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Bone And Joint Infections PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Bone and Joint Infections”.

This medical PowerPoint presentation is about bone and joint infections, serious medical conditions that can lead to significant morbidity and mortality if not treated promptly and effectively. These infections can affect the bones, joints, and surrounding tissues, and can be caused by a variety of bacteria, viruses, fungi, and other pathogens.

Some common types of bone and joint infections include:

Osteomyelitis: This is a bone infection that can occur in any bone in the body, but is most common in the long bones of the arms and legs. It is usually caused by bacteria, and can be acute or chronic.
Septic arthritis: This is an infection of the joint that can be caused by bacteria, viruses, or fungi. It can cause significant pain and swelling, and can lead to joint damage and disability if not treated promptly.
Prosthetic joint infections: These are infections that can occur after joint replacement surgery. They are usually caused by bacteria, and can be difficult to treat.
Discitis: This is an infection of the intervertebral discs in the spine. It can cause severe back pain and can lead to nerve damage if not treated promptly.

Treatment for bone and joint infections typically involves a combination of antibiotics and surgery to remove any infected tissue. In some cases, joint replacement surgery may be necessary to repair or replace damaged joints. Early diagnosis and treatment are key to preventing long-term complications and improving outcomes for patients with these serious infections.

Tags : Bone Infections, Joint Infections, bones, joints, Osteomyelitis, Septic arthritis, Prosthetic joint infections, Discitis, Orthopaedic Surgery, Orthopaedic Surgery PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1877 | Downloads : 1

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Slide 1-

Bone and Joint Infections
Slide 2-

Risk Factors Corticosteroids-33% Existing arthritis-24% Infection elsewhere-22% DM-13% Trauma-12% None-8%
Slide 3-

Frequency of Joints Knee-48% Hip-24% Ankle-7% Elbow-11% Wrist-7% Shoulder-15% Sternoclavicular-8%
Slide 4-

Pathology High vascularity S. aureus collagen-binding adhesin associated with osteomyelitis but not septic joint Disruption of normal joint by pre-existing joint disease Proteolytic enzymes released
Slide 5-

Signs and Symptoms Joint pain, swelling, warmth, and decreased range of motion Joint tenderness to pressure or movement Tendon tenderness Fever May resemble acute crystal dz. or hemothrosis
Slide 6-

Organisms Associated Neisseria-1-12% Non-gonorrhea-S. aureus-37-56%, Streptococcal-10-28%, GNR-4-19%, coagulase negative staph-5%, anaerobic-2%, PMB-less than 10% Am Rheum Disease-2002, 61:267
Slide 7-

Septic Arthritis-odd organisms Lyme, Mycoplasma Listeria, enterococcus, chlamydia M. tuberculosis, atypical Tb Candida,sporothrix, blastomycosis/coccidiomycosis Rubella, hep b and c, EBV, parvovirus, mumps
Slide 8-

Synovial Effusion Normal-clear, viscous, colorless-<200 wbc (<25% pmns) Noninflammatory-clear, viscous, yellow 200-2000 wbc-<25% pmns Inflammatory-cloudy, watery, yellow-2000-50,000 cells (>50% polys)
Slide 9-

Synovial Effusion, continued Infected-purulent->50,000 cells (>75% pmns) Great overlap at times
Slide 10-

Gonococcal vs. non gc Arthritis Gc-sexually active adults, migratory polyarthralgias, tenosynovitis, dermatitis common, >50% polyarthritis, BC positive <10%, joint fluid positive 25%
Slide 11-

GC vs. non GC Non GC-very young or elderly, polyarthralgias, tenosynovitis rare, dermatitis rare, >85% monoarthritis, BC positive 50%, joint fluid positive 85-90% NEJM-1985, 312:764-771
Slide 12-

Outcome of Bacterial Arthritis 154, 121 adults-half had joint disease 29% of joints contained synthetic material Poor outcome in 21% of patients-10% mortality Poor joint outcome in nearly 50% of patients
Slide 13-

Outcome continued Risk factors for poor outcome include-older age, existing joint disease, synthetic joint Arthritis and Rheumatism 1997, 40:884.
Slide 14-

Factors Associated with Poor Prognosis Age >60 years Pre-existing rheumatoid arthritis or hip or shoulder infection >1 week of infection >4 joints involved Positive cultures after 7 days of appropriate treatment
Slide 15-

Management Antimicrobials do achieve adequate levels in joint fluid Joint effusion drainage necessary but best method to drain is uncertain
Slide 16-

Prosthetic Hip Infxns, Organisms Gram positive-CNSE>S. aureus>streptococcus>enterocc Gram negative-Enteric>pseudomonas Anaerobes-least common J Bone Jt. Surg-1996, 78:512
Slide 17-

Results of Rx of Infxns-Prosthetic Hip Positive intraoperative-28/31 good outcome (90%) 3.5 year followup Early Postoperative 25/35 (71% good outcome) 3.3 yrs followup Late chronic-29/34 (85%) good outcome-4.2 years followup
Slide 18-

Results of Treatment continued Acute hematogenous-3/6 (50%) good outcome-2.6 years followup Journal Bone and Joint Surgery 1996, 78:512
Slide 19-

Prosthetic Joint Infection Positive intraoperative cx-6 weeks iv with no surgical Rx Early (one month)-surgical, remove liner, leave bone components, 4 weeks iv antibiotics
Slide 20-

Prosthetic Joint Infection Late chronic infection-debridement, remove components and cement, 6 weeks iv antibiotics Acute hematogenous-treatment same as early postoperative, replace components if loose J Bone Jt Surg 1995, 77: 1576
Slide 21-

Rifampin Containing Regimens Proven S. aureus or coagulase negative staph infxns. Stable joint with sms less than 21 days Initial debridement and 2 weeks of antistaph followed by oral for 3 months if hip or 6 months if hip
Slide 22-

Rifampin Containing Regimens 12/12 cured with cipro+rifampin 7/12 cured with cipro plus placebo JAMA-1998, 279, 1537 Lancet 2001, 1:175.
Slide 23-

Suppression with oral In one study of patients who were high risk/poor function if joint removed-treatment mean was 37.6 months 10/13 patients required prothesis removal for recurrent infections (mean 21.6 months
Slide 24-

Suppression-continued Conclusion-benefits are limited Orthopaedics-1991, 14:841.
Slide 25-

Osteomyelitis classification Cierny and Mader-Orthopaedic Review-1987, 16:259 I-medullary, II-superficial, III-localized, IV-diffuse Host factors-A-normal, B-compromised, C-prohibitive Waldvogel-NEJM-1970, 282:198 Hematogenous, continguous
Slide 26-

Types of Host Compromise Local-lymphedema, venous stasis, vessel disease, arteritis, scarring, xrt, neuropathy, tobacco Systemic-malnutrition, liver/renal, dm, malignancy, immunosuppresion, age extremes, chronic hypoxemia
Slide 27-

Osteomyelitis diagnosis Staging studies-MRI, CT, nuclear scans, ESR, CRP, bone biopsies and cultures
Slide 28-

Osteomyelitis treatment Surgery and antibiotics Controversies in length of treatment, etc.
Slide 29-

Diabetic Foot MRI-99% sensitive, 83% specific Plain x-ray-60% sensitive, 66% specific Tc99m bone scan-86% sensitive, 45% specific In111 WBC-89% sensitive, 78% specific, CID 1997: 25: 1318
Slide 30-

Probing to Bone Technique to determine bone infection Sterile, steel probe used positive test if bone can be touched with probe Sensitivity-89%, specificity-85% JAMA-1995. 273:721
Slide 31-

Diabetic Foot 254 isolates from 96 patients S. aureus-38 isolates, Enterococcus-31, peptostreptococcus-31, CNSE-27, streptococcus sp-27, proteus-10, klebsiella-10 CID-1995, 20 (supplement 2).
Slide 32-

Treatment Surgical debridement Avoid weight bearing Antibiotics-4-6 weeks iv/oral combination Surgical bone resection may shorten antibiotic course
Slide 33-

Prognosis Risk factors for amputation were highest in the group with severe neuropathy-12.9 odds ratio and no diabetes education-16.3 odds ratio vs low O2 tension and PVD-odds ratio of 1.1
Slide 34-

Vertebral 123 patients Back and neck pain-96% Fever-43% Increased WBC-34% ESR-84%
Slide 35-

Organisms S. aureus-68% Enterobacteriae-28% Streptococcus-8% CNSE-3% P. aeruginosa-<1%, candida-<1%
Slide 36-

Organisms continued Unusual causes include-bartonella henselae in association with cat scratch Aspergillosis-41 cases in literature with 34% no predisposing factors
Slide 37-

Vertebral-epidemiology Mean age-59 years with sms for 48 days Blood cultures positive up to 78% Paraspinal or epidural extension in 74%-did not correlate with neurologic deficits in 28%
Slide 38-

Vertebral 58/101 hematogenous vertebral osteomyelitis cases who had surgery with less back pain in follow-up Only 18% with epidural abscess and 23% with paralysis fully recovered after surg decompression
Slide 39-

Continued 100% of patients with paraparesis recovered completely following decompression surgery