Septic Arthritis

Question 1

Which joints are usually affected in adults vs kids

What about pxs w/ IVDA?

Answer 1

Adults: knee
Kids: hips
IVDA: sternoclavicular joint

Question 2

Risk factors for SA

What bugs are they at higher risk of?

Answer 2

• > 80 y/o, DM, RA, prosthetic joint, recent joint surgery, skin infection, catheter-associated bloodstream infection cutaneous ulcers, IVDA, alcoholism, previous intra-articular steroid injection
• Higher risk of gram neg
• IVDA have higher risk of polymicrobial infections

Question 3

Which bugs are most common in SA?

Answer 3

Staph aureus is most common, then Strep spp

Question 4

Epidemiology of gonococcal arthritis

Risk factors

Answer 4

Mainly young adults.
4x more common in females
Risk factors include pregnancy and menstruation.

Question 5

Gonococcal reactive arthritis vs Gonococcal septic arthritis
How many joints involved?
Which joints?
Rash?
Are bugs found in joint?

Answer 5

ReA affects multiple joints (wrists / hands). SA is mono arthritic (knee).
ReA has skin rash. SA may have lesion over joint, but not widespread.
Rare to find bugs in joint in ReA. MANY bugs in joint in SA.

Question 6

What bug causes meningitis after a diarrheal illness?

Answer 6

Listeria

Question 7

Characteristics of infected synovial fluid

Answer 7

Turbid, yellow, reduced viscosity.
Cell count usually 50-150k w/ 90% PMNs
Glucose is decreased

Question 8

Which AB’s are used for SA?
GPC, GNC, GNR
How long?

Answer 8

• Vanco for GPC, Ceftriaxone for GNC, Ceftazidime / cefepime / pip-tazo / carbapenems for GNRs
• Avoid intra-articular AB’s.
• 2 weeks IV, 2 weeks oral, unless GC (only needs 2 weeks)