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Clinical Pathology > Bone and Joint Infections > Flashcards

Bone and Joint Infections Flashcards

1
Q

Osteomyelitis

A

Infection of the bone

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2
Q

3 mechanisms of how bone infection may be brought about

A

Haematogenous- bacteria in the blood seed bone
Contiguous focus-spread from adjacent area of infection
Direct incoculation-trauma or surgery

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3
Q

Stage 1 of osteomyelitis and likely cause

A

Medullary-necrosis of medullary contents- haematogenous

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4
Q

Stage 2 of osteomyelitis

A

Superficial-necrosis limited to exposed surfaces

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5
Q

Cause of stage 2 superficial osteomyelitis

A

Contiguous- Diabetic foot ulcer, pressure sores

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6
Q

Complications of stage 3

A

Necrosis- no blood supply- can’t treat with antibiotics. Surgery required to cure

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7
Q

Stage 3 osteomyelitis

A

Localised- full thickness cortical sequestation, stable before and after debridement

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8
Q

Stage 4 osteomyelitis

A

Diffuse- extensive, unstable bone

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9
Q

describe the pain with osteomyelitis

A

localised pain, not relieved with resting and progressive

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10
Q

Clinical presentation of osteomyelitis

A 
Pain
Soft tissue swelling
Erythema
Warmth
Localised tenderness
Reduced movement of affected limb
Systemic upset uncommon (fever, chills, night sweats)
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11
Q

Most common causative organism of osteomyelitis (60%)

A

Staph A

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12
Q

6 main causative organisms of osteomyelitis

A 
Staph A
Stretococci
Enterococci
Gram -ve bacilli
Anaerobes
M. TB
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13
Q

Gold standard diagnostic procedure for osteomyelitis

A

Cultures and histology of bone biopsy/needle aspirate

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14
Q

Name 4 diagnostic tests for osteomyelitis

A

Gold standard
Blood cultures
Superficial swabs
C-reactive protein

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15
Q

When would you give empirical antimicrobial therapy in osteomyelitis?

A

When signs of sepsis

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16
Q

Which 5 antibiotics have acceptable penetrance in bone?

A 
Clindamycin
Ciprofloxacin
Vancomycin
Beta-Lactam
Gentamicin
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17
Q

What is the treatment of choice for Staph A. osteomyelitis

A

Flucloxacillin IV

18
Q

How are antibiotics usually administered in osteomyelitis?

A

IV

19
Q

Septic arthritis

A

Inflammatory reaction in joint space (arthritis) caused by infection, resulting from direct invasion of the joint

20
Q

2 classifications of septic arthritis

A

Native (natural) joint infection

Prosthetic (artificial) joint infection

21
Q

2 ways in which organisms enter the joint in native joint infection

A

Haematogenous or trauma

22
Q

How does synovial tissue facilitate ‘seeding’?

A

Highly vascular and lacks a basement membrane

23
Q

Predisposing factors for native joint infection

A

RA
Trauma
IVDU
Immunosuppressive disease

24
Q

Prognosis for native joint infection

A

Not fatal but severe lack of function if not treated

25
Q

How do organisms enter the joint in prosthetic joint infections?

A

Haematogenous

During surgery or following wound infection after surgery

26
Q

Why are prosthetic joints susceptible to infection?

A

Cement provides a surface for bacterial attachment

27
Q

How does infection affect the joint in prosthetic infection?

A

Polymorph infiltration results in tissue damage instability of the prosthesis

28
Q

How does infection affect the joint in native infection?

A

Cartilage erosion causes joint space narrowing/impaired function

29
Q

Predisposing factors to prosthetic joint infection

A 
Prior surgery at site
RB
Corticosteroid therapy
DM
Poor nutritional status
Obestiy
Age
30
Q

Clincial presentation of septic arthritis

A 
Pain
Swelling
Tenderness
Redness
Limitation of movement
Systemic upset
31
Q

Causative organisms of septic arthritis

A

Bacteria
Fungi e.g. candida
Viruses e.g. parovirus B19, rubella, mumps (usually self limiting part of systemic illness)

32
Q

Name for group A streptococcus

A

Strep. pyogenes

33
Q

Causative organisms for native joint infections

A 
Staph A
Streptococci A, B, C, G
Gram -ve bacilli
Neisseria gonorrheoae
Neisseria meningitidis
34
Q

Causative organisms for prosthetic joint infection

A

Staph A
Coagulase -ve staphylocoi
Enterococci
Gram -ve bacilli

35
Q

What do you look for in an examination of joint aspirate?

A 
High total WBCs
Lots of polymorphs
Gram stain- not particularly reliable
Crystal examination- gout can mimic infection
Culture
PCR e.g. M.TB
36
Q

Therapy for native joint infection

A

Removal of purulent material -joint drainage/washout
Empirical followed by directed antimicrobial therapy (after microbiological samples have been taken)
2-4 weeks treatment

37
Q

Difference in therapy for prosthetic joint infection, compared to native

A

Removal of implant/replacement of some elements if unstable

38
Q

2 stage revision procedure

A

Take out implant and replace with cement and antimicrobials before replacing

39
Q

Treatment for Staph A in prosthetic joint infection

A

Flucoxacillin with rifampicin (Staph A. easily becomes resistant to rifampicin, so must always be used in combination for Staph A)

40
Q

Duration of treatment for prosthetic joint infection

A

6 weeks, IV to oral switch

Clinical Pathology (53 decks)

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