and Joint Infections骨和关节感染课件.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Skeletal Tuberculosis Skeletal Tuberculosis Clinically Pott’s disease 50% have weakness or paralysis at the time of presentation or during Rx 50% associated with disc involvement 50% without disc involvement are younger and more likely to have other skeletal lesions 77% have epidural involvement by MRI (Pertuiset, 1999) Skeletal Tuberculosis Clinically Other bones: any bone; weight bearing, flat, ribs - relatively unique to TB Diagnosis AFB stain and culture of biopsy specimen (sensitivity ~85%) Skeletal Tuberculosis Treatment Chemotherapy: Duration - 9 to 18 months. Although recent studies suggest that 6 months of treatment, when combined with surgery, is as effective as longer course of antibiotics. Debridement of abscesses will lead to faster resolution and less kyphosis in those with severe disease at presentation. Skeletal Tuberculosis Treatment Criteria for surgical intervention in Pott’s Neurological deficit Spinal instability Cervical spine disease Failure of medical therapy Non-adherence to medical therapy. Case 7 A 43 year old female with a long history of rheumatoid arthritis requiring multiple joint replacements complains to her rheumatologist of a flare of her disease with pain and swelling in one of her IP joints and her right wrist. Her temperature is 37.5C, her right wrist is warm, swollen and red as is one of her IP joints on the same hand. Why isnt this just a flare of her RA? How would you differentiate infected from non-infected joint fluid? Too few joints Aspiration: Gram stain 50-75%, Culture 90%, BC 50% Case 7 What is the bug? Which antibiotics would you use and for how long? Do the joints need to be drained? How? S. aureus - 80% in RA Anti-staph (anti-MRSA?), 4 to 6 weeks Yes Serial aspiration or open procedure Case 7 What are indications for open drainage? Hips, shoulders, prosthetic joints Os