Bone infection

Osteomyelitis (bone infection) can occur with or without earlier injury
Consider bone infection if
  • Cut or sore still has pus coming out after 14 days of standard treatment
  • Cellulitis over bone that is close to the surface (eg hands, fingers, toes, front of shin) is still there after 14 days of standard treatment
  • Skin infection for long/unknown time
  • Person with diabetes has slow-healing wound or ulcer, especially on feet
Consider melioidosis
  • Especially in tropical Northern Australia
  • In wet season or after floods
  • For people
    • With diabetes, chronic kidney disease, chronic lung disease
    • Who drink too much alcohol or kava
    • Who are debilitated (run down) or have history of melioidosis

Check

  • Calculate age-appropriate REWS
    • Adult — AVPU, RR, O2 sats, pulse, BP, Temp
    • Child (less than 13 years) — AVPU, respiratory distress, RR, O2 sats, pulse, central capillary refill time, Temp
  • Weight, BGL
  • Head-to-toe exam — with attention to
    • Painful, hot, tender at one point on bone — usually limb or backbone
    • Pain when tapping on bone away from sore area
    • Bone visible at the base of a sore or ulcer

Do

  • Medical consult to send to hospital urgently
  • Pain relief
  • Insert two IV cannula
  • Blood for cultures, pus swab
  • Best not to give antibiotics before cultures collected — blood culture, bone aspiration for MC&S done in hospital
    • If very sick or delay in sending to hospital — give cefazolin IV — adult 2g, child 50mg/kg/dose up to 2g — doses — single dose
    • If allergy — medical consult