Term
| What are the indications for maggot debridement? |
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Definition
Clean
Disinfect
Stimulate healing |
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Term
|
Definition
Infection of the bone
- Contiguous - most common. Blunt trauma or surrounding space
- Hematogenous - through blood
- PVD - 2nd most common
**Acute or chronic |
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Term
| What is septic arthritis? |
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Definition
| Infection of a joint, more common than osteomyelitis. Hematogenous in origin |
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Term
| What is hematogenous osteomyelitis? |
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Definition
Vascular long bones - blood flow is slow/sluggish. Lack of macrophage. Trauma = infection.
More likely in kids
**Sequestrae - dead bone that separates from healthy bone due to impaired blood flow
** Involucrum - New bone that is separated. Leads to chronic OM |
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Term
| What causes hematogenous-OM? |
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Definition
- USUALLY S. aureus - kids
- IVDA - Pseudomonas (remember Staph in endocarditis)
- Sickle cell - Salmonella |
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Term
| What causes contiguous-OM? |
|
Definition
- Most prevalent, age > 50. From fractures and surgery.
- S. aureus, and GNB |
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Term
|
Definition
- Diabetes or severe atherosclerosis
- Polymicrobic - staph, strep, anaerobes, enterococci |
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Term
| What organisms affect different age groups in OM? |
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Definition
- Infants < 1 year - Strep, S. aureus, E. coli
- 1-16 - S. aureus, S. pyogenes, H. influenzae
- Adults - S. epidermidis, S. aureus, P. aerug, Serratia, E. coli |
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Term
|
Definition
- Radiographs - not specific
- Bone scan
- ESR and CSR always increased
- culture by aspiration |
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Term
| What is the prognosis for OM infections? |
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Definition
- Acute - cure rate 80%
- Chronic - poor outcome, need continue debridement. Prolonged Tx |
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Term
| What is the criteria for oral OM therapy? |
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Definition
- Assured compliance
- Good response to IV therapy in kids or adults WITHOUT DM or PVD. Sensitive to FQs
- Afebrile x3 days, decreased ESR |
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Term
| What is empiric tx for OM? |
|
Definition
- Kids - S. aureus - Nafcillin or Cefazolin. Nafcillin + Cefotaxime in the very young
- Adults - S. aureus - Nafcillin or Cefazolin
- IVDA - P. aerug - Cipro or Ceftazidine + Tobra
- Post-op - Nafc+ceftazidime or ticar+clav
- vascular insuff - |
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Term
| What are MRSA guidelines for OM and infectious arthritis? |
|
Definition
- Debridement
- Vanc or daptomycin
- May add rifampin
- X8 weeks (4 weeks of infectious arthritis) |
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Term
| What is infectious arthritis? |
|
Definition
- Infection of the joint - synovial fluid usually sterile. Children < 16 or adults > 50
- From adjacent bone infection, direct contamination, hematogenous |
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Term
| What are the 2 types of infectious arthritis? |
|
Definition
- nongonococcal - fever, Synvial WBC > 100,000, single joint, ESR high. Knee > hip > ankle. ACUTE. S. Aureus
- Gonococcal - migratory, lower WBC, prolonged presentation. Common in adults < 30. SUSPECT GONORRHEA |
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Term
| How is infectious arthritis diagnosed? |
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Definition
- WBC between 50-200K
- Low glucose
- cultures between 20-50% sensitive
- Lactic acid elevated in nongonococcal |
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Term
| When are other organisms that can cause infectious arthritis? |
|
Definition
- GNB - in the very young and old
- H. influenzae - Children < 5
- S. epidermidis - elderly |
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Term
| How is infectious arthritis treated? |
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Definition
- Children < 5 - Nafcillin + AG. Or cefazolin if had flu shot
- Children > 5 - Nafcillin.
**For 2-3 weeks
- Adults - Ceftriaxone 1g q24h x 7-10 days
- IVDA - Ceftazidime + tobra
**MRSA: Clinda, Vanc, or linezolid |
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Term
| What is the monitoring for bone and joint infections? |
|
Definition
- C&S at initiation
- WBC 1/week
- CRP/ESR weekly
- clinical signs of inflammation daily
- Compliance!!! |
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