From the Guidelines
Potential septic arthritis requires immediate joint aspiration for diagnosis followed by prompt empiric antibiotic therapy and surgical drainage, as recommended by the Infectious Diseases Society of America 1. The treatment approach should prioritize joint drainage or debridement, as this is a crucial step in managing septic arthritis, according to the guidelines 1. Key considerations in the treatment of potential septic arthritis include:
- Prompt empiric antibiotic therapy with broad-spectrum antibiotics, such as vancomycin, to cover common pathogens like Staphylococcus aureus
- Surgical drainage, particularly for hip and shoulder infections, to prevent permanent joint damage
- A 3-4 week course of antibiotic therapy, as suggested by the guidelines 1
- Regular monitoring of treatment response through joint aspiration and assessment of synovial fluid white cell count, protein levels, and clinical symptoms The choice of antibiotic should be guided by the suspected or confirmed pathogen, with consideration of the patient's allergy history and risk factors for specific infections. In general, the treatment of potential septic arthritis should be aggressive and prompt, with a focus on preserving joint function and preventing complications like osteomyelitis, as emphasized by the guidelines 1.
From the Research
Diagnosis and Treatment of Septic Arthritis
- Septic arthritis must be considered and promptly diagnosed in any patient presenting with acute atraumatic joint pain, swelling, and fever 2
- Risk factors for septic arthritis include age older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, hip or knee prosthesis, skin infection, and immunosuppressive medication use 2
- Physical examination findings and serum markers, including erythrocyte sedimentation rate and C-reactive protein, are helpful in the diagnosis but are nonspecific 2
- Synovial fluid studies are required to confirm the diagnosis 2
Antibiotic Therapy
- Empiric antibiotic therapy should be initiated if there is clinical concern for septic arthritis 2, 3
- Oral antibiotics can be given in most cases because they are not inferior to intravenous therapy 2
- Total duration of therapy ranges from two to six weeks; however, certain infections require longer courses 2
- Consideration for microorganisms such as Neisseria gonorrhoeae, Borrelia burgdorferi, and fungal infections should be based on history findings and laboratory results 2
- Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, other bacteria, viruses, fungi, and mycobacterium can cause the disease 2
Specific Treatment Approaches
- For previously healthy children in a Western setting, a total course of 10 days of antibiotic therapy may suffice 3
- Treatment of neonates, patients with immunodeficiency or cases caused by methicillin-resistant S. aureus, may deserve a different approach 3
- Mitigation of excessive intra-articular inflammation can be achieved through the use of adjuvant immunomodulation, such as rifampin, in conjunction with enhanced antibiotic treatment 4
- Linezolid may be used to treat septic arthritis caused by bacterial strains with an MIC ≤1 mg/L 5
Management of Staphylococcus aureus Bacteremia
- Staphylococcus aureus bacteremia causes metastatic infection in more than one-third of cases, including endocarditis, septic arthritis, and vertebral osteomyelitis 6
- Initial treatment for S aureus bacteremia typically includes antibiotics active against MRSA such as vancomycin or daptomycin 6
- Source control is a critical component of treating S aureus bacteremia and may include removal of infected intravascular or implanted devices, drainage of abscesses, and surgical debridement 6