Septic arthritis: Difference between revisions

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==Background==
= 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]]

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