Severe Bone and Joint Infection Management in Intensive Care Unit

Abstract

Bone and joint infections (BJI) are characterized by various clinical presentations, according to the site of infection (joint, spine, long bones…), the evolution (acute, chronic), the presence of an implant (prosthetic joint, osteosynthesis), the causative pathogens, patient’s medical condition, and infection route (hematogenous or surgical site infection, contiguous osteomyelitis….). BJI are a rare cause of hospitalization in the intensive care unit (ICU), and patients are usually admitted for septic shock or severe sepsis management, or in post-operative period. The severity of BJI may be explained by patient’s medical condition, by virulence of the causative pathogen, or by the occurrence of abscess or bacteremia. Clinical diagnosis of severe BJI is generally easy but microbiological documentation may be compromised by the need of prompt antibiotic treatment, situation in which joint aspiration or para-articular abscess aspiration are cornerstones of microbiological analysis and must be coupled to blood cultures. In the ICU, a broad spectrum empirical antibiotic therapy must be initiated and preceded, if possible, by microbiological samples in order to target the antibiotic therapy. Parameters that guide therapeutic choices are complex, explaining why these patients must be managed by a multidisciplinary team.