Spectrum: Local Antimicrobial Stewardship, for UCLA Health

Septic Arthritis - Post Operative Management

Procedure

1. Consult Peds ID to initiate empiric intravenous antibiotic.

  • IV Vancomycin unless otherwise specified by ID consultant*

  • Order vancomycin trough

*Additional gram negative coverage

*Consider need for additional gram negative coverage if:

  • < 36 months old

  • Immunocompromised

  • Sickle cell

2. Observe on intravenous antibiotics

  • Consider transfer to pediatric service

  • Start CCS Application and consult Social Work

3.

Repeat CRP every 48 hours

  • Consider MRI if CRP or exam is not improving.

4.

Change antibiotic to more specific therapy pending organism identification.

5.

Change to oral antibiotic when CRP and clinical exam improve, afebrile, and blood cultures are negative.

6. Consider discharge.

Discharge Criteria

  • Clinical improvement

  • Negative blood Cx x48 hours

  • Improved ROM

  • Decreased tenderness

  • Afebrile x48 hours

  • Plan for d/c abx in place and patient tolerating abx regimen

  • Prior to d/c obtain ESR & CBC

7. Schedule outpatient follow-up to occur within 1 week of discharge.

  • Pediatric ID

  • Pediatric Orthopaedics

8. Discharge home.

  • Include infection warnings and contact number for immediate return