Septic arthritis: Difference between revisions

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(added Microbiology)
(added management)
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[[Category:Bone and joint infections]]
 
[[Category:Bone and joint infections]]
   
== Background ==
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==Background==
   
=== Microbiology ===
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===Microbiology===
   
* Gonococcal: [[Neisseria gonorrhoeae]], more common in young, sexually active adults
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*Gonococcal: [[Neisseria gonorrhoeae]], more common in young, sexually active adults
* Non-gonococcal bacterial:
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*Non-gonococcal bacterial:
** [[Staphylococcus aureus]], in immunocompetent and immunocompromised people as well as those at risk for [[Staphylococcus aureus bacteremia]]
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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
** [[Group B streptococci]], more common in poorly-controlled [[diabetes]]
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**[[Group B streptococci]], more common in poorly-controlled [[diabetes]]
** [[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]]
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**[[Streptococcus pneumoniae]], more common in patients with [[hyposplenia]]
** [[Enterobacteriaceae]], especially if GI illness, or immunocompromised patients and those who inject drugs
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**[[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 species]], more common in [[diabetes]], immunocompromised, trauma, or water exposures
** [[Aeromonas species]], more common after exposure to brackish water
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**[[Aeromonas species]], more common after exposure to brackish water
** [[Salmonella species]], especially in patients with [[sickle cell disease]] or [[HIV]]
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**[[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
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**[[Eikenella corrodens]] and [[Peptostreptococcus species]], especially if recent bite or other oral flora contamination
** [[Pasteurella multocida]], after cat bite
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**[[Pasteurella multocida]], after cat bite
** [[Capnocytophaga species]], after dog bite
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**[[Capnocytophaga species]], after dog bite
** [[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise
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**[[Mycoplasma hominis]], with postpartum septic arthritis, recent genitourinary tract manipulation, and immunocompromise
* Other:
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*Other:
** [[Mycobacterium tuberculosis]] and [[non-tuberculous mycobacteria]] (especially [[Mycobacterium chelonae]] and [[Mycobacterium fortuitum]]
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**[[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 species]], [[Blastomyces dermatitidis]], [[Cryptococcus species]], [[Coccidioides immitis]], and [[Sporothrix schenckii]]
** Viral infections including [[HIV]], [[hepatitis B virus]], [[hepatitis C virus]], [[parvovirus B19]], and alphaviruses including [[chikungunya virus]]
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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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== Management ==
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* Empiric: typically treated empirically with [[vancomycin]] and [[ceftriaxone]] empirically, followed by directed therapy
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* Gonococcal
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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:
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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
   
 
[[Category:Infectious diseases]]
 
[[Category:Infectious diseases]]

Revision as of 17:04, 6 July 2020


Background

Microbiology

Management

  • Empiric: typically treated empirically with vancomycin and ceftriaxone empirically, followed by directed therapy
  • Gonococcal
  • Non-gonococcal:
    • 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