Skip to Main Content

KEY CONCEPTS

KEY CONCEPTS

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

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

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

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

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

  • imageOral 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.

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

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

  • imageMonitoring 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.

BEYOND THE BOOK

BEYOND THE BOOK

Activity #1 The long-acting lipoglycopeptide antibiotics, dalbavancin and oritavancin, are potentially useful treatments for bone and joint infections because of their infrequent dosing and gram-positive spectrum of activity. Conduct a literature search to identify one primary research report published on these agents in the last 2 years. If the manuscript provides data on the safety or effectiveness of these drugs in treating deep-seated infection for longer than 2 weeks, reflect on the advantages and disadvantages for this type of treatment strategy.

Activity #2 The OVIVA trial, as discussed in the chapter, was a practice changing study for many clinicians and has significantly motivated the process of shifting more treatment courses for bone and joint infections away from IV agents, which require OPAT, toward appropriate oral regimens. However, the results of this trial aren’t applicable to all clinical situations that arise. Review the OVIVA study methods, results, and conclusions (https://www.nejm.org/doi/full/10.1056/NEJMoa1710926) and make a list of the clinical situations and oral regimens for which these study results may apply. This will help you advocate for the use of oral therapy in the most appropriate circumstances.

INTRODUCTION

Bone and joint infections are comprised of two disease processes known, respectively, as osteomyelitis and septic or infectious arthritis. They are unique and separate infectious entities with different signs and symptoms and infecting organisms. Prosthetic joint infections, resulting from the advancement of modern technology, are distinct and blend attributes of each disease. Despite therapy, these infections all cause significant morbidity from residual damage with chronic ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.