Septic Arthritis Flashcards
What is septic arthritis?
It is defined as an orthopaedic emergency, in which there is infection and inflammation within a joint
What joint is most commonly affected by septic arthritis?
Knee Joint
What is the pathophysiological cause of septic arthritis?
The organism transmission tends to occur secondary to hematogenous spread from distant abscesses, wounds, respiratory tract infections or sexually transmitted infections
What nine risk factors are associated with septic arthritis?
Osteoarthritis
Rheumatoid Arthritis
Crystal Arthropathies
Joint Prosthesis
Immunosuppression
Diabetes Mellitus
Sickle Cell Disease
Intravenous Drug Use
Alcoholism
What are the six clinical features of septic arthritis?
Fever > 38C
Joint Pain
Joint Swelling
Joint Warmth
Joint Erythema
Reduced Joint Movement
What two investigations are used to diagnose septic arthritis?
Blood Tests
Joint Arthrocentesis
What four blood test results indicate septic arthritis?
Increased WCC Levels
Increased CRP Levels
Increased ESR Levels
Blood Culture Positive
What is the gold standard investigation used to diagnose septic arthritis?
Joint Arthrocentesis
When should joint arthrocentesis be used to diagnose septic arthritis?
It should be conducted in all cases in which there is presentation of a hot, swollen, tender joint with restricted movement
What four synovial fluid analysis results indicate septic arthritis?
Yellow/Green Fluid Colour
Increased WCC Levels
Increased Neutrophil Levels
Positive Bacterial Culture
What eight causative organisms are associated with septic arthritis?
Staphylococcus Aureus
Streptococcus Pneumoniae
Neisseria Gonorrhoea
Mycobacterium Tuberculosis
Methicillin Resistant Staphylococcus Aureus (MRSA)
Streptococcus Pyogenes
Haemophilus Influenza
Escherichia Coli
What is the most common causative organism associated with septic arthritis?
Staphylococcus Aureus
When does Neisseria Gonorrhoea tend to cause septic arthritis?
It is the most common causative organism of septic arthritis in sexually active young patients - due to disseminated gonococcal infection
When does Mycobacterium Tuberculosis tend to cause septic arthritis?
It is the most common causative organism of septic arthritis in immunocompromised patients and those from areas of high tuberculosis prevalence
When does Methicillin Resistant Staphylococcus Aureus (MRSA) tend to cause septic arthritis?
It is the most common causative organism in nursing home residents and those recently discharged from hospital
What criteria is used to diagnose septic arthritis?
Kocher Criteria
How is the Kocher criteria used to diagnose septic arthritis?
It is used to determine the septic arthritis probability, based upon clinical features and investigation findings
What are the four Kocher criteria?
Non-Weight Bearing On Affected Side= 1 Score
ESR Level > 40mm/Hr = 1 Score
Fever > 38.5C = 1 Score
WCC > 12,000 Cells/mm3 = 1Score
What does a Kocher score of 1 indicate?
3% chance of septic arthritis
What does a Kocher score of 2 indicate?
40% chance of septic arthritis
What does a Kocher score of 3 indicate?
93% chance of septic arthritis
What does a Kocher score of 4 indicate?
99% chance of septic arthritis
What is the pharmacological management option of septic arthritis?
Antibiotic Therapy
When is antibiotic therapy used to manage septic arthritis?
It is the first line management option
What is the first line empirical antibiotic used to manage septic arthritis?
Flucloxacillin
What is the first line empirical antibiotic used to manage septic arthritis - in penicillin allergic individuals?
Clindamycin
Describe the antibiotic regime used to manage septic arthritis
It is administered intravenously for a period of 2 weeks, before being switched to an oral course for a period of 2 – 4 weeks
Therefore, the total antibiotic course is 4 – 6 weeks long
Which two antibiotics are administered once culture confirms Neisseria Gonorrhoea infection?
Cefotaxime
OR
Ceftriaxone
Which two antibiotics are administered once culture confirms MRSA infection?
Vancomycin
OR
Teicoplanin
What is the surgical management option of septic arthritis?
Arthroscopic Lavage
What is arthroscopic lavage?
It involves aspiration of intra-articular fluid and washing out of contents inside a joint space
What are the three complications associated with septic arthritis?
Joint Destruction
Septic Shock
Osteomyelitis
