Septic arthritis Flashcards
OHCM, lecture 12.2.18, Wikipedia
What is septic arthritis?
Invasion of a joint by an infective agent resulting in joint inflammation. High, rapid morbidity and mortality so always exclude in an acutely inflamed joint.
What is the pathophysiology of septic arthritis?
Pathogens can enter joints through indwelling IV lines, infected skin or pneumonia (pneumococcal arthritis). May be immunosuppressed.
Give 3 risk factors for septic arthritis.
Pre-existing joint disease eg rheumatoid arthritis Recent surgery Prosthetic joints IV drug abuse Age >80 Behavioural risk - trauma, (STDs?)
Give 3 presenting features of septic arthritis.
Severe pain
Acute local tenderness, warmth and swelling
Difficulty moving joints
Fever
What investigations would you do if you suspect septic arthritis?
- Joint aspiration for synovial fluid microscopy and culture.
- Blood cultures
Describe the management of septic arthritis.
- IV antibiotics
- Arthroscopy - fluid drainage.
- Joint immobilisation and physiotherapy
- Temporarily stop immunosuppression
Give 3 common causative organisms of septic arthritis.
Staph aureus - most common overall.
P. aeruginosa in IVDUs
Gram -ve bacilli (esp salmonella in sickle-cell disease)
What antibiotics could be given if there is a risk of MRSA?
Vancomycin + Cephalosporin eg cefuroxime.
What antibiotics could be given if salmonella is suspected?
This is a gram -ve organism so cephalosporin eg cefuroxime.
What antibiotics could be given if meningococcus suspected?
Ceftriaxone.
Which patient with septic arthritis should you urgently refer?
Those with prosthetic joint involvement.
What is the usual pattern of septic arthritis?
90% monoarticular, knee > hip > shoulder.
What could cause polyarticular arthritis, with fever and tenosynovitis?
Gonococcal arthritis/ disseminated gonococcal infection.
