From the Guidelines
Treatment for septic arthritis requires prompt joint drainage and appropriate antibiotic therapy, with the goal of reducing morbidity, mortality, and improving quality of life. The initial management should include surgical drainage of the affected joint, either through arthroscopy or open arthrotomy, to remove purulent material and reduce bacterial load, as recommended by the Infectious Diseases Society of America 1. Empiric antibiotic therapy should begin immediately after obtaining synovial fluid and blood cultures, typically with intravenous antibiotics that cover Staphylococcus aureus (including MRSA) and streptococci. For adults, vancomycin 15-20 mg/kg IV every 12 hours (adjusted for renal function) plus ceftriaxone 2g IV daily is a common initial regimen, while for children, cefazolin 100-150 mg/kg/day divided every 8 hours is often used, with vancomycin added if MRSA is suspected 1. Once culture results are available, antibiotics should be narrowed to target the specific pathogen. Treatment duration typically ranges from 2-4 weeks, with transition to oral antibiotics when clinical improvement occurs (decreased pain, improved range of motion, normalized inflammatory markers), as suggested by the Surviving Sepsis Campaign 1. Joint immobilization should be brief, followed by progressive range of motion exercises to prevent stiffness. Close monitoring of inflammatory markers (ESR, CRP) helps assess treatment response, and prompt treatment is crucial as delayed therapy can lead to permanent joint damage, with worse outcomes in weight-bearing joints and in patients with pre-existing joint disease, as highlighted in the ACR Appropriateness Criteria for osteomyelitis or septic arthritis in children 1. Some key points to consider in the treatment of septic arthritis include:
- Prompt surgical drainage of the affected joint
- Empiric antibiotic therapy with broad-spectrum coverage
- Narrowing of antibiotics based on culture results
- Transition to oral antibiotics when clinical improvement occurs
- Brief joint immobilization followed by progressive range of motion exercises
- Close monitoring of inflammatory markers to assess treatment response. It is essential to prioritize the patient's quality of life and minimize morbidity and mortality by providing prompt and effective treatment for septic arthritis.
From the Research
Diagnosis and Treatment Guidelines
- Septic arthritis is a serious infection that requires prompt diagnosis and treatment to minimize irreversible damage 2.
- The diagnosis of septic arthritis should be considered in any patient presenting with acute atraumatic joint pain, swelling, and fever, especially in those with risk factors such as age older than 80 years, diabetes mellitus, and immunosuppressive medication use 3.
- Synovial fluid studies are required to confirm the diagnosis, and history and Gram stain aid in determining initial antibiotic selection 3, 4.
Antibiotic Therapy
- Empiric antibiotic therapy should be initiated if there is clinical concern for septic arthritis, and oral antibiotics can be given in most cases because they are not inferior to intravenous therapy 3.
- The choice of empiric antibiotics can be made by considering the patient's age, the synovial fluid gram stain results, and any preexisting conditions 2.
- The total duration of therapy ranges from two to six weeks, but certain infections require longer courses 3.
Joint Drainage and Other Treatments
- Joint drainage is an essential part of therapy, and the approach to periprosthetic joint infections depends on the duration of symptoms, causative organism, and individual factors 4.
- Effective treatment involves antibiotics, joint drainage and decompression, and immobilization followed by rehabilitation of the affected joint 2.
- New therapies are being sought, including the use of antimicrobial peptide or phage therapy 5.
Important Considerations
- Delay in diagnosis and treatment can result in permanent morbidity and mortality 3.
- Long-term follow-up is required to check for relapses and to assess the outcome of any residual joint damage 2.
- Successful outcome is based on effective treatment and results in normal joint function, while ineffective or delayed treatment may be crippling 6.