Bone and Joint Infections

Describe osteomyelitis

inflammation of bone causing inflammation of bone marrow and surrounding bones

Describe septic arthritis

inflammatory rxn within joint tissue and fluid due to organism

describe prosthetic joint infection

infection of prosthetic join and joint fluid

What culture to obtain for osteomyelitis

bone sample/biopsy and blood culture

What type of culture for septic arthritis?

joint aspiration with examination of synovial fluid

What type of culture for prosthetic join infection?

joint aspiration with examination of synovial fluid

Causative pathogens for bone and joint infections

Staph aureus

decsribe the duration and dose antibioitcs used for bone and joint infections comapred to other types of infections

longer duration and higher dose

Duration of treatment for osteomyelitis

4-8 weeks

Duration of treatment for septic arthritis

2-4 weeks

Duration of treatment for prosthetic joint infections

6-12+ weeks

_____ (route) is typically recommended for bone/joint infections

IV whole time

explain hematogenous spread cause of bone/joint infection. is it typically mono or poly microbial?

microbes reach bone/joint via bloodstream. Mono

osteomyelitis is typically seen in the _____ bone in kids and the ____ in adults

long bones in kids and vertebrae in adults

explain contiguous spread cause of bone/joint infection. is it typically mono or poly microbial?

spread from SSTI or direct inoculation and Poly

explain vascular insufficiency cause of bone/joint infection. is it typically mono or poly microbial?

spread from SSTI and poly

What is gold standard for diagnosing osteomyelitis? What do you treat with (general, don’t list drugs)

MRI and treat with surgery and antibiotics

when it is appropriate to hold antibiotic therapy for bone/joint infections?

when awaiting biopsy or surgery if clinically stable

Empiric IV treatment for osteomyelitis

beta lactam or FQ AND mrsa if needed with vanc/dapto/linezolid

Treatment options for MSSA osteomyelitis

nafcillin or cefazolin

Treatment options for MRSA osteomyelitis

vanc, dapto, linezolid, smz-tmp

Treatment options for streptococci osteomyelitis

penicillin or ceftriaxone

Treatment options for enterococci osteomyelitis

ampicillin, vanc, dapto, or linezolid

Treatment options for GNR (non PsA) osteomyelitis

ceftriaxone, cipro, smz-tmp

Treatment options for PsA osteomyelitis

pip/tazo, cefepime, or cipro

Treatment options for polymicrobial osteomyelitis

meropenem, ertapenem, pip/tazo, or amp/sulbactam

the antibiotic duration for vertebral osteomyelitis due to MRSA is _____

8 weeks

for diabetic foot related osteomyelitis with complete resection, the duration of antibiotics is ______

2-5 days

for diabetic foot related osteomyelitis with resection of osteomyelitis but has SSTI, the duration of antibiotics is ______

1-2 weeks

for diabetic foot related osteomyelitis with resection of osteomyelitis but it still lingers, the duration of antibiotics is ______

3 weeks

for diabetic foot related osteomyelitis with no resection, the duration of antibiotics is ______

6 weeks

explain how dalbavancin may be an alternative for osteomyelitis

2 dose strat with 1500mg IV on day 1 and 8 that provides 6-8 weeks of coverage

____ is the common pathogen of septic arthritis

staph aureus

with arthrocentesis, a PMN of _____ indicates infection in septic arthritis

>50,000

the duration of septic arthritis caused by S. aureus and GNRs is ______

4 weeks

the duration of septic arthritis caused by Streptococci is ______

2 weeks

the duration of septic arthritis caused by N. gonorrhoeae is ______

7-10 days

Prosthetic joint infections develop via same 3 mechanisms but differs from osteomyelitis and septic arthritis how?

develops biofilm that impedes antibiotic penetration

explain the empiric treatment of septic arthritis

same as osteomyelitis: b-lactam or FQ + MRSA coverage

______ is the common causative pathogen of PJI

staph aureus

ideally in PJI, what is the first thing that should be done

surgery to remove joint

debridement + retention of prosthesis is when ____. What is the risk?

joint is cleaned but not removed. High risk of infection

1-stage exchange is when ______. What is the risk?

one surgery and replaces joint. Risk of reinfection

2-stage exchange is when ______. What is the risk?

2 surgeris where you remove joint and then put spacer. Once it clears, replace joint

when should rifampin be added to PJI treatment?

debridement or 1 stage exchange

explain the empiric treatment of PJI

indicated beta lactam or FQ + MRSA coverage

route of osteomyelitis vs PJI treatment

OM is IV. PJI is PO or IV

the duration for PJI pathogen directed treatment of debridement is ______

2-6 weeks

the duration for PJI PO treatment of debridement is ______

3 months for hip, 6 months for knee or other joint

the duration for PJI PO treatment of 1-stage exchange is ______

3 months