Chapter 118: Bone and Joint Infections

Content Update

June 12, 2019

Oral versus Intravenous Antibiotics for Bone and Joint Infection: IV antibiotics have long been considered superior to oral antibiotics for serious infections based on the misconception that IV therapy is “stronger” than oral therapy. A recent randomized trial (“Oral versus Intravenous Antibiotics for Bone and Joint Infection”, or “OVIVIA”) found that oral antibiotic therapy was noninferior to IV antibiotic therapy during the first 6 weeks for complex bone and joint infections. The OVIVA trial may impact standard-of-care for bone and joint infections and lessen (or ultimately eliminate) the need for IV antibiotics for 6 weeks in select patients. Using oral therapy in appropriate patients may lead to decreased length of hospital stay, fewer adverse events, fewer IV-related complications, and overall reduced healthcare costs.

KEY CONCEPTS

• The most common cause of osteomyelitis (particularly that acquired by hematogenous spread) and infectious arthritis is Staphylococcus aureus.

• Culture and susceptibility information are essential as a guide for antimicrobial treatment of osteomyelitis and infectious arthritis.

• Joint aspiration and examination of synovial fluid are extremely important to evaluate the possibility of infectious arthritis.

• The most important treatment modality of acute osteomyelitis is the administration of appropriate antibiotics in adequate doses for a sufficient length of time.

• Antibiotics generally are given in high doses so that adequate antimicrobial concentrations are reached within the infected bone and joints.

• Oral antimicrobial therapies can be used for osteomyelitis to follow a parenteral regimen in children who have a good clinical response to IV antibiotics and in adults without diabetes mellitus or peripheral vascular disease when the organism is susceptible to the oral antimicrobial, a suitable oral agent is available, and adherence is ensured.

• The standard duration of antimicrobial treatment for acute osteomyelitis is 4 to 6 weeks.

• The three most important therapeutic approaches to the management of infectious arthritis are appropriate antibiotics, joint drainage, and joint rest.

• Monitoring of antibiotic therapy is important and typically involves noting clinical signs of inflammation, periodic white blood cell (WBC) counts, C-reactive protein, and erythrocyte sedimentation rate (ESR) determinations.