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PT2 ID 1-6 > bone, joint, MRSA, and more therapeutics > Flashcards

bone, joint, MRSA, and more therapeutics Flashcards

(65 cards)

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1
Q

how does osteomyelitis develop

A
  • in epiphysis of bones blood flow is slow allowing bacteria to accumulate
  • multiplication leads to increased bone pressure and eventually necrosis of bone
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2
Q

types of osteomyelitis

A
  • hematogenous
  • contiguous spread
  • contiguous w/ vascular insufficiency
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3
Q

hematogenous osteomyelitis age range

A

-ages 1-20; >50

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4
Q

hematogenous osteomyelitis location

A

long bones

vertebrae

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5
Q

hematogenous osteomyelitis symptoms

A 
fever
tenderness
swelling
reduced ROM
drainage
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6
Q

hematogenous osteomyelitis source

A 
pharyngitis
lacerations
cellulitis
sickle cell
respiratory infections
IV catheters
hemodialysis
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7
Q

hematogenous osteomyelitis most common pathogen

A

Staph aureus

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8
Q

contiguous spread osteomyelitis age range

A

> 50

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9
Q

contiguous spread osteomyelitis location

A

femur
tibia
skull
mandible

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10
Q

contiguous spread osteomyelitis symptoms

A 
fever
erythema
swelling
sinus tracts
drainage
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11
Q

contiguous spread osteomyelitis source

A
  • penetrating trauma
  • open reductions of fractures
  • gunshot wounds
  • orthopedic procedures
  • animal bites
  • puncture wounds
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12
Q

contiguous spread osteomyelitis pathogens

A
  • mostly Staph aureas
  • proteus
  • pseudomonas
  • anaerboes
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13
Q

contiguous w/ vascular insufficiency age range

A

> 50

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14
Q

contiguous w/ vascular insufficiency location

A

feet

toes

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15
Q

contiguous w/ vascular insufficiency symptoms

A 
pain
swelling
erythema
ulcerations
drainage
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16
Q

contiguous w/ vascular insufficiency source

A
  • DM
  • peripheral vascular disease
  • bed sores
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17
Q

contiguous w/ vascular insufficiency pathogens

A

mixed infections of:

  • S.aureus
  • proteus
  • pseudomonas
  • GNB anaerobes
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18
Q

types of cultures for identifying osteomyelitis infections

A
  • blood
  • wound swab
  • bone aspirate
  • bone biopsy
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19
Q

preferred culture technique

A

bone biopsy

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20
Q

why are wound cultures not very effective

A

high amounts of S.aureus on skin can contaminate the sample very easily

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21
Q

most common pathogens in osteomyelitis

A
  • s.aureus

- coagulase-negative staph

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22
Q

occasionally seen pathogens in osteomyelitis

A

strep
enterococci
pseudomonas
GNB

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23
Q

when can x-ray detect osteomyelitis

A

at least 50% of matrix is damaged, usually 10-14 days after illness starts

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24
Q

when to use bone scans

A

when x-ray is not helpful

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25
labs to get in osteomyelitis
- WBC w/ diff - CBC - ESR - CRP - MRSA nasal screen
26
lab indicators that infection is healing
decreasing ESR and CRP
27
what to do before selecting most appropriate antibiotic for osteomyelitis
- bone biopsy - culture - determine if its acute or chronic
28
treatment plan for chronic osteomyelitis
at least 6 weeks of IV antibiotics; may extend w/ oral therapy for 2-4 more weeks
29
empiric therapy of hematogenous osteomyelitis
- if possible wait for blood/bone cultures - if MRSA use vanco + Ceftriaxone/cefepime/levofloxacin - if no MRSA use cetriaxone, cefepime, or levofloxacin
30
D-test
- used to detect possible MRSA - uses erythromycin and clindamycin discs - flattened growth area near clindamycin disc looks like a D indicating resistance
31
gene that may be present in MRSA that induces glindamycin resistance
erm gene (macrolide resistance)
32
risk factors for MRSA
- IV drug abuse - serious underlying illness - previous antibiotics - previous hospitalization, hemodialysis - emerging in community
33
treatment options for MRSA
- TMP/SMZ, 1 po bid - doxycycline or minocycline 100 mg bid - IV vancomycin, daptomycine, linezolid, ceftaroline
34
empiric strategy for contiguous osteomyelitis without vascular insufficiency
- get blood and bone culture - IV vanco + cefepime/ceftriazoxone/Amp-sulbactam - adjust regimen once culture results known
35
empiric strategy for contiguous osteomyelitis with vascular insufficiency
- debride ulcers - get bone culture - IV vanco + cefepime/ceftriaxone/pip-tazo/amp-sulbactam/ertapenem
36
specific antibiotics for osteomyelitis from S.aureus after blood culture is back
``` nafcillin cefazoline clindamycin vancomycin (MRSA) linezolid (refractory MRSA) ```
37
antibiotics for pseudomonas
ceftazidime cefepime pip-tazo cipro
38
most common bacteria to cause osteomyelitis from IV drug use
- S.aureus | - P.aeruginosa
39
treatment for osteomyelitis after a trauma
- vanco IV + ceftriaxone/ceftazidime/cefepime/amp-sulbactam | - linezolid IV + ceftazidime/cefepime
40
antibiotics for osteomyelitis in patients with peripheral vascular disease
Vanco IV + - amp/sulbactam - pip/tazo - ertapenem
41
PO therapy for pseudomonas
ciprofloxacin
42
when to add PO rifampin
when bone penetration is critical and when an infected prosthetic device is present
43
PO drugs for s.aureus
``` dicloxacillin clindamycin tmp/smz levofloxacin linezolid ```
44
PO drugs for mixed culture
tmp/smuz | ciprofloxacin
45
PO drugs for anerobes
clindamycin | metronidazole
46
signs of septic arthritis
- erythema - warm to touch - pain - possible cellulitis - difficulty with ambulation
47
it is important to rule out when when checking for septic arthritis
gout
48
baseline labs for septic arthritis
``` ESR CRP CBC w/ diff BMP joint fluid analysis ```
49
most common bacteria in septic arthritis
- s.aureus - N.gonorrhoeae (75% of sexually active) - streptococcus
50
empiric strategy for treating septic arthritis
``` vanco with or without -ceftriazxone -ciprofloxacin -levofloxacin for 2-4 weeks ```
51
most common pathogens in prosthetic joint infections
- coagulase negative Staph | - staph aureus
52
biofilm
.commonly found on foreign material in prosthetics such as screws -makes it difficult for antibiotics to kill bacteria
53
clinical presentations of PJI
- acute joint pain, erythema, warthm | - eventually implant loosening, persistent joint pain
54
baseline labs for PJI
``` ESR CRP CBC w/ diff BMP joint aspirate *avoid antibiotics if possible before surgery* ```
55
one stage revision in PJI
- remove old hardware and replace with new HW during same surgery OR space w/ Abx implant - treat with IV abx for 6 weeks
56
two stage exchange in PJI
- complete one stage, if ESR ,30 and CRP <1 during wek 5 and 6 stop abx - begin 6 weeks of abx free - if no new infection occurs and ESR.CRP remain at goal then implant new joint
57
antibiotics for MRSA in knee joints in debridement and retention
rifampin + - levofloxacin - doxycycline - minocycline - tmp/smz DS
58
drug of choice for anaerobes
metronidazole
59
pathogenesis of MRSA infections
- colonization can be latent for months-years | - transmission is person to person
60
core prevention strategies for MRSA
- hand hygiene - contact precautions - recognize previously colonized pts. - rapidly reporting MRSA lab results - MRSA education
61
bacteria that requires soap and water to remove
C.diff
62
contact precautions to prevent MRSA
- use gown and gloves - don equipment prior to entering room - remove before leaving - single patient rooms - dedicated equipment in room
63
MRSA skin infection treatment
- topical mupirocin - incision and drain of abscesses - heat furuncles to promote drainage
64
MRSA skin infection treatment drugs
- tmp/smz - doxycycline - minocycline - linezolid - clindamycin - add rifampin for replasing cases
65
decolonization procedures
- mupirocin 2% ointment in nares BID - topical body w/ chlorhexidine as shower soap qd - OR - dilute bleach bath - oral abx if active infection

PT2 ID 1-6 (7 decks)

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