septic arthritis

Question 1

risk factors of septic arthritis

Answer 1

old age, comorbidities (HIV, diabetics, sickle cell), sepsis, IV drug abuse, intra articular injections, prosthetic joint

Question 2

commonest organisms for each patient category?

Answer 2

staph aureus- for all ages and all categories

salmonella- sickle cell
group B strep- infants
gram -ve bacili- IV drug abuse
pseudomonas- IV drug abusers
coagulase negative staph- prosthetic joint
candida or fungal- immunocompromised

Question 3

routes of spread?

Answer 3

hematogenous, direct inoculation, spread from osteomyelitis

Question 4

clinical presentation?

Answer 4

pain, fever, limited ROM, inability to bear weight, redness, swelling, heat

Question 5

diagnosis?

Answer 5

CBC- WBC high
CRP/ESR- high

synovial fluid aspiration: cell count and differential, culture and gram stain, crystal

color is yellow and cloudy

Question 6

treatment?

Answer 6

start IV antibiotic based on gram stain result

if +ve: vancomycin
if -ve: 3rd generation cephalosporin

then switch to organism specific antibiotic for 6-12 wks

for urgent decompression and debridement and drain within 8 hrs, do joint arthrotomy