ID Lecture 37: Pathophys & Therapeutics of Osteomyleitis, Septic Arthritis, and Diabetic Foot Ulcer | Quizlet

Diabetic Foot Ulcer (DFU)

breakdown in the epidermis and dermis that is likely to be colonized by bacteria but NOT infected

Diabetic Foot Infection (DFI)

foot ulcer w/ inflammatory response due to invasion of pathogenic bacteria

Describe the pathophysiology of DFU

Diabetes (chronic high BG)

Vascular dx, neuropathy, and impaired neutrophil function

Impaired wound healing, ischemia, and dry/cracked skin

Diabetic foot ulcer

Charcot foot

repeat injury to the food that is not allowed to heal - no infection is present

What are the s/sx of DFI?

Inflammation

Redness

Warmth

Swellling

Tenderness/pain

Purulent secretions

What is considered to be a mild DFI?

Small area is involved (<2 cm)

What is considered to be a moderate DFI?

Larger/deeper (>2cm)

+/- osteomyleitis

(no SIRS criteria)

What is considered to be a severe DFI?

Sepsis +/- Osteomyleitis

(SIRS criteria are met)

What are the common pathogens of a mild DFI with no other complicating factors?

Staph or streptococci

What are the common pathogens of a mild DFI with recent antibiotic use?

Staph, strep, and gram negative rods

What are the common pathogens of a mild DFI with a previous MRSA infection/colonization?

Staph, strep, gram negative rods, and MRSA

What are the common pathogens of a moderate/severe DFI with no other complicating factors?

Staph, Strep, and gram negative rods

What are the common pathogens of a moderate/severe DFI with a macerated ulcer or live in a warm climate?

Staph, Strep, gram negative rods, and PA

What are the common pathogens of a moderate/severe DFI with a ischemic limb, necrosis, or live in a dry climate?

Staph, Strep, gram negative rods, and anaerobes

What are the common pathogens of a moderate/severe DFI with risk factors for MRSA?

Staph, Strep, gram negative rods, and MRSA

True or false: Culture uninfected wounds.

False - something will grow and lead to false treatment

When should cultures be taken in infected wounds?

Deep tissue culture before starting antibiotics

What is arguably the most important thing besides antibiotics in DFIs?

Wound care

When should antibiotics be started in DFIs?

Systemic s/sx of infection

Culture positive

When would antibiotics not be started in DFIs?

no s/sx of systemic infection

What is the recommended treatment for mild DFIs with no complicating factors?

Cephalexin

Augmentin

What is the recommended treatment for mild DFIs with previous MRSA infection or colonization?

Bactrim

Doxycycline

Linezolid

Clindamycin (last line)

What is the recommended treatment for mild DFIs with recent antibiotic use?

Augmentin

What is the recommended treatment for moderate to severe DFIs with no other complicating factors?

IV

- Ampicillin/Sulbactam

- Ceftriaxone

PO

- Augmentin

What is the recommended treatment for moderate to severe DFIs with a warm macerate ulcer or warm climate?

IV

- Zosyn

- Cefepime

PO

- Levofloxacin

- Augmentin + Ciprofloxacin

What is the recommended treatment for moderate to severe DFIs with an ischemic limb, necrosis, or gas?

IV

- Ampicillin/Sulbactam

- Ceftriaxone + Metronidazole

- Carbapenems

PO

- Augmentin

What is the recommended treatment for moderate to severe DFIs with MRSA risk factors?

Add to any regimen:

IV

- Vancomycin

- Linezolid

- Daptomycin

PO

- Doxycycline

- Bactrim

- Linezolid

What antibiotics are options for treatment of osteomyelitis?

highly bioavailable PO antibiotics

What are some non-pharmacological treatments of DFUs?

Wound care

Off-loading

Vascular eval

Glycemic control

Smoking cessation

How long should the duration of antibiotics be for mild DFI without osteomyelitis?

1-2 weeks

How long should the duration of antibiotics be for moderate/severe DFI without osteomyelitis?

2-4 weeks

True or false: Antibiotics need to be continued until the wound is healed.

False

How long should antibiotics be taken in DFI with osteomyelitis where there is no residual infection?

2-5 days

How long should antibiotics be taken in DFI with osteomyelitis where there is residual soft tissue infection but no bone?

1-2 weeks

How long should antibiotics be taken in DFI with osteomyelitis where there is residual but viable bone?

3 weeks

How long should antibiotics be taken in DFI with osteomyelitis where there is no surgery or residual non-viable bone?

6 weeks

What antibiotics are highly bioavailable orally?

Clindamycin

Bactrim

Doxycycline

Quinolones

Septic arthritis

inflammation of the joint caused by infection

What are the risk factors for septic arthritis?

Age

Previous joint injury

IV drug use

Alcoholism

IA injections

Cutaneous ulcers

Diabetes

What are the most common pathogens seen with septic arthritis?

S. aureus

Streptotocci

How does septic arthritis typically present?

Monoarticular

Knee (most common)

Severe pain that limits mobility

Warmth and redness

What is used to diagnose septic arthritis?

Athrocentesis with WBC >50,000

What is important to look for besides WBC in septic arthritis? Why?

Presence of crystals - because gout presents like septic arthritis

What antibiotics are recommended for septic arthritis?

Vancomycin IV +/- Ceftriaxone if there are risk factors for Gram negative or gonorrheal infection

When should antibiotics be started in septic arthritis?

After aspiration of synovial fluid

OR

Septic

What are the most common bacterial causes of prosthetic joint infections?

S. aureus

Gram negative rods

Coagulase negative staph

Corynebacterium

Propionibacterium

Bacillus spp

*CREATE BIOFILMS*

What is the s/sx of prosthetic joint infections?

Similar to septic arthritis

Joint loosening

Painful prosthesis

Draining sinus tract

When should antibiotics be started in prosthetic joint infections?

After intra-op cultures are obtained

Systemic infection

What treatment is recommended for prosthetic joint infections if debridement and retention of prosthesis occured?

2-6 weeks of IV and PO Rifampin

What treatment is recommended for prosthetic joint infections had a resection arthroplasty w/ or w/o planned staged reimplantation?

6 weeks IV or PO

What is the treatment recommendation of a 1 stage exchange in a prosthesic joint infection?

2-6 weeks IV therapy

PLUS Rifampin

Followed by Rifampin PLUS therapy for 6 months