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Arthritis, Septic

Jeffrey P. Feden, MD, FACEP Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Infection due to bacterial invasion of the joint space

  • Systems affected: musculoskeletal

  • Synonyms: suppurative arthritis; infectious arthritis; pyarthrosis; pyogenic arthritis; bacteri...

DIAGNOSIS

HISTORY

  • Typically presents with a combination of joint pain, swelling, warmth, and decreased range of motion

  • Nongonococcal arthritis: mostly monoarticular (80%)

    • Typically large joints (knee in ...

TREATMENT

GENERAL MEASURES

  • Admit for parenteral antibiotics and monitoring. Begin antibiotics immediately after arthrocentesis.

  • Drainage of purulent material is required if:

    • Pediatric: Surgical drainage ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Can monitor synovial fluid to verify decreasing WBC and sterile fluid after initial treatment

  • If no improvement within 24 hours, reevaluate and c...

REFERENCES

1
Mathews CJ, Weston VC, Jones A, et al. Bacterial septic arthritis in adults. Lancet.  2010;375(9717):846–855. [View Abstract on OvidMedline]
2
Margaretten ME, Kohlwes J, Moore D, et al....

CODES

ICD10

  • M00.9 Pyogenic arthritis, unspecified

  • M00.20 Other streptococcal arthritis, unspecified joint

  • M00.00 Staphylococcal arthritis, unspecified joint

  • M00.10 Pneumococcal arthritis, unspecified join...

CLINICAL PEARLS

  • Arthrocentesis and synovial fluid analysis are mandatory in cases of suspected septic arthritis.

  • Gram stain has variable sensitivity in septic arthritis. sWBC count is generally >50,...

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