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MSK infection Flashcards

1
Q

What is osteomyelitis?

A

An infection of the bone

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2
Q

Should you give empiric antibiotics for osteomyelitis?

A

Not unless septic. Wait for cultures to come back first and treat specifically.

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3
Q

What are the six main forms of osteomyelitis?

A 
Open fractures/direct inoculation
Diabetic/Vascular 
Hematogenous spread 
Vertebral osteomyelitis
Sickle Cell Osteomyelitis
Gaucher's Disease
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4
Q

When do you suspect osteomyelitis of an open fracture?

A

When there is non-union and poor wound healing

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5
Q

What organisms most commonly cause open fracture osteomyelitis?

A

S. Aureus and aerobic gram -ive

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6
Q

How do you treat open fracture osteomyelitis?

A

Aggressive debridement
Fixation
Antibiotics

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7
Q

What is the standard course of antibiotics for osteomyelitis?

A

6 weeks of antibiotic appropriate in organism

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8
Q

Why do diabetics get osteomyelitis?

A

Because of increased blood sugar and stasis

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9
Q

How do you diagnose diabetic osteomyelitis?

A

Probe to bone and culture

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10
Q

What organisms most commonly cause diabetic osteomyelitis?

A

Polymicrobial

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11
Q

How do you treat diabetic osteomyelitis?

A

Debridement

Flucloxacillin and doxycycline/metronidasol

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12
Q

What groups are prone to haematogenous osteomyelitis?

A

Prepubescent children
PWID
Central lines

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13
Q

What organisms cause haematogenous osteomyelitis?

A

S. Aureus
Strep
Unusual pathogens: Pseudomonas and candida etc

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14
Q

What is distinctive about haematogenous osteomyelitis?

A

Can get it in odd places like pubis and clavicle

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15
Q

What is Sickle Cell osteomyelitis?

A

Sickle Cell sufferers are more susceptible to OM and septic arthritis

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16
Q

What organism commonly causes Sickle Cell osteomyelitis?

A

Salmonella

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17
Q

Why is it important to know about Gaucher’s disease?

A

Because it can mimic OM but is sterile

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18
Q

How does vertebral osteomyelitis present?

A 
Fever
Insidious pain
Neuro signs
Raised inflammatory markers
Epidural or subdural abscesses
19
Q

What groups are susceptible to vertebral osteomyelitis?

A

As haematogenous spread same as haematogenous in addition to those with a history of TB.

20
Q

Which organisms commonly cause vertebral osteomyelitis?

A

TB and S. Aureus

21
Q

How do you treat vertebral osteomyelitis?

A

Drain abscesses

Antibiotics

22
Q

What factors increase your chance of developing a prosthetic joint infection?

A

RA
Obesity
Malnutrition
Diabetes

23
Q

What are the two methods of developing a prosthetic joint infection?

A

Direct inoculation at time of surgery

Hematogenous seeding

24
Q

When is hematogenous infection of a prosthetic likely?

A

If it occurs under a month after operation

25
Q

When is direct inoculation of a prosthetic joint likely?

A

If it occurs over a month after the operation

26
Q

What organisms tend to cause prosthetic joint infection?

A

PVL producing S. Aureus
Staph Epidermidis
E. Coli

27
Q

How do you treat a prosthetic joint infection?

A

Remove prosthetics

6 week intensive antibiotics (Flucloxacillin, clindamycin)

28
Q

Why are antibiotics of little use if an infected prosthetic is still present?

A

Because a biofilm forms on the prosthetic protecting bacteria from antibiotics

29
Q

How do you diagnose a prosthetic joint infection?

A

Multiple cultures and CRP

30
Q

How do you treat acute osteomyelitis?

A

Almost always S. Aureus therefore IV flucloxacillin 2/52 then oral fluclox 4/52
Clindamycin 2nd line

31
Q

How do you treat chronic osteomyelitis?

A

Unless diagnosed otherwise assume S. Aureus therefore oral flucloxacillin
Doxycycline 2nd line

32
Q

What is pyomyositis?

A

An bacterial (normally S. Aureus) infection of the skeletal muscle

33
Q

How does pyomyositis present?

A

Pus filled abscesses

34
Q

How do you treat pyomyositis?

A

Drain abscesses and antibiotics for 3/52

35
Q

What is tetanus?

A

In infection with the bacteria Clostridium tetani

36
Q

Describe clostridium tetani

A

Gram +ive bacteria that looks like a drumstick/mace

37
Q

How does clostridium tetani cause tetanus?

A

Produces toxin which prevent NT release from inhibitory neurons resulting in spastic paralysis

38
Q

How does tetanus present?

A

Spastic paralysis

39
Q

How do you diagnose tetanus?

A

Clinically as bacteria are difficult to grow

40
Q

How do you treat tetanus?

A

Debridement
Anti-toxin
Supportive therapy
Penicillin/metronidazole

41
Q

When are tetanus vaccines given?

A

2, 3 and 4 months or after infection top up

Toxoid vaccine

42
Q

What things can cause myositis?

A

Viruses- HIV, influenza, Rabies
Protozoa
Fungus

43
Q

How can osteomyelitis cause septic arthritis?

A

By leaking into the synovial space

44
Q

Other than the synovial space where can osteomyelitis leak too?

A

Under the periosteum causing abscess formation

MSK (17 decks)

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