MANUAL MINORS
Septic arthritis is an acute joint infection caused by the invasion of microorganisms, usually bacteria, into the synovial fluid and surrounding tissues. It is a medical emergency that, if not treated promptly, can lead to irreversible joint destruction, sepsis, and serious systemic complications.
Staphylococcus aureus is the most common causative agent, although it can also be caused by streptococci, Gram-negative bacilli, or other pathogens, depending on factors such as age or comorbidities.
Diagnosis
The diagnosis is based on clinical suspicion, especially in patients presenting with a swollen, warm, painful joint with limited movement. It is crucial to perform joint aspiration for synovial fluid analysis, which includes cell count, Gram stain, culture, and determination of glucose and protein levels.
In addition, imaging studies (X-ray, ultrasound, or MRI) are used to assess structural damage and rule out other causes. Blood tests, such as full blood count, CRP, and ESR, are often elevated but are non-specific.
Differential Diagnosis
Disease | Key Features |
|---|---|
Gout | Presence of urate crystals in synovial fluid, self-limiting acute attacks. |
Pseudogout | Calcium pyrophosphate crystals in synovial fluid, typically affects the knee or wrist. |
Rheumatoid arthritis | Chronic autoimmune disease, morning stiffness, positive RF and ANA. |
Reactive arthritis | Occurs after urinary or gastrointestinal infection, no direct infection in the joint. |
Septic bursitis | Inflammation of the bursa with infection, generally without affecting the joint itself. |
Emergency Management
The management of septic arthritis in emergencies is critical and must be initiated quickly. After joint aspiration and sample collection for culture, empirical intravenous broad-spectrum antibiotics should be administered, covering both Gram-positive and Gram-negative bacteria.
Vancomycin and ceftriaxone are common regimens until cultures identify the specific microorganism and allow treatment adjustment. In severe cases, referral to an orthopaedic specialist should be considered for surgical drainage if adequate drainage cannot be achieved through aspiration.
Definitive Treatment
Definitive treatment includes targeted antibiotic therapy based on culture results and the sensitivity of the identified pathogen. The duration of treatment is generally 2 to 4 weeks intravenously, followed by oral therapy if necessary.
In some cases, surgical debridement or joint lavage is required to remove purulent material and prevent permanent joint damage. Additionally, rehabilitation with physiotherapy may be necessary to restore joint function after the infection resolves.
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