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Material After Quiz 3 before Test #1
Bone and Joint Infections
61
Pharmacology
Graduate
02/02/2012

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Cards

Term
Osteomylitis Pathology
Definition
Contiguous spread- 47%
Peripheral Vascular Disease- 34%
Hematogenous- 19%
Diabetes Mellitus and Peripheral Vascular Disease predispose you for Osteomylitis
Term
Acute Osteomyleitis
Definition
Inflammatory Bone change after a 2 week infection
56%
Term
Chronic Osteomyelitis
Definition
Necrotic Bone Present after 6 week
44%
Term
Infectious arthitis vs Osteomyelitis
Definition
Arthitis happens in the joint space and not in the bone. MRI helps differentiate
Term
Hematogeneous origin more likely if
Definition
Children <16yr
Vertebral involvement- adults >50yr
Metaphysis of long bones
Neonates
Single organism
Term
Osteomyelitis organisms in children
Definition
S. aureus, H. influenze type b, Group B stretococcus, E. coli
Term
Osteomyelitis organisms in adults
Definition
S. aureus, E. coli (bacteremia with UTI), Mycobacterium tuberculosis
Term
Osteomyelitis organism from sickle cell and immunocomproimised
Definition
Salmonella spp. (bowel infarction)
Term
Osteomyelitis organisms associated with intravenous drug use
Definition
Pseudomonas aeruginosa and higher incidence of MRSA
Term
What percent of bone is lost if osteomyelitis is seen on an x ray?
Definition
50%
Term
Gold standard for Osteomyelitis diagnosis
Definition
Bone biopsy with isolation of microorganisms from culture
Term
Osteomyelitis diagnosis criteria
Definition
Bone biopsy, blood culture, increased ESR and CRP
Term
When to use an MRI for diagnosis
Definition
After pt has not improved for over 72 hours
Term
Difference between Children and Adults concerning infections in the bones
Definition
Childrens may show up within 7 to 10 days
Adults infections are not obvious and changes show 50% of mineral content loss
Term
Sensitivity vs Specificity
Definition
Sensitivity- showing a positive that something is present
Specificity- showing what the present thing is on the imaging
Term
Stage 1 Osteomyelitis
Definition
Medullary Osteomyelitis
Hematogeneous Infection
Term
Stage 2 Osteomyelitis
Definition
Superficial Osteomyelitis
Only Cortical Bone
Contiguous Infection
Term
Stage 3 Osteomyelitis
Definition
Localized Osteomyelitis
Medullary Cavity and Cortical Bone
Not through the Diameter of the Bone
Term
Stage 4 Osteomyelitis
Definition
Diffuse Osteomyelitis
Entire Thickness of the Bone
Loss of Stability
Infected nonunion of Bone
Term
Physiologic Class of Staging A? B? C?
Definition
A-normal host
B-systemic or local compromise
C- treatment is worse than the disease
Term
Staph aureus treatment in children from a hematogeneous source
Definition
Oxacillin (or naficillin) and ceftriaxone
Term
What drugs to use for community acquired MRSA
Definition
Vancomycin or clindamycin substituted for penicillinase
Term
E. coli treatment in adults from a hematogeneous source
Definition
levofloxacin IV plus rifampin
Term
If culture for hematogeneous source is negative what are the most common bacteria for adults and children?
Definition
children- Staph aureus
adults- E coli
Term
Length of parenteral antibiotics for children from a hematogeneous source
Definition
7 to 21 days followed by oral therapy
Term
Length of parenteral antibiotics for adults from a hematogeneous source
Definition
Good response- 2 weeks followed by oral therapy
Poor response- 4 weeks then reassess
Term
Length of oral antibiotics for children from a hematogeneous source
Definition
3 to 6 weeks
Term
Length of oral antibiotics for adults from a hematogeneous source
Definition
4 weeks then reassess and you may restart treatment
Term
oxacillin doasing
Definition
100-200mg/kg/day q 4-6h
Max: 12 g/day
Term
cefazolin dosing
Definition
50-100 mg/kg IV/IM q8h
Max: 6 g/day
Term
Nafcillin dosing
Definition
100-200 mg/kg/day IV q4-6h
Max: 12 g/day
Term
Treatment of contiguous spread of osteomyelitis covers what types of bacteria?
Definition
gram positive and gram negative and anaerobic bacteria
Term
Drugs used to treatment contiguous spread of osteomyelitis
Definition
linezolid (Zyvox)
trimethoprim/ sulfamethoxazole (Bactrim DS)
clindamycin
fluoroquinolone
Term
linezolid (Zyvox) for Osteomyelitis Contiguous Spread
Definition
myelosuppression- reversible
600 mg PO q12h
Term
trimethoprim/ sulfamethoxazole (Bactrim DS) for Osteomyelitis Contiguous Spread
Definition
neutropenia- treat with folic acid
combine with rifampin in outpatient setting
Community acquired MRSA
160/800 PO q6h
Term
what do you combine with trimethoprim/ sulfamethoxazole (Bactrim DS) for increased effectiveness in the outpatient setting
Definition
rifampin
Term
clindamycin for Osteomyelitis Contiguous Spread
Definition
bacteriostatic
high bone concentrations
Community acquired MRSA
Term
If the Osteomyelitis is resistant to other drugs what should you use?
Definition
clindamycin
Term
Fluoroquinolone used for Osteomyelitis Contiguous Spread
Definition
levofloxacin
Term
Drugs used in treatment of MRSA in Osteomyelitis
Definition
vancomycin
Tetracyclines (minocyclines, doxycycline)
tigecycline
daptomycin
Term
vancomycin in MRSA in Osteomyelitis
Definition
Only in IV form
15-20 mcg/ml
Term
Tetracyclines for MRSA in Osteomyelitis
Definition
Bacteriostatic
Suppressive oral therapy
Term
tigecycline for MRSA in Osteomyelitis
Definition
Bacteriostatic
IV formulations only
Term
daptomycin
Definition
binds to cell wall membrane and causes depolarization
alters protein synthesis
Reports of resistence
Term
rifampin for osteomyelitis
Definition
150, 300 mg Max: 600mg qd
10 mg/kg PO qd
combo with Bactrim
Breaks up adhesions caused by Staphylococcus species
Term
Implantation of beads as treatment for osteomyelitis
Definition
30 yr use vancomycin is less toxic than polymethymethacrylate .5g vancomycin for 10g of BIOPEX
Term
Chronic osteomyelitis treatment
Definition
6 months of minocycline or doxycycline Bcteriostatic against MRSA
Term
Most common bacterial agent of infectious arthritis for adults 18 to 30?
Definition
N. gonorrhae
48% S. aureus for non gonococcal infections
Term
What type of spread is the majority of cases of infectious arthritis from?
Definition
Hematogeneous
Term
Risk Factors for adults with septic arthritis
Definition
> or equal to 80yr hx of chronic arthritis superficial skin ulceration prosthetic joint diabetes IV drug use Biologic agent therapy
Term
Clinical Predictors to differentiate septic arthritis from transient synovitis
Definition
1. HX of fever >38.5*C 2. Inability to bear weight 3. ESR>40mm/hr 4. serum WBC >12,000 If all 4 predictors then 99% predictive for septic athritis
Term
Empiric Treatment for Neonates for Infectious Arthritis
Definition
ceftriaxone
clindamycin may be used as well
polyarticular disease
Term
Empiric Treatment for Children for Infectious Arthritis
Definition
Anti- staphyloccoccal agent
Consider MRSA
Oral Therapy after 4 to 7 days
Term
Empiric Treatment for Adults for Infectious Arthritis
Definition
Similar to osteomyelitis
switch to oral sooner with reduction in ESR, fever, and WBC
Term
Empiric Treatment for positive gram stain for Infectious Arthritis
Definition
cefazolin
cocci- Vancomycin (MRSA is suspect)
Term
Empiric Treatment for Negative gram stain for Infectious Arthritis
Definition
cocci-ceftriaxone (Rocephin)
rods-ceftazidime (Fortaz)
any third generation cephalosporin
Vancomycin plus ceftazidime or an aminoglycoside
Term
Empiric Treatment for Psuedomonas- IV drug users for Infectious Arthritis
Definition
ceftazidime and gentamicin
Term
Empiric treatment if allergic to penecillin or cephalosporin for Infectious Arthritis
Definition
aztreonam or a floroquinolone
Term
Sequelae from osteomyelitis
Definition
limited joint pain
persistent pain
shortening of the effected extremity
50% of children develop residual joint damage
Term
Skeletal Tuberculosis
Definition
MC is the Thoracic spine
Potts Disease
Articular TB is progressive of the hip or knee
Extraspinal TB osteomyelitis may develop on any bone
Term
Disgnosis of Skeletal TB
Definition
50% have positive CXR
QuantiFERON-TB Gold test
Most cases are mistake for neoplasia
Follow treatment outlined for TB
Surgery to drain abcess for on MRI
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