Approach to managing sepsis or septic shock associated with a bone or joint source

Patients with sepsis or septic shock associated with a bone or joint source require broad-spectrum therapy because the risk of mortality is high. Empirical regimens target Staphylococcus aureus as well as other potential pathogens (eg beta-haemolytic streptococci, Enterobacterales, Pseudomonas aeruginosa).

For patients with sepsis or septic shock associated with a bone or joint source, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. Collect other relevant samples (eg joint aspirate, pus aspirate, bone biopsy) as soon as possible; however, do not delay antibiotic administration to do so. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.

Antibiotic regimens for sepsis or septic shock associated with a bone or joint source are included in these guidelines for patients with an:

• open fracture
• arthroplasty device.

For all other patients, see Adults with sepsis or septic shock associated with a bone or joint source or Children with sepsis or septic shock associated with a bone or joint source.