Discussion »
differential diagnosis »
(also consider Brucella melitensis, Borrelia burgdorferi and Treponema pallidum)
- Painful knee--an unusual cause secondary to pseudomonas septic arthritis of the hip.
- Septic until proven otherwise: approach to and treatment of the septic joint in adult patients.
- Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses.
medical considerations
- consider the need for a cardiac echo (eval for endocarditis), labs for immunosuppression (HIV, Hep B)
- reference: Immunoglobulin G Deficiency-Associated Septic Arthritis Identified Following Corticosteroid Injection and Knee Arthroscopy: A Case Report.
synovial fluid exam »
(cell count and crystals)
- gram stain: (gram negative bacilli, gram negative cocci: (NG), gram positive bacilli:, gram positive cocci)
- references:
Treatment Based on Age »
less than 3 months, from 6 mo to 2 yrs, greater than 2 yrs
Treatment Based on Location »
(open joint injuries, septic knee, pediatric septic hip)
Antibiotic Treatment Based on Organism »
- IV antibiotic menu(criteria for PO ATBs)
- Anaerobic JointInfections
- Niseria gonococcus
- most common organism causing septic arthritis in young adults;
- look for skin lesions;
- unlike most forms of septic arthritis, GC does not necessarily require surgical washout, andand usually responds to IV antibiotics alone.
- references:
- Antibiotic concentrations in septic joint effusions.
- Etiology and medical management of acute suppurative bone and joint infections in pediatric patients..
- Benefits and risks of sequential parenteral--oral cephalosporin therapy for suppurative bone and joint infections.
- The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis.
- Septic arthritis in the elderly.
- Staphylococcal septic arthritis: antibiotic and nonsteroidal anti-inflammatory drug treatment in a rabbit model.
- Experimental septic arthritis in rabbits treated by a combination of antibiotic and steroid drugs.
- Dexamethasone Therapy for Septic Arthritis in Children: Results of a Randomized Double-blind Placebo-controlled Study
Surgical Drainage and Lavage
consider vancomycin in calcium sulfate carrier.
references
- Lavage of septic joints in rabbits: effects of chondrolysis.
- Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint.
- Results of treatment of septic knee arthritis: a retrospective series of 40 cases.
- Arthroscopic drainage in septic arthritides of the knee: a multicenter study.
- Arthroscopic treatment of septic joints: prognostic factors.
- Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy.
- Arthroscopic management of septic arthritis: stages of infection and results.
- Arthroscopic therapy of septic arthritis. Surgical technique and results
- Septic arthritis: Arthroscopic management with local antibiotic treatment.
- Septic arthritis: current diagnostic and therapeutic algorithm.
- Management of septic arthritis: a systematic review.
- Tidal irrigation in septic arthritis of the knee: a potential alternative to surgical drainage.
- Treatment of septic knee arthritis: comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system.
- Percutaneous aspiration irrigation drainage technique in the management of septic arthritis in children.
Controversies: use of steroids with septic arthritis
- Acute Septic Arthritis
- Dexamethasone Added to Antibiotics Improved Clinical and Laboratory Outcomes in Children with Septic Arthritis
- Osteomyelitis and septic arthritis in children: current concepts
- Dexamethasone therapy for septic arthritis in children: results of a randomized double-blind placebo-controlled study.
- Intra-articular corticosteroids in septic arthritis: beneficial or barmy?
- Experimental septic arthritis in rabbits treated by a combination of antibiotic and steroid drugs.