Penetrating trauma

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21
Q

Acute symptoms of osteomyelitis

A

-Fever
-Localized pain/tenderness/swelling
-Decreased range of motion

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22
Q

Chronic symptoms of osteomyelitis

A

-Pain
-Drainage/sinus tract
-Decreased range of motion

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23
Q

Laboratory findings consistent with osteomyelitis

A

Elevated WBC count, ESR, CRP

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24
Q

What diagnostic tests would you do for osteomyelitis?

A

-X-ray
-CT or MRI
-Nuclear bone scan

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25
What are the two approaches to treatment of osteomyelitis?
-Surgical intervention -Antibiotic therapy
26
When can you hold antibiotic therapy in osteomyelitis?
While awaiting biopsy/surgical intervention if patient is clinically stable
27
What are the empiric options for osteomyelitis?
-Cefazolin -Ceftriaxone -Cefepime -Zosyn -Unasyn -Meropenem -Cipro -Levo
28
What medications would you use to cover MRSA in osteomyelitis?
-Vanco -Dapto -Linezolid
29
What medication would you use if you need to cover anaerobes in osteomyelitis?
Metronidazole
30
When would you cover for MRSA?
Pretty much all the time since everywhere has a MRSA prevalence above 20%
31
What is the treatment duration for vertebral osteomyelitis due to MRSA?
8 weeks
32
What is the treatment duration for diabetic foot infection osteomyelitis where there is a complete resection of all infected bone/tissue?
2-5 days
33
What is the treatment duration for diabetic foot infection osteomyelitis where there is a complete resection of all infected osteomyelitis but soft tissue infection remains?
1-2 weeks
34
What is the treatment duration for diabetic foot infection osteomyelitis where there is a resection performed, but osteomyelitis remains?
3 weeks
35
Can oral antibiotics be used to treat osteomyelitis?
Yes, they were proven to be non-inferior but they must be highly bioavailable for bone and joint infections
36
Which highly bioavailable oral antibiotics can be used for streptococci?
-Amoxicillin -Cephalexin -Clindamycin (if susceptible) -May add rifampin
37
Which highly bioavailable oral antibiotics can be used for MSSA?
-Dicloxacillin -Cephalexin -Cefadroxil -Bactrim -Linezolid -May add rifampin
38
Which highly bioavailable oral antibiotics can be used for MRSA?
-Linezolid -Bactrim -Clindamycin (if susceptible) -May add rifampin
39
Which highly bioavailable oral antibiotics can be used for GNRs?
-Bactrim -FQs -May add rifampin
40
What is the half-life of dalbavancin?
346 hours, so only two doses need to be taken
41
What are the three pathways to develop septic arthritis?
-Hematogenous -Direct inoculation -Contiguous
42
Risk factors for septic arthritis
-Joint disease -Advanced age -Chronic disease -Sexually transmitted infection -Immunosuppression -Trauma -Prosthetic joint -IV drug use -Endocarditis
43
Most common pathogens for septic arthritis
Staph aureus
44
What is the most common pathogens for septic arthritis in sexually active adults?
Neisseria gonorrhoeae
45
Signs and symptoms of septic arthritis
-Joint pain -Decreased range of motion -Swelling -Erythema -Warmth -Fever -Chills -Monoarticular in the majority of cases
46
What are the cases in which septic arthritis can be polyarticular?
-Rheumatoid arthritis -Immunosuppression -Prolonged bacteremia
47
What laboratory findings are important when diagnosing septic arthritis?
-Increased WBC count -ESR -CRP
48
What is an arthrocentesis used to find in septic arthritis?
-Polymorphonuclear neutrophil (PMN) count greater than 50,000 -Gram stain and culture
49
What radiologic tests are done in septic arthritis?
-X-ray -CT -MRI
50
What antibiotics are chosen for septic arthritis?
Same as osteomyelitis, acceptable to use narrowest possible agent
51
Staph. Aureus, GNR treatment duration in septic arthritis
4 weeks
52
Streptococci treatment duration in septic arthritis
2 weeks
53
N. gonorrhoeae treatment duration in septic arthritis
7-10 days
54
What are the three pathways to develop prosthetic joint infection?
-Hematogenous -Direct inoculation -Contiguous
55
Most common pathogen in prosthetic joint infections
Staph. aureus
56
Why are prosthetic joint infections difficult to treat?
They involve the development of biofilm which impedes antibiotic penetration
57
Signs and symptoms of a prosthetic joint infection
-Joint pain -Decreased range of motion -Swelling -Erythema -Warmth -Fever -Chills -Sinus tract or persistent wound drainage over joint prosthesis -Loosening of prosthesis -Review history of prosthesis
58
What laboratory findings are important when diagnosing a prosthetic joint infection
-Increased WBC count -ESR -CRP
59
What is an arthrocentesis used to find in a prosthetic joint infection?
-Cell count/differential -Gram stain -Culture
60
What radiologic tests would you use for a prosthetic joint infection?
X-ray
61
What are the two approaches to treatment of prosthetic joint infection?
-Surgical intervention -Antibiotic therapy
62
What are the primary types of surgical intervention for a prosthetic joint infection?
-Debridement and retention of prosthesis -1-stage exchange (taking joint out and putting a new one in) -2-stage exchange (implanting a prosthetic spacer while on antibiotic therapy before putting in the new joint)
63
What is the empiric antibiotic selection for prosthetic joint infection
Same as osetomyeltitis
64
Why do you withhold antimicrobial therapy in stable patients with a prosthetic joint infection?
Increases chances of isolating an organism from culture
65
When is rifampin added to antimicrobial therapy in the treatment of a prosthetic joint infection?
Retention of prosthesis or a one stage exchange
66
How do you treat a patient with a prosthetic joint infection who retained prosthesis?
-Pathogen directed treatment + rifampin for 2-6 weeks -Oral antibiotic treatment + rifampin for 3 months (hip) or 6 months (knee or other joint) -May consider long-term antibiotic suppression after completion of treatment
67
How do you treat a patient with a prosthetic joint infection who got a 1-stage exchange?
-Pathogen directed treatment + rifampin for 2-6 weeks -Oral antibiotic treatment + rifampin for 3 months
68
How do you treat a patient with a prosthetic joint infection who got a 2-stage exchange?
Pathogen directed treatment for 4-6 weeks
69
How do you treat a patient with a prosthetic joint infection who got a 1-stage exchange?
Pathogen directed treatment for 24-48 hours

Therapeutics V (52 decks)

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