136.3 🩺 內科專科考前版

136.3.0.1 1⃣ 22E 曎新

  • OVIVA trial (NEJM 2019): 1-2 wk IV → oral non-inferior in stable, culture-confirmed adult bone/joint infection
  • PJI: DAIR for early, 2-stage gold; rifampin essential for staph biofilm
  • Linezolid / Tedizolid for MRSA bone (good bone penetration)
  • Inhaled antibiotics (gentamicin beads, local antibiotic spacer) for refractory

136.3.0.2 2⃣ DM Foot Specialist

  • IDSA 2023 update + IWGDF
  • WIfI score: Wound, Ischemia, foot Infection — risk stratification
  • Probe-to-bone + plain X-ray (delayed changes) → MRI > bone biopsy
  • Vascular evaluation essential (ABI, TBI, transcutaneous oxygen)
  • Multidisciplinary: ID + endocrine + podiatry + vascular

136.3.0.3 3⃣ 台灣 context

  • DM foot 高盛行率
  • TB endemic — vertebral osteo 經垞需排陀 Pott’s
  • 健保 vancomycin / linezolid / daptomycin requires ID approval