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35 Cards in this Set
- Front
- Back
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Define osteomyelitis |
A progressive infectious process resulting in inflammatory destruction, bone necrosis (sequestrum) and new bone formation (involucrum) |
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Name three types of spread for osteomyelitis |
Haematogenous
Contiguous
Diabetic |
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Haematogenous spread is usually following what and is common in which patient group? |
Following Bacteraemia
Children
Metaphyseal area of long bones |
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Contiguous spread of osteomyelitis occurs after which three insults? |
Trauma
Surgery
Overlying soft tissue infection |
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Contiguous spread may be associated with what surgical procedure particularly? |
Prothesis/pins/plates |
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Diabetic osteomyelitis occurs as a result of what? |
Reduced vascularity Decreased local immunity Metabolic disturbances |
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Diabetic osteomyelitis is often associated with what complication of diabetes? |
Foot ulcers |
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Diabetic osteomyleitis often results in what unavoidable consequence? |
Amputation |
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What x-ray sign may be shown in osteomyelitis? |
Periosteal thickening and elevation
Lysis and sclerosis |
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Explain the work up for osteomyelitis |
Blood cultures for haem spread FBC and CRP Deep tissues from theatre (acute) Imaging for periosteal elevation
Only start ABx when all swabs returned |
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Most common causative organism of osteomyelitis |
Staph aureus |
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Most common three causative organisms in babies below 12 months? |
GBS S.aureus E.coli |
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Most common 3 causative organism for osteomyelitis in 1-16 year olds? |
S.aureus S.pyogenes H.influenzae |
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Most common three causative organisms of osteomyelitis in adults? |
S.aureus S.epidermidis P.aeruginosa |
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Septic arthritis can be cause by which two methods of spread? |
Haematogenous
Contiguous |
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Septic arthritis occurs most commonly in which two joints? |
Hip
Knee |
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Most common causative organism of septic arthritis in adults? |
S. aureus or streptococcal species |
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Common causative organism of septic arthritis if <3 years |
H.influenzae |
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10% of septic arthritis infections are.... |
Polymicrobial |
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Young adults can be susceptible to infection by which pathogen causing septic arthritis? |
N. gonorrhoea |
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Reactive arthritis comes from which two bacterial infections.... |
GI - Salmonella, Campylobacter, Shigella
Sexually - Chlamydia and Gonorrhoea
Rarely Hep B |
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Reactive arthritis diagnosis is made by what... |
Serology Positive stool cultures/GU swabs |
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Up to which time period may prosthetic joint infection occur |
<3 months after replacement |
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Occurs in what percentage of joint replacements? |
0.5%-2% |
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Three most common causative organisms of prosthetic joint infection? |
Coagulase negative staph
S.aureus
S. viridans |
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What do the bugs produce on foreign material? |
Biofilm |
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What does biofilm confer to the bacteria? |
Physical protection and resistance against bacteria |
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Rx options for prosthetic joint? |
Conservative - washout and debride with systemic ABx
Radical - Remove prosthesis
Lifelong suppressive therapy if unfit for surgery (50% retain useful joint function)
Do nothing if old and frail |
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Treatment without removal involves what?
And what is the success rate? |
Surgical drainage
6 weeks ABx
Success rate ~20% |
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Length of ABx treatment for osteomyelitis? |
2-3 weeks for septic arthritis
4 weeks for paediatric osteomyelitis
6-8 weeks for adult osteomyelitis |
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ABx for S.aureus |
Flucloxacillin + rifampicin |
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Abx for MRSA |
Vancomycin + rifampicin |
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ABx for streptococci? |
Benpen or cefuroxime |
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Abx for coliforms |
Ciprofloxacin |
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Abx for pseudomonas |
Ciprofloxacin and gentamicin |
