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Arthritis Sepsis

Inflammation of a synovial membrane with


purulent effusion into the joint capsule, often due
to bacterial infection
Risk Factor and Etiology
• Previous arthritis
• Trauma
• Diabetes Mellitus
• Immunosupression
• Bacteremia
• Sickle cell anemia
• Prosthetic joint
Clinical Presentation: “red,
PATHOGENESIS hot, painful joint”

• Hemotogenous spread • Fever


• Spread through adjacent • Erythema
tissues • Edema
• Direct • Heat
inoculation(aspiration/art • Pain
hrotomy) • Markedly decreased passive
and active ROM
Diagnosis
• Needle aspiration, open • CBC with diff: leukocytosis and
drainage and lavage left shift
(arthroscopically or • ESR: monitor treatment
arthrotomy) • CRP: monitor treatment
Contraindications to • Blood cultures: may be + in 50%
S aureus
arthrocentesis:
• Urethral, cervical , pharyngeal and
1. avoid aspirating from an rectal swabs: N gonorrheae
area that has overlying soft • Synovial fluid analysis: Gram
tissue infection stain, culture, cell count, and
2. Bleeding disorders crystal analysis
3. Anticoagulation therapy
Treatment
• <5 year-old: 2nd and 3rd • Gram-positive
generation cephalosporins
– Streptococcus, methicillin-
• >5 year-old and adults: cefazolin, sensitive staphylococcus
2nd gen. cephalosporins
• Cefazolin 3x2 gram,
• S. aureus→cefazolin/vancomycin Sulbactam/ampicillin 4x2
• Adults: ciprofloxacin+rifampin gram
• N. gonorrhoeae→cefriaxone, – Meticillin-resistant
• Gram-negative bacilli→3rd gen. staphylococcus
cephalosporin+ aminoglycoside • Vancomycin 2x1 gram
• Gram-negative
– Ceftriaxone 1x2 gram
Prognosis and complications
• Poor prognosis factors
– Immunodeficiency, RA, prematurity, osteomyelitis, hip,
prosthetic infections, + blood cultures, symptoms >1 week, >4
joints, + cultures after aspiration after 7 days of abx tx
• Complications:
– Mortality 8%-15% in three series
– arthritis stiffness, dislocation, subluxation, AVN, local growth
distrubance, osteomyelitis, postinfection synovitis
• Favorable outcome in 50%-80% of cases