Joint infection

Question 1

What is the most common organism which causes infection in native joints in children and adults?

Answer 1

Staph aureus.

Question 2

What organism historically caused infection in joints in children?

Answer 2

H influenzae

Question 3

Name some other organisms which cause joint infections in adults

Answer 3

Streptococci (group b, group a, strep pneumoniae)
Neisseria gonorrhoea
Gram neg bacilli such as E coli and pseudomonas aeruginosa
Clostridium and bacteriodes

Question 4

Who are more susceptible to N gonorrhoea joint infections?

Answer 4

Young, sexually active individuals, esp MSM

Question 5

Who are more susceptible to joint infections caused by gram neg bacilli such as E coli?

Answer 5

Extremes of ages
Systemically unwell patients
IVDU

Question 6

Who are more susceptible to joint infections by anaerobes such as clostridium and bacteriodes?

Answer 6

Diabetics

Question 7

What are some risk factors for septic joint?

Answer 7

Direct or penetrating trauma
Local skin breaks or ulcers
Damaged joint
Immunosuppression (including use of steroids)
Elderly 
Rheumatoid arthritis
Diabetes

Question 8

Describe a typical presentation of a septic joint
Most common joints affected?
How might children present?

Answer 8

Painful, red, swollen, hot joint.
Fever
90% are monoarthritis.
Knee > Hip > Shoulder

Children might not use that joint (eg. not standing on one foot)

Question 9

How do we manage a septic joint?

Answer 9

Aspirate always
Antibiotics guided by the aspiration
Long course of abx - usually 6 weeks minimum
Joint wash out and repeat aspiration until no recurrent effusion
Rest, splint, physio
Analgesia
Stop immunosuppression temporarily if you can