Septic arthritis
From IDWiki
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 species, more common in diabetes, immunocompromised, trauma, or water exposures
- Aeromonas species, more common after exposure to brackish water
- 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
- Pasteurella multocida, after cat bite
- Capnocytophaga species, 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 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
Management
- Empiric: typically treated empirically with vancomycin and ceftriaxone empirically, followed by directed therapy
- Gonococcal
- Ceftriaxone 1 g IV daily for 7 to 14 days
- Don't forget azithromycin 1 g po once
- 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