Term
|
Definition
Contiguous spread- 47%
Peripheral Vascular Disease- 34%
Hematogenous- 19%
Diabetes Mellitus and Peripheral Vascular Disease predispose you for Osteomylitis |
|
|
Term
|
Definition
Inflammatory Bone change after a 2 week infection
56% |
|
|
Term
|
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
|
|
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
|
Definition
Medullary Osteomyelitis
Hematogeneous Infection |
|
|
Term
|
Definition
Superficial Osteomyelitis
Only Cortical Bone
Contiguous Infection |
|
|
Term
|
Definition
Localized Osteomyelitis
Medullary Cavity and Cortical Bone
Not through the Diameter of the Bone |
|
|
Term
|
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
|
|
Term
| Length of oral antibiotics for adults from a hematogeneous source |
|
Definition
| 4 weeks then reassess and you may restart treatment |
|
|
Term
|
Definition
100-200mg/kg/day q 4-6h
Max: 12 g/day |
|
|
Term
|
Definition
50-100 mg/kg IV/IM q8h
Max: 6 g/day |
|
|
Term
|
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
|
|
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
|
|
Term
| Fluoroquinolone used for Osteomyelitis Contiguous Spread |
|
Definition
|
|
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
|
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
|
|
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
|
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
|
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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|
