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Septic Arthritis: General Orders and Treatment


- Diff Dx

- Evaluation: (before antibiotics are infused):
    - synovial fluid analysis
         - culture & gram's stain;
         - leukocyte count
         - glucose and viscosity (both decreased w/ infection);
    - blood culture, CBC, CRP, & sed rate
    - radiographs (and possibly ultrasound):
         - need to rule out concomitant metaphyseal osteomyelitis;
    - misc: bone scans

- Treatment:
    - based on antimicrobial suseptabilities as well as patient age:
         - less than 3 months
         - from 6 mo to 2 yrs
         - greater than 2 yrs;
    - drainage:
         - drainage can be provided by repeated closed needle aspiration, arthroscopy, or arthrotomy;
              - septic hip demands open drainage;
              - if joint cannot be adequately drained because of loculations or if the joint is not responding clinically with gradually decreasing synovial-fluid leukocyte counts and negative cultures, open surgical drainage will be necessary