Septic arthritis: Difference between revisions
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+ | ==Background== |
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− | == |
+ | ===Microbiology=== |
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− | === Microbiology === |
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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]] |
[[Category:Infectious diseases]] |
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Latest revision as of 11:32, 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