Sepsis due to Bone and Joint Infection
Antimicrobial prescribing: NHS Fife
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 IV 500mg 8 hourly
Do not continue Gentamicin beyond 3-4 days without Microbiology adviceDuration: 7-10 days for soft tissue infection; discuss other diagnoses with Microbiology