135.3 🩺 內科專科考前版

135.3.0.1 1️⃣ 22E 更新

• N. gonorrhoeae 抗藥: ceftriaxone 仍 first-line, but XDR strains emerging — surveillance important
• Prosthetic joint infection (PJI): rifampin add-on for staph crucial; DAIR (debride, antibiotic, implant retention) viable in early acute
• Lyme arthritis post-treatment (PTLDS): controversy on long-term symptoms; antibiotics not recommended beyond standard course

135.3.0.2 2️⃣ Prosthetic Joint Infection (PJI) Specialist

135.3.0.2.1 Classification

• Early (< 3 mo post-op): direct contamination at OR
• Delayed (3-12 mo): less virulent, indolent
• Late (> 12 mo): hematogenous (e.g., from dental, skin, UTI)

135.3.0.2.2 Treatment Strategies

• DAIR: 表淺 acute, < 4 weeks symptom; antibiotic 6-12 wk
• One-stage revision: known organism + sensitivity + good soft tissue
• Two-stage revision (gold standard): explant → spacer + 6 weeks IV antibiotic → reimplant
• Permanent fusion / amputation: refractory

135.3.0.2.3 Antibiotic Highlights

• Rifampin add-on for Staphylococcus (penetrates biofilm)
• Combination: vancomycin + rifampin × 6 wk → PO suppression
• Long-term suppression for inoperable patients

135.3.0.3 3️⃣ 台灣 context

• 細菌性關節炎 most common = S. aureus
• DGI 增加 (sexually transmitted upsurge)
• 健保 vancomycin / linezolid / daptomycin 需 ID consult
• TB arthritis still seen — endemic country

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