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Septic Arthritis in the Adult


- Pts w/ RA:
    - may be prone to bacterial infections because of inherent phagocytic defect or because of long-term oral or intraarticular administration of corticosteroid or other immunosuppressive agents;
    - staph. aureus is recovered from 80 % infected rheumatoid joints;
Nongonococcal Bacterial Arthritis in Adults Treated at Boston U.Med Center;
  -----------------------------------------------------
  Type of Bacteria                      No. of Patients
  staphylococcus aureus                       39
  Streptococcal species                       26
    - note: patients with strep infections usually have a poor prognosis, and it is important to consider concomitant multiple myeloma;
  gram-negative bacilli                       22
  Diplococcus pneumoniae                       6
  staphylococcus epidermidis                   4
  -----------------------------------------------------
 - Consider S. aureus (40%), Gr A strep (27%), Enterobacteriaceae (23%);
 - Rx: Penase Res Pen (Oxacillin) +/- aminoglycosides
       or Timentin or Unasyn
       or alternative try vancomycin
       Base initial choice on results of gram stain;
       Intraarticular antibiotics not required;
       Needle drainage perfered except for Hip;
       Consider Lyme Disease

* Adult w/ possible VD:
    - Consider Gonnorhea; Rx: Ceftriaxone
    - Alternative try Spectinomycin or Ciprofloxacin (or if Penase res bug unlikely try Ampicillin;
    - Note Gm stain rarely positive;
    - Test for genital C.trachomatis; If not available treat empirically