Septic Arthritis Flashcards Preview

Z Year3 MSK Conditions > Septic Arthritis > Flashcards

Flashcards in Septic Arthritis Deck (21)
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1
Q

What are RF for septic arthritis?

A
  1. Underlying joint disease
  2. Prosthetic joint
  3. Age
  4. Immunosuppression
  5. Contiguous spread
  6. Exposure to ticks
2
Q

What are common causative agents for SA?

A
  1. Staph aureus
  2. Streptococci
  3. Neisseria gonococcus
  4. Grave -ve bacilli
    Staph aureus >30 yrs
    Neisseria gonorrhoea <30 yrs
3
Q

What are symptoms and signs for SA?

A
  1. Hot swollen, painful, restricted joint
  2. Acute presentation
  3. Single, large joint
  4. Fever
  5. Acute monoarthritis
4
Q

What are some DDx for SA?

A
  1. Osteoarthritis
  2. Psoriatic arthritis
  3. RA
    Gout
  4. Pseudogout
  5. Hemarthrosis
  6. Trauma
  7. Bursitis
  8. Cellulitis
  9. Lyme disease
  10. TB, extrapulmonary
5
Q

When should you assume SA?

A

Hot, swollen, acutely painful joint with restriction of movement is septic arthritis until proven otherwise, even in absence of fever

6
Q

What synovial fluid investigations do you do?

A
  1. Synovial fluid sample, gram stain, polarising microscopy
  2. Synovial fluid culture and sensitivities
  3. Synovial fluid WCC
7
Q

What bloods are done for SA?

A
  1. Blood culture
  2. WCC
  3. ESR
  4. CRP
  5. U+Es
  6. LFTs
8
Q

What imaging is done for SA?

A
  1. Plain X ray

2. US

9
Q

Why are all these bloods and cultures taken?

A

Check for antibiotic sensitivity

10
Q

What is the management plan for SA?

A

Empirical IV Abx 2 weeks + 4 weeks oral Abx
• Cover S.aureus and Streptococcus spp
• Adapt after MC&S

11
Q

What are possible complications of SA?

A
  1. Antibiotic associated allergic reaction
  2. Osteomyelitis
  3. Joint destruction
12
Q

What is the mortality of SA like?

A

Mortality rate up to 11%

13
Q

What is the cause of septic arhtirits?

A

Caused by current infection (haematogenous spread or direct inoculation)

14
Q

What are RF for infection?

A
  1. IV drug use
  2. diabetes
  3. immunosuppression
15
Q

What are RF for joint damage?

A
  1. Rh arthritis
  2. prosthetic joint
  3. gout
16
Q

What is the aspirate like in septic arthritis?

A
  1. Turbid
  2. yellow
  3. low viscosity fluid
  4. Raised WCC (neutrophils >90%)
17
Q

What do you need to stop in SA?

A

any biologic therapies e.g., TNF alpha inhibitors (12 months or forever if prosthetic joint)

18
Q

What is general management for septic arthritis?

A
  • Antibiotic
  • Joint aspiration
  • Analgesia
19
Q

What is the Abx regimen for SA?

A

Flucloxacillin 4-6 weeks (longer if complicated); if penicillin-allergic then use clindamycin instead.

20
Q

What is the Abx regimen for SA with MRSA suspected?

A

Vancomycin (or teicoplanin) for 4-6 weeks (longer if infection complicated)

21
Q

What is the Abx regiment for SA If suspecting gonococcal arthritis or Gram-negative infection?

A
  1. cefotaxime (or ceftriaxone)
  2. treat Gram-negative infections for 4-6 weeks (longer if infection complicated)
  3. treat gonococcal infection for two weeks