Spectrum: Local Antimicrobial Stewardship, for UCLA Health

Aspiration/Debridement in OR

Procedure

1.

Aspiration/Debridement

  • Incision, irrigation and debridement

  • Biopsy

  • Culture

  • Consult Peds ID

  • Begin empiric abx after discussing with Peds ID (IV Vancomycin unless otherwise specified by ID consultant*) in OR after sample obtained

  • Leave drain in place per attending protocol

Vancomycin IV

*Additional Gram Negative Coverage

*Consider need for additional gram negative coverage (e.g. cefazolin) if:

  • < 36 months old

  • Immunocompromised

  • Sickle cell

2.

Send specimen in sterile specimen cup:

  • Aerobic cultures

  • Histopathology

  • If < 3 years old, also send in blood culture bottle (Kingella Kingae) and PCR*

*Kingella PCR

Order "Misc. Referral Lab Test "

  • Test code: 18872

  • Accepted Specimen type: 0.7mL synovial fluid in a leak-proof container

  • Performing Lab: Quest

  • Test name: Kingella kingae DNA, Qualitative, real-time PCR

3.

Observe on antibiotics

  • Consider transfer to pediatric service.

  • Start CCS Application and consult social work

  • Await culture results for specific antibiotic selection

  • Repeat CRP every 48 hours

4.

Physical therapy evaluation for gait training toe-touch weight bearing for lower extremity osteomyelitis

5. Continue IV antibiotic until clinical exam improved, WBC normalized & CRP appropriately down-trending.

Consider PICC for prolonged IV therapy.

Clinical Improvement?

Yes

No