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 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