Orthopedic Infection

Joint Infection and Osteomyelitis – VASP


  • 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. 




  • 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