Sepsis due to Bone and Joint Infection

Clinical features

Cellulitis, bursitis and septic arthritis

Clinical features may include:

• Erythema
• Swelling of limb or joint
• Pain
• Inability to weight bear

Be alert for possible NECROTISING FASCIITIS (see separate guidance for Necrotising Fasciitis / Fournier's Gangrene

 

Investigations

• Blood culture
• Swab of discharge from any superficial lesions for culture
• Aspiration of joint fluid if there is septic arthritis (may need to involve orthopaedics, especially for a prosthetic joint)

Infection Control

Basic universal precautions

Treatment

FLUCLOXACILLIN IV 2g 6 hourly

If true penicillin allergy or if known / suspected MRSA:

VANCOMYCIN IV Dose as per calculator

 

If there is a history of IVDU, consider adding:

GENTAMICIN IV Dose as per calculator 

PLUS

METRONIDAZOLE PO 400mg 8 hourly

(IV 500mg 8 hourly if oral route unavailable)

Do not continue Gentamicin beyond 4 days (96 hours) without Microbiology adviceDuration: 7-10 days for soft tissue infection; discuss other diagnoses with Microbiology