CC Nov 2015 Diabetic foot infections and Osteomyelitis

echoecho's version from 2015-11-30 18:36


Question Answer
What 3 diseases are a common and grouwing complication of DM?1) cellulitis 2) deep soft tissue infections 3) osteomyelitis
The CDC show that the number of infections steadily increased at the end of the 20th century and beginning of the 21st century showing ____ as the major cuase of lower extremity amputation?PVD
The ISDA (Infectious Diease Society of America) guidelines recommends that diabetic infections should be suspected in patients with what signs and symptoms?1) redness, warmth, swelling, tenderness 2) purulent secretions 3) discolored granulation tissue 4) undermining of wound edges 5) foul smell
LIst the factors that increase the risk of infection in diabetic foot wounds?1) positive probe-to-bone test 2) ulcer present for > 30 days 3) hx of recurrent foot ulcers 4) a traumatic foot wound 5) peripheral vascular disease 6) previous lower extremity amputation 7) peripheral neuropathy 8) renal insufficiency
Why is a validated classification scheme from the IDSA used to clasify diabetic foot infections as mild, moderate and severe and to aid in discussions with patients and families?Severity of infection is associated with increased risks of hospitalizations (4%; 52% and 89%) and limb amputations (3%, 46% and 70%) respectively
*** Osteomyelitis should be suspected in a diabetic foot with adequate circulation when an ulcer does not heal after ____ weeks of appropriate wound care and off-loading, when exposed bone is present or if an ulcer is > 2 cm.?6
In addition to assessment of the wound and the status of the patient's glycemic control, a patient should be evaluated for what?for patient's 1) glycemic control 2) venous insufficiency 3) presence or absence of protective sensation 4) biomechanical problems
Give the sensitivity and specificity of the 5 methods for diagnosis osteomyelitis in diabetic foot ulcers?1) exposed bone or positive probe-to-bone test (sensitivity 60%; specificity 91%) 2) plain radiography (sensitivity 54%; specificity 68%) 3) MRI (sensitivity 90%; specificity 79%) 4) bone scan (sensitivity 81%; specificity 28%) 5) leukocyte scan (sensitivity 74%; specificity 68%)
*** Which of the methods for diagnosing osteomyelitis is moderately predictive of osteomyelitis? Which methods is the most accurate (highest sensitivity and good specificity) imaging test for dx of osteomyelitis?1) "the presence of exposed bone or positive probe-to-bone test result 2) MRI
Lab signs of inflammation such as what lab tests may be present but alone are not diagnostic of osteomyelitis?CRP, ESR
A multidisciplinary approach is recommended for patients with osteomyelitis, name the team?1) PCP 2) wound care specialist 3) podiatrist 4) infectious disease specialist 5) vascular surgeon
Importance of obtaining deep _____ for culture in any diabetic foot infection is important?deep
Cultures should be obtained prior to what?starting an antibiotic
What is the ideal culture? Which specimen should be avoided?1) by biopsy or curettage after the wound has been properly cleaned and debrided 2) swab specimen
What is the most commonly isolated organism? List other organisms which are causes?1) Staphylococcus aureus 2) S. epidermidis, E. coli, Klesiella pneumonia, Proteus mirabilis, Pseudomonas aeruginosa
Patient treated with what therapy have better outcomes than patients who are not?bone-biopsy-directed therapy
*** Cultures from what, adjacent to bone seem to be as accurate as bone biopsy?deep sinus tracts
The Infectious Diseases Society of America (IDSA) states that bone biopsy is most likely to be useful in suspected osteomyelitis when?1) patient or physician prefers definitive diagnosis to justify choice of early surgery in favor of prolonged treatment 2) cultures of soft tissue or blood suggest a high risk of osteomyelitis with antibiotic-resistant organism 3) there is progressive deterioration or persistently elevated inflammatory markers during empiric or culture-directed therapy 4) suspect bone is a planned target for insertion of orthopedic metal ware
What is the therapy for diabetic foot osteomyelitis, although there have been reports of cure with _____ therapy also?1) surgical 2) antimicrobial
Are there any definitive studies that directly compare primary medical therapy to primary surgical therapy?no
List 4 situations in which nonsurgical therapy might be preferred?1) there is no acceptable surgical target 2) the pt has limb ischemia caused by unreconstructable vascular disease but wishes to avoid amputation. 3) infection is confined to the forefoot and there is no minimal soft tissue loss 4) the pt and physician agree that surgical management carries excessive risk or is otherwise not appropriate or desirable
Diabetics present an elevated surgical risk, but _____ insufficiency and _____should not limit surgical approaches where competent surgical and anesthesiology clinicians are available?renal, PVD
What type of foot infections are generally considered more likely to progress to higher-level amputation and should be approached with early surgical intervention?hindfoot
True or false? There is limited evidence to guide clinicians in the choice of initial antimicrobial therapy in diabetic foot infections?true
Which antibiotics are used for mild infections?Keflex, Augmentin, Doxycycline, Bactrim
Which antibiotics are used for moderate to severe infections?IV Unasyn (ampicillin-sulbactam), IV Primaxin (Imipenem-cilastatin), MRSA treated with Vancomycin (Vancocin) and Pseudomonas treated with IV Zosyn (piperacillin-tazobactam)
What is the appropriate length of therapy?not well defined
What should the choice of antibiotic be based on in both soft tissue and bone infections?culture and sensitivity results in both soft tissue and bone infections
What is the treatment after patient undergoes surgical removal of the infected bone, why?1) minimal treatment is required postoperatively 2) since the surgery should be the primary means of eliminating the infection
If only soft tissue infection remains, ___ to ___ weeks of treatment is recommended?1; 3
If infected but viable bone remains, treatment should be extended for ___ to ___ weeks?4; 6
If surgery cannot be performed or dead bone remains postoperatively, extended treatment (more than ____ _____) may be required?3 months
*** SUMMARY = What are the major cause for lower extremity amputations?diabetic foot infections
*** SUMMARY = Studies helpful to make the dx of osteomyelitis include?1) MRI 2) positive probe-to-bone test 3) plain radiographs 4) bone scan 5)leukocyte scan
*** SUMMARY = Culture for suspected osteomyelitis should be obtained either by what 2 means (after the wound has been properly cleaned and debrided)?1) biopsy 2) curettage
*** SUMMARY = Treatment of diabetic foot osteomyelitis is generally _____ (surgical vs nonsurgical) unless certain circumstances exist where ______ (surgical vs. nonsurgical) therapy is preferred?surgical; nonsurgical