Septic Arthritis These slides give you information about septic arthritis and its treatment and how to diagnose it clinically and by arthrocentesis or serum labs.

1. BACTERIAL (SEPTIC)
ARTHRITIS
Hamzeh Yacoub

2. OVERVIEW
Inflammation of one or more joints due to an
infection.
Generally it is monoarticular.
most commonly affecting the knee, hip, and
shoulder.
Leads to rapid joint destruction if untreated.
Septic arthritis can originate from anywhere in
the body.
May begin as a result of open wound, trauma,

3. WHO IS AT RISK?
I. joint damaged patients: OA, RA.
II. Immunosuppression: neutropenia,
DM…
III. IV drugs abusers.
IV. Prosthetic joint.

6. GONOCOCCAL SEPTIC ARTHRITIS
Gonnococcal infections are less
destructive and more responsive to ABs.
Neisseria gonorrhea: sexually
transmitted gram –ve. It causes what is
known Disseminated gonococcal infection
(DGI).

7. NON-GONOCOCCAL SEPTIC
ARTHRITIS
S. Aureus : most common.
S. epidermidis: common in prosthetic
joints and IV..
Streptococci
Gram –ve enterococci: in hospitalized
and immunocompromised patients (esp.
with UTIs).
H. influenza: in kids bw 6 months – 2

8. CLINICAL FEATURES OF DGI
At first it starts as genitourinary symptoms before it
disseminates and causes:
I. Arthritis-dermatitis syndrome: fever,
migratory polyarthralgia, tenosynovitis and
dermatitis.
II. Monoarhtritis.

9. NON-GONOCOCCAL CLINICAL
FEATURES
Acute pain, tenderness, swelling, warmth
and erythema.
Some patients have evidence of the source
responsible for septicemia ( skin, pharynx,
cardiac valve, lung).
SA is acute in onset (rule out OA).

10. LEFT S.A

11. SA IN THE STERNOCLAVICULAR
JOINT

12. S.A DIAGNOSIS
Synovial ultra sound guided arthrocentesis, WBCs
more than 50k/mm^3 and most of it are neutrophils.
Culture is also done.
Note that synovial fluid will be less viscous than
normal.
Serum labs include high ESR, CRP, WBCs.
Ultrasound can document the presence of an effusion
which would be amenable to drainage.

14. SEPTIC ARTHRITIS IMAGING (X-
RAY)

15. SHOULDER SEPTIC ARTHRITIS
IMAGING

16. SEPTIC ARTHRITIS TREATMENT
Antibiotics should be started before culture
results.
Vancomycin for gram +ve
Ceftriaxone, ceftiazidime for gram –ve
IV Antibiotics for 6 weeks.
Don’t give antibiotic before the sample!!
Drainage.

17. SURGICAL DRAINAGE
Drainage by Arthroscopy: in the help of
arthroscope, particularly useful for knee.
Arthrotomy

18. SEPTIC ARTHRITIS COMPLICATIONS
Chondrolysis: lysis/break down of cartilage.
Septic dislocation of the joint.
Avascular necrosis especially for femoral head.
Shortening of limbs because of cartilage
destruction.
Late degenerative changes may lead to
osteoarthritis.

19. SEPTIC ARTHRITIS IN PEDIATRICS
Pediatric Septic Hip Arthritis is an intra-
articular infection in children, peaks in the first
few years of life.
Affects 4-5 per 100,000 children annually.
surgical emergency and requires prompt
recognition and urgent surgical incision and
drainage followed by IV antibiotics.

20. MOST COMMON SITE
Hip is the most common site, knee is more
frequently affected in older children.

21. CLINICAL FEATURES
Septic arthritis presents as a painful joint, often
accompanied by fever, irritability, and refusal to
bear weight.
On examination, range of motion is clearly
limited and The joint is tender and may be
visibly swollen.