From the Guidelines
Septic arthritis requires prompt diagnosis and treatment, with the recommended approach involving immediate joint aspiration, empiric antibiotic therapy, and joint drainage, either through repeated needle aspirations or surgical intervention, with a treatment duration of at least 2 weeks, as suggested by the most recent study 1.
Key Considerations
- The treatment approach should be adjusted based on culture results, with initial empiric antibiotic therapy including intravenous antibiotics such as vancomycin and ceftriaxone or cefepime, to cover MRSA and gram-negative bacteria, respectively.
- Joint drainage is essential, particularly for hip, shoulder, or poorly responding infections, and can be achieved through repeated needle aspirations or surgical intervention.
- Patients typically require hospitalization initially, with close monitoring of inflammatory markers (ESR, CRP) to assess treatment response.
- Risk factors for septic arthritis include advanced age, immunosuppression, pre-existing joint disease, and recent joint procedures.
Treatment Duration
- A recent study 1 suggests that 2 weeks of antibiotic therapy may be adequate for the treatment of septic arthritis, particularly in cases where surgical debridement is performed.
- However, the optimal treatment duration may vary depending on the specific circumstances of the case, including the presence of implanted foreign bodies, the type of surgical procedure performed, and the antibiotic agent used.
Important Considerations
- Early treatment is crucial to prevent permanent joint damage, sepsis, and potential mortality.
- The choice of antibiotic therapy should be guided by culture results and local antimicrobial resistance patterns.
- Close monitoring of the patient's response to treatment is essential to ensure optimal outcomes.
From the Research
Definition and Diagnosis of Septic Arthritis
- Septic arthritis is an acute onset of monoarticular inflammation of a joint due to an infectious etiology, usually bacterial but can be viral or fungal 2.
- It must be considered and promptly diagnosed in any patient presenting with acute atraumatic joint pain, swelling, and fever 3.
- 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 3, 2.
- Physical examination findings and serum markers, including erythrocyte sedimentation rate and C-reactive protein, are helpful in the diagnosis but are nonspecific 3.
- Synovial fluid studies are required to confirm the diagnosis, and history and Gram stain aid in determining initial antibiotic selection 3.
Treatment and Management of Septic Arthritis
- Management involves a combination of medical and surgical treatments tailored to infection severity, causative pathogens, and overall patient condition 2.
- Medical treatment is not inferior to surgical treatment, but 30% of patients with septic arthritis ultimately require surgical treatment 2.
- 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.
- Total duration of therapy ranges from two to six weeks; however, certain infections require longer courses 3.
- Consideration for microorganisms such as Neisseria gonorrhoeae, Borrelia burgdorferi, and fungal infections should be based on history findings and laboratory results 3.
Complications and Prognosis of Septic Arthritis
- Septic arthritis causes significant morbidity and mortality and requires prompt diagnosis and treatment 2.
- Poor functional outcomes, such as amputation, arthrodesis, prosthetic surgery, and severe functional deterioration, occur in approximately 24% to 33% of patients with septic arthritis 2.
- The 90-day mortality rate of knee septic arthritis is 7% in patients 79 years and younger and from 22% to 69% in patients older than 79 years 2.
- Delayed management of septic arthritis may be associated with significant mortality (10-15%) and morbidity (25-50%) 4.