Septic arthritis: Difference between revisions

Latest revision as of 15:32, 14 December 2022

Background

Microbiology

Gonococcal: Neisseria gonorrhoeae, more common in young, sexually active adults
Non-gonococcal bacterial:
- Staphylococcus aureus, in immunocompetent and immunocompromised people as well as those at risk for Staphylococcus aureus bacteremia; this is the most common causative organism overall
- Group B streptococci, more common in poorly-controlled diabetes
- Streptococcus pneumoniae, more common in patients with hyposplenia
- Enterobacteriaceae, especially if GI illness, or immunocompromised patients and those who inject drugs
- Pseudomonas, more common in diabetes, immunocompromised, trauma, or water exposures
- Aeromonas, more common after exposure to brackish water
- Salmonella, especially in patients with sickle cell disease or HIV
- Eikenella corrodens and Peptostreptococcus, especially if recent bite or other oral flora contamination
- Pasteurella multocida, after cat bite
- Capnocytophaga, after dog bite
- Mycoplasma hominis, with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise
Other:
- Mycobacterium tuberculosis and non-tuberculous mycobacteria (especially Mycobacterium chelonae and Mycobacterium fortuitum
- Fungal infections including Candida, Blastomyces dermatitidis, Cryptococcus, Coccidioides immitis, and Sporothrix schenckii
- Viral infections including HIV, hepatitis B virus, hepatitis C virus, parvovirus B19, and alphaviruses including chikungunya virus

Investigations

Note: for fluid analysis, 1 cells/microL = 1,000,000 (1E6) cells/L; alternatively 1E9 cells/L = 1,000 cells/microL

Management

Empiric: typically treated empirically with vancomycin and ceftriaxone empirically, followed by directed therapy

Gonococcal Arthritis

Ceftriaxone 1 g IV daily for 7 to 14 days
Don't forget azithromycin 1 g po once

Non-Gonococcal Arthritis

Treated with targetted antimicrobials
Duration is traditionally 4 weeks, including at least 2 weeks of parenteral antimicrobials
However, can do as short as 2 weeks for hand and wrist septic arthritis

@@ Line 1: / Line 1: @@
+==Background==
-[[Category:Bone and joint infections]]
-== Background ==
+===Microbiology===
+*Gonococcal: [[Neisseria gonorrhoeae]], more common in young, sexually active adults
-=== Microbiology ===
+*Non-gonococcal bacterial:
+**[[Staphylococcus aureus]], in immunocompetent and immunocompromised people as well as those at risk for [[Staphylococcus aureus bacteremia]]; this is the most common causative organism overall
+**[[Group B streptococci]], more common in poorly-controlled [[diabetes]]
+**[[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]]
+**[[Enterobacteriaceae]], especially if GI illness, or immunocompromised patients and those who inject drugs
+**[[Pseudomonas]], more common in [[diabetes]], immunocompromised, trauma, or water exposures
+**[[Aeromonas]], more common after exposure to brackish water
+**[[Salmonella]], especially in patients with [[sickle cell disease]] or [[HIV]]
+**[[Eikenella corrodens]] and [[Peptostreptococcus]], especially if recent bite or other oral flora contamination
+**[[Pasteurella multocida]], after cat bite
+**[[Capnocytophaga]], after dog bite
+**[[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise
+*Other:
+**[[Mycobacterium tuberculosis]] and [[non-tuberculous mycobacteria]] (especially [[Mycobacterium chelonae]] and [[Mycobacterium fortuitum]]
+**Fungal infections including [[Candida]], [[Blastomyces dermatitidis]], [[Cryptococcus]], [[Coccidioides immitis]], and [[Sporothrix schenckii]]
+**Viral infections including [[HIV]], [[hepatitis B virus]], [[hepatitis C virus]], [[parvovirus B19]], and alphaviruses including [[chikungunya virus]]
+== Investigations ==
-* Gonococcal: [[Neisseria gonorrhoeae]], more common in young, sexually active adults
-* Non-gonococcal bacterial:
+* Note: for fluid analysis, 1 cells/microL = 1,000,000 (1E6) cells/L; alternatively 1E9 cells/L = 1,000 cells/microL
-** [[Staphylococcus aureus]], in immunocompetent and immunocompromised people as well as those at risk for [[Staphylococcus aureus bacteremia]]
-** [[Group B streptococci]], more common in poorly-controlled [[diabetes]]
+==Management==
-** [[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]]
-** [[Enterobacteriaceae]], especially if GI illness, or immunocompromised patients and those who inject drugs
+*Empiric: typically treated empirically with [[vancomycin]] and [[ceftriaxone]] empirically, followed by directed therapy
-** [[Pseudomonas species]], more common in [[diabetes]], immunocompromised, trauma, or water exposures
-** [[Aeromonas species]], more common after exposure to brackish water
+=== Gonococcal Arthritis ===
-** [[Salmonella species]], especially in patients with [[sickle cell disease]] or [[HIV]]
-** [[Eikenella corrodens]] and [[Peptostreptococcus species]], especially if recent bite or other oral flora contamination
+*[[Ceftriaxone]] 1 g IV daily for 7 to 14 days
-** [[Pasteurella multocida]], after cat bite
+*Don't forget [[azithromycin]] 1 g po once
-** [[Capnocytophaga species]], after dog bite
-** [[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise
+=== Non-Gonococcal Arthritis ===
-* Other:
-** [[Mycobacterium tuberculosis]] and [[non-tuberculous mycobacteria]] (especially [[Mycobacterium chelonae]] and [[Mycobacterium fortuitum]]
+*Treated with targetted antimicrobials
-** Fungal infections including [[Candida species]], [[Blastomyces dermatitidis]], [[Cryptococcus species]], [[Coccidioides immitis]], and [[Sporothrix schenckii]]
+*Duration is traditionally 4 weeks, including at least 2 weeks of parenteral antimicrobials
-** Viral infections including [[HIV]], [[hepatitis B virus]], [[hepatitis C virus]], [[parvovirus B19]], and alphaviruses including [[chikungunya virus]]
+*However, can do as short as 2 weeks for hand and wrist septic arthritis
 [[Category:Infectious diseases]]
+[[Category:Bone and joint infections]]