Bone and prosthetic infections

Red flags

Consider urgent referral for patients with the following:

  • Evidence of septicaemia/bacteraemia
  • Septic arthritis
  • Cellulitis
  • Bone infection with associated valvular heart disease or new heart murmur
  • Suspected mycobacterial, gonococcal infection

Information that may lead to more urgent categorisation

  • Presence of sequestrum on Xray (refer orthopaedics)
  • Non response or relapse after prolonged antibiotic use

Refer to Orthopaedics in the following situations:

  • Infection related to recent surgery (within 2 yrs)
  • If osteomyelitis with sequestrum present

Any other bone/prosthetic related infection refer to Infectious Diseases.

Other important information for referring practitioners

Important general advice

If suspected septic arthritis DO NOT commence antibiotic treatment unless blood cultures and joint fluid has already been collected for microscopy and culture. If not confident in the collection of these specimens refer to the Emergency Department.

Lifestyle changes

  • Encourage healthy nutrition
    • Weight reduction especially in the case of weight bearing prostheses
  • Reduce alcohol intake if excessive

Medical management

  • All cases of osteomyelitis should be referred for specialised advice and management
  • If the causative organism can be found commencement of an appropriate antibiotic can be done in Primary Care. Do not commence antibiotics without first
    • Collect blood cultures (two sets from separate sites)
    • Joint aspiration fluid for microscopy and culture
  • Likely infecting organisms in bone infections are
    • Staphylococcus aureus (most common)
    • Streptococcal species
    • Other organisms may occur in particular settings
  • As staph aureus infections are the most common in adults it may be appropriate, once blood cultures and culture of any sinus discharge/synovial fluid have been performed to commence on an anti-staphylococcal antibiotic such as
    • Flucloxacillin/dicloxacillin
    • Clindamycin
    • Co-Trimoxazole
    • Cephalexin
    • If in any doubt discuss with ID specialist
  • If recent surgery especially prosthetic joint replacement consider referral to orthopaedic or contact original surgeon for advice prior to commencing antibiotics
  • If no recent surgery and no sequestrum present refer to Infectious Diseases
  • If patient may be suitable for treatment in primary care consider contacting Infectious diseases for advice
  • Optimise co-morbid chronic diseases e.g. diabetes
  • Screen for immunocompromised host

Referral requirements

A referral may be rejected without the following information.

  • Reason for referral
  • Presence of any Red Flags
  • Duration and nature of symptoms (fever, pain, swelling , inflammation)
  • Location of suspected infection
  • History of recent surgery (joint replacement or trauma). Include hospital discharge letter if available
  • Treatments trialled with duration and reasons for failure
  • Drug history and allergies
    • History of iv drug use or alcoholism
  • List relevant co-morbidities
    • Immunosuppression
    • Diabetes
  • Examination details (include severity of inflammation, any discharge, sinus etc)
    • Any vascular insufficiency
  • Investigations
    • FBC, ESR, CRP, E/LFT
    • Plain Xray of affected area (any periostitis, osteopenia, loosening of prosthesis)
    • Microscopy and culture of any discharge or aspirate collected
    • Blood cultures (two sets collected from separate sites)

Additional referral information (useful for processing the referral)

  • Mycobacterial culture of any discharge
  • Isotope bone scan or Indium-111- labelled white cell scan
  • MRI (may not be possible if ferrous metal prosthesis)

Out of catchment

Metro North Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service. If your patient lives outside the Metro North Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander
  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can’t order, or the patient can’t afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary
  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use
  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander
  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature
  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)

Send referral

Hotline: 1300 364 938

Fax: 1300 364 952

Electronic: eReferral system

Mail: Metro North Central Patient Intake
Aspley Community Centre
776  Zillmere Road

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