Infectious Disease Exam 2 - Bone & Joint Infections

Question 1

Osteomyletitis

Answer 1

Infection of the bone
One of the most difficult infections to treat
Progressive destruction of bone

Question 2

Hematogenous Osteomyletitis

Answer 2

Seeding from microorganism into the bone as a result of trauma or surgery

Question 3

Contiguous Osteomyletitis

Answer 3

Spread from adjacent soft tissue and joints into bone

Question 4

Hematogenous Osteomyletitis - Pathogens (Neonates)

Answer 4

Staph
E. Coli
Group B strep (comes from mother)

Question 5

Hematogenous Osteomyletitis - Pathogens (Pre-puberty)

Answer 5

Staph

Question 6

Hematogenous Osteomyletitis - Pathogens (Elderly)

Answer 6

Staph

E. Coli

Question 7

Contiguous Osteomyletitis - Pathogens (Adults>50 WITH vascular insufficiency)

Answer 7

Staph. (MRSA)
Enterobacteriaceae
Pseudomonas
Enterococcus
Anaerobes 
**Treat like DM infection

Question 8

Contiguous Osteomyletitis - Pathogens (Adults>50 WITHOUT vascular insufficiency)

Answer 8

Staph.

Question 9

Hematogenous Osteomyletitis - Treatment (Neonates)

Answer 9

Nafcillin OR Vancomycin + 3rd or 4th Gen Cephalosporin (NOT Ceftriaxone - elevates bilirubin)

Question 10

Hematogenous Osteomyletitis - Treatment (Pre-Puberty)

Answer 10

Nafcillin (DOC)
Vancomycin (B-Lactam allergy/MRSA)
Clindamycin (D-test) (B-Lactam allergy/MRSA)

Question 11

Hematogenous Osteomyletitis - Treatment (Elderly)

Answer 11

Nafcillin OR Vancomycin (if MRSA) + 3rd or 4th Gen Cephalosporin

Question 12

Contiguous Osteomyletitis - Treatment (Adults>50 WITHOUT vascular insufficiency)

Answer 12

Nafcillin
Cefazolin
Vancomycin (B-Lactam allergy/MRSA)

Question 13

Contiguous Osteomyletitis - Treatment (Adults>50 WITH vascular insufficiency)

Answer 13

Vancomycin PLUS one of the following:
Piperacillin/tazobactam
Carbopenem
Cefepime or Ceftazidime PLUS clindamycin or metronidazole
Ciprofloxacin or Levofloxacin PLUS clindamycin or metronidazole

Question 14

Biofilms in Osteomyletitis

Answer 14

Makes difficult to penetrate with antibiotics
Remove hardware
Rifampin

Question 15

Oral antibiotics for Osteomyletitis

Answer 15

Consider after 1-2wks of therapy
Fluoroquinolones
Clindamycin
Linezolid
TMP/SMX