SHM's Clinical Quick Talks-Septic Arthritis

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Septic arthritis is a serious condition that occurs when an infectious organism enters a joint, causing damage and loss of function. It is most commonly seen in large joints and is more prevalent in males. Risk factors include recent joint surgery, rheumatoid arthritis, older age, joint prostheses, skin infections, immunosuppression, and diabetes.<br /><br />The most common organisms causing septic arthritis are Staphylococcus aureus, beta-hemolytic streptococci, Neisseria gonorrhoeae, and Escherichia coli. Different risk factors are associated with specific organisms, such as IV drug use and S. aureus, dialysis and S. aureus, and sickle cell disease and Salmonella.<br /><br />Clinical features of septic arthritis include sudden onset of pain, redness, swelling, and limited range of motion in a single joint, most commonly the knee. Diagnosis is confirmed through arthrocentesis, which involves analyzing the synovial fluid for cell count, gram stain, culture, and crystal analysis. However, gram stain is only 50% sensitive, and cultures take several days to finalize.<br /><br />Initial management involves starting empiric antibiotic treatment based on the suspected pathogen. Non-prosthetic joint infection may require joint wash-out or daily joint aspiration, followed by 2-4 weeks of pathogen-specific antibiotics. Prosthetic joint infections usually require surgical intervention, such as wash-out or removal of the prosthesis, followed by a two-stage revision. Empiric treatment includes vancomycin and a third or fourth generation cephalosporin, followed by pathogen-specific antibiotics based on culture data.<br /><br />In summary, septic arthritis is a medical emergency that can lead to irreversible joint damage and serious complications. Prompt diagnosis through arthrocentesis and appropriate antibiotic treatment are crucial for management. Prosthetic joint infections often require surgical intervention. The choice of antibiotics depends on the suspected organism.

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Megan Schermerhorn, Amy Dechet, Sonam Kiwalkar

Keywords

septic arthritis

infectious organism

joint damage

large joints

males

arthrocentesis

empiric antibiotic treatment

prosthetic joint infections

surgical intervention

prompt diagnosis