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Year 2 > Microbiology of MSK infections > Flashcards

Microbiology of MSK infections Flashcards

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1
Q

What is the most common cause of osteomyelitis?

A

Staph aureus

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2
Q

What are the first line treatment choices for staph/strep infection?

A

Flucloxacillin
Vancomycin (pen allergic)
Clindamycin (virulent strain requiring anti-toxin)

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3
Q

What are the first line treatment choices for coliform infection?

A 
Gentamicin 
Ceftriaxone (try to avoid)
Ciprafloxacin (oral but try to avoid)
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4
Q

What makes infection of implanted devices so hard to treat?

A

Biofilm formation

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5
Q

What is a biofilm?

A

Bacterial growth coated in protein and polysaccharides

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6
Q

How do biofilms affect the environment of the area they’ve infected?

A

Reduce pH

Reduce oxygen availability

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7
Q

What are the three types of implant infection?

A

Early post-op
Delayed
Late

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8
Q

Which bacteria tend to cause early post-op implant infections?

A

Staph aureus
Streptococci
Enterococci

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9
Q

Which bacteria tend to cause delayed implant infections?

A

Coag. negative staph

P. acnes

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10
Q

Which bacteria tend to cause late implant infections?

A

Staph aureus

E.coli

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11
Q

Describe the time frame for each type of implant infection

A

Early post op - 0-3 mnth
Delayed - 3-24 mnth
Late - >24 mnth

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12
Q

How does an early implant infection present?

A

Fever
Effusion
Warmth
Drainage

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13
Q

How does a delayed implant infection present?

A

Persistant pain
Device loosening
Fistula

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14
Q

How does a late implant infection present?

A

Acute OR subacute

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15
Q

Describe the route of infection for each type of implant infection

A

Early - perioperative
Delayed - perioperative
Late - haematogenous

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16
Q

What is the diagnostic criteria for systemic inflammatory response syndrome (SIRS)?

A

Temperature >38 OR 90

Respiratory rate >20 OR PaCO2 12,000 OR

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17
Q

SIRS is an ongoing response in chronic infections. T/F

A

False - SIRS is only acute

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18
Q

What defines the need for immediate antibiotic treatment of a patient?

A

Presence of SIRS - immediate treatment

Absence of SIRS - delay until specimens cultured

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19
Q

How are prosthetic joint infections treated?

A

Debride joint

Long course of high dose (+/- IV) antibiotics

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20
Q

What are the two surgical options for prosthetic joint infection?

A

Debride and retain prosthetics (DAIR)

Debride and remove prosthetic (one or two stage)

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21
Q

What are the most common acute prosthetic joint infections?

A

Staph aureus

Strep

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22
Q

What are the most common chronic prosthetic joint infections?

A

Coag negative staph

Propionibacteria

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23
Q

What type of samples are obtained in PJI? Why?

A

Bone samples - reflect the infecting organism

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24
Q

How are gram positive joint infections treated?

A

Flucloxacillin/vancomycin

Teicoplanin (if resistant)

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25
How are gram negative joint infections treated?
Co-trimoxazole | Amoxicillin
26
How long does DAIR treatment take?
4 weeks + 8 weeks
27
How long does one stage treatment take?
4 weeks + 6 weeks
28
How long does two stage treatment take?
6 weeks + 6 weeks
29
How long does hip treatment take?
3 months (12 weeks)
30
How long does knee treatment take?
6 months (24 weeks)
31
Is CPR always elevated?
No - Usually normal in chronic infections Can be influenced by underlying diseases Can be influenced by surgery
32
How long should PJI treatment be continued after resolution of clinical symptoms and signs? What should then be done?
2 weeks | CT/MRI
33
When can we be sure of a clinical cure following PJI?
2 years post treatment
34
Describe surgical prophylaxis
Give dose 60min pre surgery | Stop dose within 24 hours post surgery
35
What surgical prophylaxis is given in orthopaedics?
Co-amoxiclav/co-tramoxazole peri op and two post op doses | Eradicate MRSA pre-op
36
What are the underlying risk factors for bone and joint infections (BJI)?
``` Immunosuppression Diabetes Implants IV drug user Sickle cell anaemia ```
37
Which BJI pathogen is common in children
Kingella
38
How does a BJI present acutely?
Fever Inflammation over the affected joint Reduced mobility/fixed immobilisation
39
How does a BJI present acutely in a child?
Listless Not feeding Not playing Cranky
40
What is septic arthritis?
Infection of a joint space
41
What are the possible routes of infection with regard to septic arthritis?
Haematogenous Contiguous (bone-bone) Direct inoculation (injection, trauma, etc)
42
Which organisms tend to be involved in septic arthritis?
Staph aureus Strep H. influenzae (children) Gonorrhoea
43
How is septic arthritis diagnosed?
``` Blood culture (IF FEVER) Inflammatory markers FBC U&E Lactate Joint aspirate +/- washout --> culture Crystals and gram stain USS X-ray/CT/MRI/bone scan ```
44
How is septic arthritis treated? How long for?
Flucloxacillin | Ceftriazone if
45
What is osteomyelitis?
Inflammation of bone/medullary cavity
46
Which bones tend to be affected by osteomyelitis?
Long bones | Vertebrae
47
Which pathogens tend to be involved in acute osteomyelitis?
S. aureus | Strep
48
Which pathogens tend to be involved in chronic osteomyelitis?
TB Pseudomonas Salmonella Coliforms
49
When might osteomyelitis reoccur?
Inefficient treatment
50
Incidence os osteomyelitis is increasing in children. T/F
True
51
What are the possible routes of infection with regard to osteomyelitis?
Haematogenous Contiguous (bone-bone) Peripheral vascular disease associated Prosthesis associated
52
Define the timeframe of acute osteomyeltis
53
What is the most likely route of infection in acute osteomyelitis?
Haematogenous
54
Acute osteomyelitis can become septic arthritis in which bones especially? Why?
Hip Shoulder Ankle Elbow Metaphyses are found within the joint space
55
Why are infants more at risk of osteomyelitis becoming septic arthritis?
They have blood vessels connecting the metaphysis to the epiphysis
56
Chronic osteomyeltis has a higher risk of which complications?
Abscess Septicaemia Permanent bone deformity
57
How should chronic osteomyelitis be managed?
Antibiotic treatment according to culture results (if no SIRS)
58
How is osteomyelitis diagnosed and managed? How long for?
Blood culture (IF FEVER) Bone biopsy +/- washout --> culture Empiric flucloxacillin 4-8 weeks
59
What are the risk factors for prosthetic joint infections?
Diabetes Rheumatoid arthritis Malnutrition Obesity
60
Coagulate negative staph are skin commensals. T/F
True - this can make it difficult to determine whether they are contaminants or causing infections
61
Why can it be difficult to get a microbiology diagnosis of PJI? How can this be reduced?
Most infecting organisms are skin commensals | Multiple tissue and bone cultures
62
How can PJI be diagnosed?
``` Multiple tissue/bone cultures Blood culture (RARELY +VE) Inflammatory markers FBC Imaging ```
63
How is PJI treated?
Debridement At least 6 weeks antibiotic treatment Re-implant joint post - treatment
64
What is necrotising fasciitis?
Severe infection of subcutaneous soft tissues
65
How common is necrotising fasciitis?
Uncommon
66
How often to people die from necrotising fasciitis?
High mortality (rapidly progressive)
67
Where are the common sites of necrotising fasciitis infection?
Abdominal wall Perineum Limbs Post-op wounds
68
How does necrotising fasciitis present?
Highly painful Minimal signs of inflammation Systemic symptoms Rapid expansion
69
Describe type 1 and type 2 necrotising fasciitis
Type 1 - anaerobes (synergistic gangrene) | Type 2 - group A strep
70
How can necortising fasciitis be diagnosed?
``` Clinical Swabs + biopsy --> microbiology, gram stain, culture Blood culture Inflammatory markers FBC ```
71
How is necrotising fasciitis managed?
Debridement | Antibiotics
72
Which antibiotics are given in type 1 necrotising fasciitis?
Pip-taz Clindamycin Gentamicin
73
Which antibiotics are given in type 2 necrotising fasciitis?
Penicillin & clindamycin
74
Necrotising faciitis requires droplet protection. T/F
False - contact precautions
75
Which pathogen is responsible for gas gangrene?
Clostridium perfringens
76
Describe the pathogenesis of gas gangrene
Spores lie within tissues --> Predisposition (dead tissue, hypoxia) --> Multiplication --> Accumulation of gas bubbles within tissue
77
On compression of an area with gas gangrene what can be felt?
Crepitus
78
How is gas gangrene managed?
Urgent debridement High dose penicillin and/or metronizaole +/- hyperbaric oxygen
79
What pathogen causes tetanus?
Clostridium tetani
80
Where can tetanus bacteria be found?
Animal mouths Soil Rust
81
How does tetanus present? Why?
Spastic paralysis Lock jaw Produces a neurotoxin which prevents release of neurotransmitters
82
How long is the incubation period of tetanus?
4 days - several weeks
83
How is tetanus treated?
``` Debridgement Anti-toxin Supportive Penicillin/metronidazole Toxoid booster vaccination ```
84
When are the tetanus vaccines given?
2, 3 & 4 months

Year 2 (72 decks)

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