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Infectious Disease > Osteomyelitis > Flashcards

Osteomyelitis Flashcards

1
Q

What causes Osteomyelitis

A
  • Methicillin-resistant Staphylococcus aureus (MRSA)
  • Human Bites
  • Tetanus
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2
Q

Any strain of S. aureus that has developed multiple drug resistance(s) to beta-lactam antibiotics.
These antibiotics include methicillin and other more common antibiotics such as oxacillin, penicillin, and amoxicillin

A

MRSA

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3
Q

Any strain of S. aureus susceptible (abled to be killed by) beta-lactam antibiotics.

A

MSSA

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4
Q

Most common clinical manifestation of MRSA

A

SSTIs, specifically furuncles, carbuncles, and abscesses, are the most frequently reported clinical manifestations of MRSA.

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5
Q

Treatment of MRSA

A

Incision, drainage, & irrigation is the mainstay of therapy for any fluctuant lesion, followed by proper packing of the wound, daily dressing changes, and oral antibiotics.

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6
Q

Antibiotics for MRSA

A
  • TMP-SMX (160mg/800mg) PO BID x 5-10 days
  • Clindamycin 300 – 600mg PO BID x 5-10 days
  • Doxycycline 100mg PO BID x 10 days
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7
Q

Disposition of MRSA

A

Unless complications develop, most cases of MRSA should be retained onboard.

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8
Q

3rd most common bite wound after dog and cat bites

A

Human bites

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9
Q
  • Typically sustained when a clenched fist strikes the teeth of another person
  • Highly prone to infection given the proximity of the skin over the knuckles to the joint capsule
A

Clenched fist injury

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10
Q

Location:
- Typically dorsal aspect of 3rd, 4th or 5th MCP joint
Patho-anatomy:
- Teeth lacerate overlying skin and penetrate capsule of MCP joint during kinetic impact
- Mouth flora (bacteria) enter joint
- Bacteria are trapped under extensor tendon and/or joint capsule as fist is released from clenched position

A

Clenched Fist Injury (Fight Bite)

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11
Q

Treatment of Clenched Fist Injury (Fight Bite)

A
  • Initial wound care is the primary factor in preventing infection:
  • Control bleeding, clean wound with soap & water, sterile saline, povidone iodine, or CHX.
  • Let it bleed for minute or 2 unless its arterial, better to let the blood push it out since all of your interventions will be pushing in.
  • Assess for foreign body, tendon injury (frequently missed), and neurovascular integrity.
  • Human bite wounds should not be closed due to high risk of developing infection
  • Consider antibiotics
  • Dress/bandage to prevent secondary infection.
  • Follow up in 24h for reassessment
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12
Q

Do Trivial human bites that do not break the skin or are very superficial require prophylaxis

A

No

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13
Q

When would a human bite warrant prophylactic

A
  • Lacerations undergoing partial closure and wounds requiring surgical repair
  • Wounds on the hand(s), face, or genital area
  • Wounds near a bone or joint
  • Wounds in areas of underlying venous and/or lymphatic compromise
  • Wounds in immunocompromised hosts (including diabetes)
  • Wounds with associated crush injury
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14
Q

Which medications should not be used for human bite prophylactic

A
  • ABX without activity against E. corrodens should be avoided
    Meaning you cannot use:
  • Cephalexin (keflex)
  • PRPs (dicloxacillin)
  • Macrolides (erythromycin & azithromycin)
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15
Q

What antibiotic should be used for human bites

A

Amoxicillin-clavulanate 875/125mg PO BID x 5 days

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16
Q

Deep infection of fight bite

A
  • Pain with passive movement
  • Pain out of proportion to exam
  • Joint swelling
  • Crepitus
  • Systemic illness (fever and hemodynamic instability)
17
Q

Antibiotics needed to cover S.aureus and streptococci

A
  • Augmentin 875/125mg BID for 3-5 days
    If penicillin allergy:
  • Doxycycline 100mg BID for 3-5 days PLUS
  • Clindamycin 300mg TID for 3-5 days
18
Q

Labs for fight bites

A
  • Aerobic and anaerobic wound culture
  • CBC
  • ESR and CRP if concern for osteomyelitis
  • Blood culture if there are signs of systemic illness
19
Q

Rads for fight bite

A
  • Hx of clench fist injury warrant imaging
  • Rule out foreign body and fracture
20
Q

When is MEDADVICE warranted for human bites

A
  • Clenched-fist wounds
  • Complex facial lacerations
  • Deep wounds, especially if significant avulsion or amputation present (likely Medevac)
  • Wounds associated with neurovascular compromise (likely Medevac)
21
Q
  • An acute or chronic inflammatory process involving bone & structures secondary to infection with pyogenic organisms, including bacteria, fungi, and mycobacteria.
A

Osteomyelitis

22
Q

When would younger adults get osteomyelitis

A

trauma (penetrating injury i.e. stepping on nail) and related surgery

23
Q

When would older adults get osteomyelitis

A

infection to bone from adjacent soft tissues and joints (ie. diabetic foot wounds, decubitus ulcers).

24
Q

Osteomyelitis most affects which area in adults

A
  • Affects the vertebrae of the spine and/or the hips.
  • However, extremities are frequently involved due to skin wounds, trauma and surgeries.
25
Q
  • Patients present with dull pain at the involved site, with or without movement.
  • Local findings (tenderness, warmth, erythema, and swelling)
  • Systemic symptoms (fever, rigors) may also be present.
  • involving the hip, vertebrae, or pelvis tend to manifest few signs or symptoms other than pain.
A

Osteomyelitis

26
Q

Labs for osteomyelitis

A

CBC may have leukocytosis, blood cultures may be positive, erythrocyte sedimentation rate (ESR) elevation, C-reactive protein (CRP) elevation

27
Q

What is an essential component in the evaluation of suspected osteomyelitis

A
  • Plain radiographs, magnetic resonance imaging (MRI), and technetium-99 bone scintigraphy.
  • A plain radiograph typically initial imaging of choice but may have a delay of about 14 days before appearance/findings suggestive of OM.
  • Radiographs are often used to R/O other potential causes such as metastasis or osteoporotic fractures.
28
Q

Treatment of osteomyelitis

A
  • 2 pillars of OM Tx are surgical containment & prolonged ABx therapy
  • Surgical Containment:
    Surgical debridement of all diseased bone is often required due to poor antibiotic penetration
  • Prolonged antibiotic therapy cornerstone of treatment for OM
  • Results of C&S should guide antibiotic treatment, however, empiric ABx therapy consists of IV Vancomycin & IV Ceftriaxone.
29
Q

Disposition of osteomyelitis

A

Patient needs to be evacuated to higher level MTF

30
Q
  • Widely distributed in soil, and the intestines & feces of farm animals. In agricultural areas, a significant number of adults may harbor the organism.
  • Bacterium itself is sensitive to heat & cannot survive in the presence of oxygen (obligate anaerobe), however, c. tetani spores are very heat-resistant & resistant to many of the most common antiseptics:
A

Tetanus

31
Q
  • Acute, often fatal, exotoxin-mediated disease produced by gram-positive, spore-forming anaerobic rod, Clostridium tetani.
A

Tetanus

32
Q

What temperature can tetanus survive at for autoclaving

A

Spores can survive autoclaving at 249.8°F for 10-15 minutes & are relatively resistant to phenol & other chemical agents.

33
Q

Tetanus toxin is what causes the symptoms of tetanus and is one of the most potent toxins known, how much to keel

A

Minimum lethal dose in humans is approximately 2.5 ng per kg.
227.5 nanograms of tetanus toxin drops (kills) a 200-pound man.

34
Q

Commonly presents first in a descending pattern:
- Typically the first sign is trismus or lockjaw, sardonic smile, followed by nuchal rigidity, dysphagia, and rigidity of abdominal muscles.
- Muscle spasms may occur frequently (q10-15 min) and may last upwards of several minutes each episode.
- Other symptoms include hyperthermia, diaphoresis, hypertension, and episodic tachycardia

A

Tetanus

35
Q

Common late symptoms are:
- Periods of apnea due to contraction of thoracic muscles or pharyngeal muscle contraction
- Fracture of long bones/ vertebrae during muscle spasms
- Nosocomial infections secondary to long-term hospitalization, aspiration pneumonia
- Death typically occurs secondary to respiratory arrest

A

Tetanus

36
Q

Prevention of tetanus

A
  • All Wounds are either considered:
    Clean vs. contaminated/dirty
  • Superficial vs. deep/penetrating.
  • Dirty wounds increased risk for tetanus; wounds are dirty if:
  • Contaminated with dirt, soil, feces, or saliva (animal or human bites).
  • Penetrating or puncture wounds = Potential risk for the development of tetanus.
  • Wounds containing:
  • Devitalized tissue (necrotic or gangrenous wounds), frostbite, crush injuries, avulsion fractures, and burns are particularly conducive for proliferation of C. tetani.
37
Q

When should TDAP be given

A
  • No documentation or questionable TDAP HX = NO TDAP.
  • TDAP was > 5 years ago:
38
Q

Treatment of tetanus

A
  • Immediate transfer to nearest MTF (urgent MedEvac)
  • Clean/debride wounds as best as possible
    Supportive therapy and airway protection
    Antibiotics:
  • Metronidazole 500mg IV Q6-8H for 7-10 days (preferred)
  • Pen G 2-4Mil Units IV Q4-6hrs (alternate)
  • Neutralization of unbound toxin:
  • Tetanus Immune Globulin (TIG); Human Tetanus Immune Globulin (HTIG):
    500 units IM at different sites from the Tetanus Toxoid, part of the dose should be infiltrated around the wound
39
Q

How long is recovery for tetanus

A

Recovery after tetanus infection is notoriously prolonged (multiple months to a year in some cases).

Infectious Disease (20 decks)

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