septic arthritis

what is septic arthritis?

infection of one or more joints

what is the most common bacteria in septic arthritis?

staph aureus

is staph aureus gram positive or negative?

positive

what is the common bacteria in septic arthritis in young, sexually active individuals?

neisseria gonorrhoea

is neisseria gonorrhoea gram positive or negative?

gram negative

when does septic arthritis occur?

when bacteria enter the synovium

which joint does septic arthritis most commonly affect?

knee

what are the risk factors for septic arthritis? (5)

- diabetes

- advancing age

- prosthesis

- immunodeficiency/suppression

- IV drug users

what is the usual onset time for presentation of septic arthritis?

acute

what are the symptoms of SA?

- pain

- fever

- swelling

- inability to weight bear

what are the signs of SA? (5)

- pain on active and passive movement

- reduced range of motion

- erythema

- warmth

- joint effusion

what is the gold standard investigation that should be done for SA?

urgent joint aspiration for WBC, gram stain, culture and crystal microscopy

what can crystal microscopy rule out?

gout/pseudogout

what will blood tests reveal for SA?

- elevated CRP

- elevated WCC

what diagnostic criteria is used for SA?

Kocher diagnostic criteria

what are the Kocher diagnostic criteria?

1) fever > 38.5

2) non-weight bearing

3) raised ESR and WCC

what is the sepsis 6 management?

3 IN:

- IV antibiotics

- oxygen

- IV fluids

3 OUT:

- blood culture

- urine output

- lactate

within what time should sepsis 6 be completed?

within 1 hour of recognition of signs

what should be done ideally before giving antibiotics?

joint aspiration

how long are the antibiotics generally given for in SA?

- 2 weeks IV

- 6 weeks altogether

which antibiotics are used as first line?

flucoxacillin (clindamycin if pencillin allergic)

which antibiotic can be used for MRSA?

vancomycin

which antibiotic can be used for gonococcal/gram negative infections?

ceftriaxone

what can be done if unresponsive to antibiotics?

joint drainage