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Microbiology Flashcards

(53 cards)

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1
Q

What is osteomyelitis?

A

Inflammation of the bone and medullary cavity, usually located in one of the long bones

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2
Q

How can osetomyelitis be classified?

A

Acute vs chronic
Contiguous vs haematogenous
Host status - presence of vascular insufficiency

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3
Q

What is an example of how the host status can change oestomyelitis?

A

Those with sickle cell are susceptible to salmonella ostemomyelitis

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4
Q

What is the gold standard for diagnosis of oesteomyelitis?

A

Bone biopsy
MRI
If you can see bone or tendon this is DEFINITELY osteomyelitis

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5
Q

When should antibiotics be prescribed for oestomyelitis?

A

AFTER CULTURES

NEVER EMPIRICAL unless septic or there is systemic upset

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6
Q

What are the hallmarks of inflammation?

A 
Color
Dolor
Tumor
Rubor
Function lasea
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7
Q

What risk factors predispose to osteomyelitis?

A 
Open fractures
Diabetes/ vascular insufficiency
Haematogenous osteomyelitis 
Vertebral osteomyelitis 
Prosthetic joint infection
Specific hosts and pathogens
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8
Q

When is osteomyelitis likely to occur?

A

Bone is highly resistant to infection and therefore, will only occur with necrosis +/- high inoculum

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9
Q

How long does an infection bone take to heal?

A

Debrided bone takes 6 weeks to be revascularised with soft tissue

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10
Q

How long should antibiotics be given for in osteomyelitis?

A

6 weeks

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11
Q

What bacterium is likely to affect prosthetic joints?

A

Staphylococcal coagulase negative - staphylococcal epidermidis

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12
Q

How are open fractures managed?

A

Aggressive debridement
Fixation
Soft tissue cover

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13
Q

What bacteria are likely to infect an open fracture?

A

Staphylococcus aureus and aerobic gram negative bacteria (pseudomonas, neisseria, e.coli, salmonella, kelbsiella, proteus, shigella)

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14
Q

What is the treatment for diabetic ulcers?

A

Surgical debridement and antimicrobial’s

Antibiotics CANNOT penetrate abscesses or necrotic tissue - these need surgical removal

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15
Q

What are the three markers you need to evaluate for the presence of osteomyelitis?

A

Chronic, indolent or deep ulcer
Positive probe-to-bone test
Elevated levels of inflammatory markers (CRP, PV)

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16
Q

What radiological investigations are best for osteomyelitis?

A

X-ray

Gold standard is MRI

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17
Q

What are appropriate cultures for osteomyelitis?

A

Per-cutaneous aspirate

Bone biopsy surgically

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18
Q

What is the definition of a mild diabetic foot ulcer?

A

2 or more: pus, erythema, pain, tender, warmth, in-duration
OR
Cellulitis <2cm confined to skin or subcutaneous

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19
Q

What is the treatment for a mild ulcer?

A

Flucloxacillin (oral)

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20
Q

What are the main bacterial causes for mild diabetic feet ulcers?

A

MSSA
MRSA
Streptococci

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21
Q

How long is treatment for feet ulcers?

A

7 days
10 days if severe
14 days IV if S.aureus bacteraemia

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22
Q

What are the main bacterial causes for moderate and severe diabetic feet ulcers?

Study These Flashcards
A 
MSSA
MRSA
Streptococci
Enterobacteriacae
Obligate anaerobes
23
Q

How are moderate diabetic feet ulcers treated?

Study These Flashcards
A

Flucloxacillin and metrondiazole (oral)

24
Q

How are severe diabetic feet ulcers treated?

Study These Flashcards
A

Flucloxacillin
Metrondiazole
Gentamicin or aztreonam (IV)

25
What is the alternative for penicillin allergic patients with a mild diabetic foot ulcer?
Doxycycline | Co-trimoxazole
26
What is the alternative for penicillin allergic patients with a moderate diabetic foot ulcer?
Doxyxycline and metrondiazole
27
What is the alternative for penicillin allergic patients with a severe diabetic foot ulcer?
Vancomycin Gentamicin/ aztreonam Metrondiazole
28
Who is susceptible to haematogenous osteomyelitis?
Prepubertal children PWID Central lines/ dialysis Elderly
29
What is gaucher's disease?
Lysosomal storage disorder that can mimic a bone crisis | Often affects tibia
30
What can vertebral osteomyelitis be associated with?
Epidural abscess | Psoas abscess
31
Who is susceptible to vertebral osteomyelitis?
``` PWID IV site infections GU infections STI Post operative ```
32
What are the clinical symptoms of osteomyelitis?
``` 50% fever 90% insidious pain and tenderness 15% neurological signs 90% raised inflammatory markers 32% abnormal plain film NEED to do MRI ```
33
How is vertebral osteomyelitis treated?
Drain lare paravertebral abscesses Antibiotics for 6 weeks ONLY repeat MRI if: unexplained increase in inflammatory markers, increasing pain, new anatomical signs
34
What is Potts disease?
Skeletal TB | Less than half have pulmonary TB
35
What are risk factors for developing an infection in prosthetic joints?
RA Diabetes Malnutrition Obesity
36
What unusual organisms are likely in PWIF haematogenous osteomyelitis?
``` Candidia = heroin Eikenella = those who lick needles before injection ```
37
What additional test should be done in those who present with TB?
HIV test
38
What is the mechanism of prosthetic joint infection?
Direct inoculation at time of surgery Manipulation of joint at time of surgery Seeding of a joint at a later time
39
What can PVL staph auerus cause?
Skin infections Necrotising pneumonia Bacteraemia Septic arthritis
40
What will sessile bacteria form?
A biofilm
41
What are organisms that indicate a very bad infection?
Fungal is BAD | Mycobacteria is even WORSE
42
How is prosthetic joint osteomyelitis diagnosed?
Culture perioperative tissue Blood cultures CRP Radiology
43
How is prosthetic joint osteomyelitis treated?
Remove prosthesis and cement Therapy for 6 weeks Re-implant device after aggressive antibiotic treatment
44
How is staphylococcus epidermidis treated?
Vancomycin IV
45
Where can septic arthritis originate from?
Direct invasion through a penetrating wound Haematogenous spread Spread from infectious focus (cellulitis abscess) Spread from focus of osteomyelitis in adjacent bone
46
How is septic arthritis diagnosed?
Severe pain, red, hot, swollen Joint fluid - microscopy, C&S Blood culture if pyrexial Exclude crystals
47
What viruses can cause viral arthritis?
Alphavirus Hep B Rubella virus Parovirus B19
48
What is pyomisitis?
Bacterial skeletal muscle infection which results in pus filled abscesses
49
How is clostridium tetani classed?
Gram positive, strictly anaerobic spore forming bacillus
50
What is the incubation period of tetanus?
4 days to several weeks
51
What can tetanus infection cause?
``` Spastic paralysis Trismus Risus sardonicus Dysphagia Complete tetanic spasm ```
52
How is tetanus treated?
Surgical debridement Antitoxin Supportive measures Booster vaccination - toxoid
53
What can cause myositis (inflammation of muscles)?
Viral - HIV, influenza, CMV, rabies, chikungunya Protozoa Fungal Schistomsoma, taenia

MSK (34 decks)

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