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10. Bones and joints infections.pptx
- 1. Bones and jointsinfections By Solomon Weldegebreal(B.pharm, Msc)
- 2. Bones and jointsinfections • Osteomyelitis • Prosthetic Joint Infections, • Diabetic Foot Infections, and Septic Arthritis
- 3. Introduction • Infection ofthe bone with subsequent bone destruction • Around 20 cases per 100,000 population • The epidemiology of osteomyelitis has been changing over the past several decades The incidence of acute hematogenous osteomyelitis, which is most often seen in children, has been declining • the frequency of contiguous osteomyelitis has been increasing - PVD, DM, Trauma, prosthetic implants and surgical interventions
- 5. Pathophysiology • Healthy bonetissue is normally resistant to infection but may become susceptible under certain condition • Bone can become infected via: via the presence of bacteria in the bloodstream, by direct inoculation from trauma or surgery, and by spread from an adjacent site (e.g., soft- tissue infection).
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- 12. Clinical presentation • Hematogenousthe patient typically experiences systemic and localized signs and symptoms • In comparison, patients with chronic infection typically present with only localized signs and symptoms. • Common signs and symptoms of osteomyelitis include: Systemic: Fever, chills, malaise Localized: Pain or tenderness, edema, erythema, inflammation, decreased range of motion of infected area
- 13. Diagnosis • The diagnosisof osteomyelitis is based on clinical findings, laboratory tests, and imaging studies • The gold standard for diagnosis is a bone biopsy with isolation of microorganism(s) from culture and the presence of inflammatory cells and osteonecrosis on histological exam o Due to the invasive nature of this procedure, imaging studies and laboratory tests are generally used in making diagnose.
- 14. Diagnosis • Non-specific inflammatorymarkers for infection include WBC, ESR, and CRP may be elevated or within normal limits. An elevated WBC is mostly seen in patients with a cute osteomyelitis. CRP rises faster than ESR during early stages of infection. CRP returns to normal levels more quickly than ESR.
- 16. Treatment Desired Outcomes The treatmentgoals for osteomyelitis are to eradicate the infection and prevent recurrence. Cure rates of greater than 85% have been reported for acute hematogenous osteomyelitis. In contrast, chronic osteomyelitis is associated with higher failure rates largely due to the presence of necrotic bone
- 17. General approach totreatment • Antimicrobial therapy alone is the mainstay of treatment for acute osteomyelitis. • In comparison, treatment for chronic osteomyelitis typically requires a combination of antimicrobial therapy and surgical intervention • If the patient is not a candidate for surgical intervention, prolonged antimicrobial therapy is generally necessary
- 18. Pharmacologic treatment • Empiricantimicrobial therapy should target likely causative pathogen(s) based on patient-specific risk factors and route of infection • Empiric antimicrobial coverage against S. aureus should be considered for all classifications of osteomyelitis. • Specific recommendations may vary based on factors such as patient allergies, potential for harboring a resistant organism, institution formulary, and cost considerations
- 19. Pharmacologic treatment • Typically,treatment is initiated with intravenous • antimicrobials to ensure that therapeutic drug concentrations will be achieved in the bone • Intravenous therapy can be administered in the inpatient or outpatient setting • Following 1 to 2 weeks of intravenous therapy, a switch to oral antibiotics may be considered in patients with good adherence and outpatient follow-up
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- 21. Pathogen-Targeted Antimicrobial Therapyand Dosing Recommendations in Pediatrics and Adults
- 24. Selective toxicity anddrug interactions associated with antimicrobials
- 28. Patient Case • W.A.is a 55-year-old man who presents with weight loss, malaise, and severe back pain and spasms that have progressed during the past 2 months. He has also experienced loss of sensation in his lower extremities. Four months before this admission, he had surgery for a fractured tibia, followed by an infection treated with unknown antibiotics. W.A. has hypertension and diverticulitis. On physical examination, he is alert and oriented, with the following vital signs: temperature 99.4°F (37.4°C); heart rate 88 beats/minute; respiratory rate 14 breaths/minute; and blood pressure 130/85 mm Hg. His laboratory values are within normal limits, except for WBC 14,300, erythrocyte sedimentation rate 89 mm/hour, and C- reactive protein 12 mg/ dL. Magnetic resonance imaging shows bony destruction of lumbar vertebrae 1 and 2, which is confirmed by a bone scan. A computed tomography–guided bone biopsy shows gram-positive cocci in clusters. Which one of the following is the best initial therapy for W.A.? A. Vancomycin 15 mg/kg intravenously every 12 hours—duration of antibiotics: 6 weeks. B. Nafcillin 2 g intravenously every 6 hours—duration of antibiotics: 2 weeks. C. Levofloxacin 750 mg/day orally—duration of antibiotics: 6 weeks. D. Ampicillin/sulbactam 3 g intravenously every 6 hours—duration of antibiotics: 2 weeks.
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