Septic arthritis: Difference between revisions
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==Background== |
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= Septic arthritis = |
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===Microbiology=== |
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*Gonococcal: [[Neisseria gonorrhoeae]], more common in young, sexually active adults |
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*Non-gonococcal bacterial: |
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**[[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 |
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**[[Group B streptococci]], more common in poorly-controlled [[diabetes]] |
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**[[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]] |
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**[[Enterobacteriaceae]], especially if GI illness, or immunocompromised patients and those who inject drugs |
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**[[Pseudomonas]], more common in [[diabetes]], immunocompromised, trauma, or water exposures |
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**[[Aeromonas]], more common after exposure to brackish water |
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**[[Salmonella]], especially in patients with [[sickle cell disease]] or [[HIV]] |
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**[[Eikenella corrodens]] and [[Peptostreptococcus]], especially if recent bite or other oral flora contamination |
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**[[Pasteurella multocida]], after cat bite |
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**[[Capnocytophaga]], after dog bite |
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**[[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise |
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*Other: |
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**[[Mycobacterium tuberculosis]] and [[non-tuberculous mycobacteria]] (especially [[Mycobacterium chelonae]] and [[Mycobacterium fortuitum]] |
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**Fungal infections including [[Candida]], [[Blastomyces dermatitidis]], [[Cryptococcus]], [[Coccidioides immitis]], and [[Sporothrix schenckii]] |
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**Viral infections including [[HIV]], [[hepatitis B virus]], [[hepatitis C virus]], [[parvovirus B19]], and alphaviruses including [[chikungunya virus]] |
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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 |
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==Management== |
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*Empiric: typically treated empirically with [[vancomycin]] and [[ceftriaxone]] empirically, followed by directed therapy |
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=== Gonococcal Arthritis === |
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*[[Ceftriaxone]] 1 g IV daily for 7 to 14 days |
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*Don't forget [[azithromycin]] 1 g po once |
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=== Non-Gonococcal Arthritis === |
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*Treated with targetted antimicrobials |
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*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 |
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[[Category:Infectious diseases]] |
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[[Category:Bone and joint infections]] |
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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
