Joint Infection and Osteomyelitis – VASP
Evaluation
- Blood cultures prior to antibiotics
- MRI is the most sensitive and specific imaging modality for osteomyelitis.
- Ortho consult for Joint fluid aspirate or bone bx; send for culture and send fluid for cell count/differential. Ideally, joint fluid is inoculated into BCx bottle to improve recovery
- Reserve some specimen to allow for cell count/differential and Gram stain.
Management
- Hold antibiotics until culture obtained, if patient is clinically stable
- Osteomyelitis is a 6-week treatment course, can consider early transition to oral if good bioavailability and susceptibility.
- For prosthetic joint infection, procedure/retention of hardware determines duration
- First line empiric: Vancomycin + ciprofloxacin 750mg BID
- Antimicrobial therapy will be guided by culture data, ID consult recommended for joint infection treatment due to need for prolonged antibiotic therapy