Septic Arthritis Flashcards
Septic arthritis most commonly caused by?
Staphylococcus or Streptococcus species. Neisseria gonorrhoeae may be suspected in sexually active patients.
Presentation of septic arthritis?
single hot, red, painful joint, sometimes with systemic symptoms
Risk factors for septic arthritis?
existing joint disease (e.g., rheumatoid arthritis or osteoarthritis)
concomitant immunosuppressive medication
prosthetic joints
low socioeconomic status
IVDA
ETOH use
DM
recent intra-articular glucocorticoid injection
cutaneous ulcers
direct joint trauma (including recent joint surgery, aspiration, or injection)
Diagnosis of septic arthritis?
Labs: Inc CRP/ESR/WBC
Synovial fluid analysis: WBC >50,000 (predominantly with neutrophils, closer to 20,000 with gonococcal septic arthritis)
Synovial fluid Gram stain and Cx
urate or calcium pyrophosphate crystals is diagnostic for gout or pseudogout (presence does not exclude concomitant septic arthritis)
Blood cultures: develop via bacteremia.
XR: to exclude fx as a cause of acute joint pain and swelling and serve as a baseline assessment of damage for future comparison
Treatment of septic arthritis for native joint?
Empiric Abx:
gram +: vanc
gram -: ceftriaxone
if immunocomproised: add psuedomonal coverage
Surgical drainage and decompression of the infected joint either via surgical lavage or bedside arthrocentesis is (esp when the effusion is large)
Surgery if hemodynamically unstable to deep joint infxn
Treatment of septic arthritis for prosthetic joint?
If not a surgical candidate > long term suppression
Little perceived benefit from txt or multiple failed attempts> remove without replacement, long term suppression, amputation
IF joint implanted <3 m ago or hematogenous infxn AND sxs < 3 w, AND no abscess or sinus tract, AND implant stable AND organism that is NOT multi-drug resistant, small colony variant staph aureus, enterococcus, quinolone resistant pseudomonas or fungus
» debridement with retention of prosthesis with abx
if not» 1-2 stage exchange, abx
Higher risk of surgical debridement failure in septic arthritis with?
history of inflammatory arthropathy, involvement of a large joint, synovial-fluid nucleated cell count of >85.0, infection with S. aureus, and history of diabetes.
