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2 MSK > Microbiology > Flashcards

Microbiology Flashcards

(75 cards)

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1
Q

which antibiotic has a high CDIF risk

A

clindomycin

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2
Q

what is adult osteomyelitis

A

inflammation of bone and medially cavity

usually in long bones

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3
Q

how can osteomyelitis be classified

A

acute vs chronic (by time) -most common
contiguous vs haematogeneous (by spread)
host status eg. presence of vascular insufficiency

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4
Q

how is osteomyelitis confirmed

A

direct biopsy

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5
Q

diagnostic factor for osteomyelitis

A

if you can see tendon

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6
Q

how is osteomyelitis treated

A

await microbiological diagnosis
treat with the appropriate antibiotics
EXAM Q
no empiric antibiotics

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7
Q

investigations for osteomyelitis

A

good standard- bone biopsy

MRI

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8
Q

5 features of infection seen in osteomyelitis

A 
calor
rubor 
tumor 
dolor 
functino laesa
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9
Q

why does bone infection occur

A

due to necrosis

or a bacteria with high inoculum

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10
Q

what are the aims of surgery for osteomyelitis

A

remove infected tissue

drain and debride

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11
Q

how long does debrided bone take to be covered by vascularised soft tissue

A

6 weeks

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12
Q

most common sites of bone infection

A 
prosthetic joint infection 
diabetic foot infection (vascular insufficiency) 
post-traumatic infection (open fracture)
vertebral osteomyelitis 
haemotogeneous osteomyelitis (IVDU)
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13
Q

when do coagulase negative staph cause problems

A

mainly in people who have prosthetics, however usually just a commensal

coagulase positive staph are much much more virulent

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14
Q

is fever a reason to start empiric antibiotics for osteomyelitis before getting results back

A

no

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15
Q

is sepsis a reason to start empiric antibiotics in osteomyelitis

A

yes

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16
Q

what does coagulase do

A

clots plasma

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17
Q

antibiotic for staph aures

A

flucloxacillin

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18
Q

coag negative staph is golden true/false

A

false
coag positive staph aures is gold
coag negative staph is white

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19
Q

what bacterial infection open fractures

A

staph areas

gram negative bacteria

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20
Q

how to treat open fractures osteomyelitis

A

aggressive debridement
fixation
soft tissue cover

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21
Q

clinical signs of open fracture osteomyelitis

A

non-union and poor wound healing

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22
Q

when are diabetic ulcers likely to get infected

A

when ulcer is >2cm for >2months

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23
Q

what microbes infect diabetic ulcers

A

polymicrobial however often staph aures

treat staph aures first and if no improvement treat gram negative too

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24
Q

treatment for infected diabetic ulcers

A

probe to bone (diagnostic)

debridement and antimicrobials

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25
what is the best diagnostic test for osteomyelitis
bone biopsy
26
best imaging for osteomyelitis
MRI rely on MRI if patient cant go to theatre
27
how do u treat a mild diabetic ulcer infection
flucloxacillin
28
how to treat moderate diabetic foot ulcer infection
flucloxacillin (oral) + metronidazole (oral)
29
how to treat severe diabetic foot ulcer infection
flucloxacillin (IV) Gentomycin metronidazole 7 days (14 if blood infection, 6 weeks if osteomyelitis)
30
does fluclox cover MRSA
no but covered MSSA
31
what does metronidazole cover
anaerobes
32
what does gentamicin cover
gram negatives
33
what antibiotics cover gram positives
fluclox/vancomycin if allergic | oral switch is doxycycline (to help get patient out of hospital quicker)
34
what antibiotics cover gram -ve
gentamicin/aztreonam IV if severe | oral cotrimoxazole/doxycyxline
35
can you switch IV vancomycin to oral
no because it isn't absorbed | used as topical treatment for bowel in cdiff
36
when is pseudomonas likely to be an infection
if its in bone or blood but not on skin
37
significant organisms to not be ignored
staph aures group A, B C or G strep miller group anaerobes
38
what is haemotogenous osteomyelitis
bone infection from bacteria in blood
39
who tends to get haemitogenous osteomyelitis
IVDUs (PWID) prepubertal children people with central lines/dialysis elderly
40
sources of infection in haemitogeneous osteomyelitis
``` tonsils throat teeth skin infection GI UTI mostly staph aures ```
41
if person has staph aures in blood what do you do
remove all lines treat with IV minimum 14 days look for endocarditis if endocarditis 4-6 weeks
42
organisms found in blood of PWID
staph aures strep viridians unusual: eikenella corrodes (needle lickers) candida (heroin, or lemon juice)
43
causes of haemotogenous osteomyelitis in PWID
continuous haemotogenous direct inoculation
44
what organisms do people with sickle cell myelitis have
staph aures | salmonella
45
SAPHO (adults) and CRMO (kids)
chronic lytic regions on X-ray that look like osteomyelitis
46
how does vertebral osteomyelitis occur
mostly haematogenous may be associated with epidural access or psoas access may be associated with PWID, IV site infections, GU infections, SSTI, post op
47
everyone with vertebral osteomyelitis have fever true/false
false 5%
48
investigations for vertebral osteomyelitis
``` MRI, Ga-67 scan vertebral biopsy (before antibiotics) ```
49
treatment for vertebral osteomyelitis
drainage of large abscess antimicrobials for 6 weeks minimum expect >50% decrease in ESR duration extended in complicated cases
50
why would you repeat MRI in vertebral osteomyelitis
unexplained increase in inflammatory markers increased pain new anatomical signs
51
those with vertebral tb also have pulmonary tb true/false
false <50%
52
risk factors for infection of prosthetic joints
rheumatoid arthritis diabetes malnutrition obesity
53
what are the mechanisms of infection in prosthetic joints
direct inoculation at time of surgery manipulation of joint at time of surgery seeding of joint at later time
54
what is a biofilm
a layer of bacteria which is really close to the prosthetic and grows really slowly, difficult to treat with antibiotics
55
where do you get biofilms
cystic fibrosis | anywhere you have metals or plastic
56
pathogens which infect prosthetic joints
``` staph aures staph epidermis propionibacterium acnes (upper limb prosthesis) rarely strep e.coli, pseudomonas fungi mycobacteria ```
57
how to diagnose prosthetic joint osteomyelitis
culture preoperative tissues blood culture CRP radiology
58
treatment for prosthetic joint osteomyelitis
removal of prosthesis and cement antimicrobial therapy for at least 6 weeks re-implantation of joint after aggressive antibiotic therapy
59
how does septic arthritis occur
direct invasion through wound ematogenous spread spread from focus osteomyelitis in adjacent bone spread from infection focus in adjacent soft tissues
60
symptoms of PVL producing staph aures
``` skin infection necrotising fascitis invasive infections bacteraemia septic arthritis ```
61
what is septic arthritis
inflammation of the joint space caused by infection can be blood born organisms can be extension of local infection can be introduced directly following injection or trauma
62
bacterial causes of septic arthritis
``` staph aures streotococci coag neg staph - prosthetics neisseria gonorrhoea -sexually active haemophilia influenzae- less common now bc of vaccination ```
63
how to diagnose septic arthritis
clinical picture joint fluid microscopy blood culture exclude crystals
64
treatment for septic arthritis
high dose flucloxacillin if <5 years old add ceftriaxone adjust when organism confirmed
65
what is pyomyositis
bacterial infection of the skeletal muscle
66
who gets pyomyosititis
immunosuppressed
67
What else can cause psyomyositis
viral - diffuse fungal -v rare parasites (Taenia- tape worm, trichenella (rare meat)
68
what is myonecrosis
flesh eating bugs causing necrosis of muscle tissue
69
what causes tetanus
clostridium tetani gram +ve strictly anaerobic rods spores spores found in soil, gardens ect
70
what happens in tetanus
neurotoxin causes spastic paralysis
71
clinical signs of tetanus
extreme muscle spasm | spastic paralysis
72
what is the incubation period for tetanus
4 days - several weeks
73
tetanus treatment
``` surgical debridement antitoxin supportive measures antibiotics... penicillin/metonidazole booster vaccination ```
74
how to prevent tetanus
vaccination at 2,3,4 months check green book
75
how is tetanus diagnosed
clinically culture v difficult

2 MSK (35 decks)

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