Term
| What is peripheral motor neuropathy? |
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Definition
| abnormal foot anatomy + increased pressure, callus formation and ulcers |
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Term
| What is peripheral sensory neuropathy? |
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Definition
| Lack of protective sensation=failure to sense injuries |
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Term
| What is peripheral autonomic neuropathy? |
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Definition
| DEficient sweating=cracked dry skin |
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Term
| What is neuro-osteoarthropathic deformities? |
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Definition
| similar to motor neuropathy, deformities lead to increased pressure (especially mild-plantar area) |
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Term
| What are the pathogen involved in infected ulcer, abx naiive (monomicrobial)? |
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Definition
| Beta-hemolytic strep/ S.aureus |
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Term
| what are pathogens involved in chronic ulcer, exposure to abx (polymicrobial)? |
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Definition
| S.aureus, Strep, Enterobacteriaceae |
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Term
| Pathogens involved in macerated ulcer from soaking (polymicrobial)? |
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Definition
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Term
| Pathogens involved in nonhealing ulcer w/ prolonged abx exposure (polymicrobial, resistance)? |
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Definition
| S.aureus, CoNS, Enterococci, diphteroids, G- Rods, others |
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Term
| Pathogens extensive necrosis or gangrene (polymicrobial)? |
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Definition
| Mixed aerobic G+ cocci, G- Rods and anearobes |
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Term
| What needs to be present to consider infected? |
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Definition
At least 2 of the followings:
Warmth
Erythema
Tenderness
Swelling
Or, pus from ulcer site and/or nearby sinus tract |
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Term
| Treatment for non-infected site? |
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Definition
Provide supportive care
Ensure wound care
Off-load local foot pressure
Ensure proper footwear
Optimize glycemic control
Consult as needed, no Abc tx needed
evaluate & re-evaluate for healing |
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Term
| According to IDSA PEDIS 2 (mild infection) is? |
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Definition
| >=2 markers of inflammation w/ cellulitis/ erythema <= 2 cm around ulcer, limited to superficial; no systemic toxicity |
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Term
| According to IDSA PEDIS 3 (moderate infection) is? |
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Definition
| Features of mild infection & >=1 of the following: cellulitis > 2 cm around ulcer, lymphangetic streaking, spread beneath fascia, abscess, gangrene, involvement of bone or joint, muscle. |
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Term
| According to IDSA PEDIS 4 (severe infection)is ? |
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Definition
| Systemic toxicity or metabolic instability fever, chills, tachycardia, hypotension, confusion, acidosis, vomiting, severe hyperglycemia, azotemia |
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Term
| Tx mild 1st time infections? |
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Definition
narrow spectrum Abx w/ good G+ activity (probably monomicrobial Staph or Strep)
-Dicloxacillin PO
- Clindamycin PO
-Cephalexin PO
If chronis infx (polymicrobial & anaerobes):
TMP-SMX PO, Augmentin PO (G+ & G-), Levo PO (some anaerobic, but not MRSA) |
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Term
| Treatment for moderate infections? |
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Definition
TMP-SMX PO, Augmentin PO, Levo PO/IV, Cefoxitin 2nd GC IV, Ceftriaxone 3rd GC IM/IV, Ampicillin/ Sulbactam IV
- Linezolid (MRSA) PO/IV/ + or - Aztreonam IV
- Daptomycin IV /+ or - Aztreonam IV
- Ertapenem IV
- Levo/ Cipro IV/PO + clinda IV/PO
- Ticarcllin/ clavulanate or piperacillin/tazobactam IV
- Cefuroxime 2nd GC IV/PO + or - metronidazole IV/PO |
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Term
| Treatment of severe infection? |
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Definition
| Piperacillin/tazobactam IV, Levo/Cipro IV/PO + clinda IV/PO, Imipenem-cilastatin IV, Vanco & ceftazidime (pseudomonas coverage) (+ or - metronidazole (covers anearobes)) |
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Term
| Which type of osteomyelitis id the most prevalent? |
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Definition
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Term
| Hematogenous osteomyelitis? (disease of childre <16 yo) |
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Definition
Long bones predisposed: Femur, tibia, fibula, humerus, Vascular structure (sludging of blood at hairpins), less active phagocytosis
Single pathogen mostly S. aureus
other based on risk fatcors:
Neonates: E.coli or grp B strep
Elderly: (vertbra) E.coli 2nd to UTI |
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Term
| Contiguous- spread osteomyelitis w/ vascular insufficiency predisposing factors? |
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Definition
| age >50, postoperative (hip fractures, soft tissue infx) |
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Term
| Contiguous- spread osteomyelitis w/ vascular insufficiency pathogens? |
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Definition
Single or mutliple
S. aureus predominant pathogen
Other based on site:
Mandibular osteomyelitis-mixture of aerobic/ anaerobic oral flora |
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Term
| What is the gold standard lab test for osteomyelitis? |
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Definition
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Term
| Hematogenous emperic therapy? |
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Definition
All IV: MRSA likely:
New born: Vanco IV + 3rd gen Ceph IV (E.coli)
Children: Vanco IV
Adults: Vanco IV (if G- or anearobes vertebral (Ecoli) add another agent
If MRSA unlikely:
New born: Nafcillin IV + 3rd gen Ceph IV (cefotaxime, cefazidime, ceftizoxime, ceftriaxone)
Children: Nafcillin IV (S.aureus)
Adults: Nafcillin 2 g IV Q 4 h (S. aureus)
Duration 6 wks, children 4 wks |
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Term
| Tx if foot bone non-diabetic, d/t puncture wound? |
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Definition
Cirpo, ceftazidime (alternative)
treat for 6 wks |
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Term
| Tx long bone (post fracture)? |
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Definition
Vanco + ceftazidime
Linezolid + ceftazidime (alternative)
Treat for 6 wks |
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Term
| Tx sternum (post op)-MRSA/MRSE likely? |
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Definition
| Vanco, linezolid (alt) Treat for 6 wks |
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Term
| Emperic tx Osteomyelitis w/ vacular insufficiency? |
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Definition
Cover all:
MRSA- Vanco or linezolid
MSSA- Cefazolin or nafcillin or ampicillin/sulbactam
Gram- bacilli include pseudomonas:
3rd gen ceph (ceftazidime) or cipro or levo
Anaerobes ( if foul smelling): Metronidazole or clinda (amp/sulb would also work)
duration 6 wks |
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Term
| PO abx for acute osteomyelitis (confirmed)? |
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Definition
Children: amoxicillin, cephalexin, dicloxacillin
Adults: PO FQ |
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Term
| Who are candidates for PO outpatient? |
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Definition
Children w/ good clinical response to IV
Adults w/o DM or PVD
Less likely to develop chronic osteomyelitis |
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Term
| Limitation for PO cirprofloxacin? |
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Definition
| Poor coverage for anaerobes, staph, pseudomonas resistance high, not used in children <16/18 yo, not to be used in pregnancy |
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Term
| Advantages of PO Ciprofloxacin? |
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Definition
Effective against G- bacilli (enterobacter, serratia)
Avoids long term AMG /toxicities, effective in chronic osteomyelitis, 12 hr dosing schedule |
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