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KEY CONCEPTS

KEY CONCEPTS

  • Image not available. The most common cause of osteomyelitis (particularly that acquired by hematogenous spread) and infectious arthritis is Staphylococcus aureus (S. aureus).

  • Image not available. Culture and susceptibility information are essential as a guide for antimicrobial treatment of osteomyelitis and infectious arthritis.

  • Image not available. Joint aspiration and examination of synovial fluid are extremely important to evaluate the possibility of infectious arthritis.

  • Image not available. The most important treatment modality of acute osteomyelitis is the administration of appropriate antibiotics in adequate doses for a sufficient length of time.

  • Image not available. Antibiotics generally are given in high doses so that adequate antimicrobial concentrations are reached within the infected bone and joints.

  • Image not available. 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.

  • Image not available. The standard duration of antimicrobial treatment for acute osteomyelitis is 4 to 6 weeks.

  • Image not available. The three most important therapeutic approaches to the management of infectious arthritis are appropriate antibiotics, joint drainage, and joint rest.

  • Image not available. 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.

PATIENT CARE PROCESS

Patient Care Process for Bone and Joint Infections

Image not available.

Collect

  • Patient characteristics (eg, age, sex, pregnancy status)

  • Patient medical history

  • Social history (eg, ethanol or illicit drug use) and living conditions

  • Current medications and recent antibiotic use

  • Objective data

    • Culture of bone, synovial fluid, or deep tissue (not superficial)

    • Labs including white blood cells (WBC), serum creatinine (SCr), and C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR)

    • Imaging for infection

Assess

  • Risk factors for bone and joint infections (Table 136-1)

  • Markers of infection (Tables 136-2 and 136-3)

  • Culture results and antimicrobial susceptibilities

  • Ability/willingness to adhere to treatment regimen, including self-administration of outpatient parenteral therapy or travel to infusion center

  • Ability/willingness to pay for treatment options (eg, home health, infusion center visits, and/or prescriptions from pharmacy)

  • Ability/willingness to obtain laboratory monitoring tests (eg, WBC, SCr, CRP, or ESR)

  • Emotional status (eg, presence of anxiety, depression)

Plan*

  • Drug therapy regimen including specific antibiotic dose, route, frequency, and duration (see Table 136-5)

  • Monitoring parameters including efficacy (eg, WBC, CRP or ESR, pain, limb swelling) and safety (eg, complete blood count, SCr, diarrhea); frequency and timing of follow-up (Table 136-6)

  • Patient education (eg, purpose of treatment, invasive procedures, drug-specific information, medication administration/injection technique)

  • Self-monitoring for resolution of symptoms, occurrence of adverse effects, when to seek emergency medical attention

  • Referrals to other providers when appropriate (eg, infectious diseases specialist, orthopedic surgeon, vascular surgeon, endocrine/diabetes specialist)

Implement*

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up (2-4 weeks)

Follow-up: Monitor and Evaluate...

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