Septic arthritis: Difference between revisions

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

Latest revision as of 11:32, 14 December 2022

Background

Microbiology

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

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