Septic Arthritis Inflammation of joint due to a bacterial or fungal infection. Its mainly occur due to pyogenic organism.

1. Septic Arthritis
Prepared by:
RN Arpana Bhusal
BNS

2. NORMAL & ABNORMAL

3. Introduction
Inflammation of joint due to
a bacterial or fungal infection.
Its mainly occur due to
pyogenic organism.
It presents as an acute painful
arthritis, but it may present as
subacute or chronic arthritis.
It also named as infective
arthritis, pyogenic arthritis or
supporative arthritis

4. Causes
Acute Septic Arthritis:
Most common causative organism: Staph.aureus
Other organisms are streptococcus, Pneumococcus and Gonoccus
Chronic Septic arthritis:
Mycobacterium Tuberculosis, Candida albucans
Less common

5. Routes of Infection
Hematogenous:
It is most commonest route and may be a primary focus ofinfection in
the form of pyoderma, throat infection and septicemia.
Secondary to near by Oteomyelitis:
Particularly common route in joints with intra-articular metaphysis. E.g
hip,shoulder.
Penetrating wounds:
The knee, being a superficial joint, I soften affected via this route.
Iatrogenic:
It may occur following intra-articular steroid injection in different
arthritis and during femoral artery punctures for blood collection.
Umbilical cord sepsis:
Infection can travel to joints

6. Risk Factors
 Artificial joint implants
 Bacterial infection somewhere else in your body
 Chronic illness or disease (such as diabetes, rheumatoid arthritis, and
sickle cell disease)
Intravenous (IV) or injection drug use
Medications that suppress your immune system
Recent joint injury
Recent joint arthroscopy or other surgery
 Seen at any age
 Children younger than 3 years( Hip)

7. Pathogenesis
) Any one of the etiology enter to the body through various route, it
reaches to the joint.
Begin an inflammatory response in the synovium which resulting in the
exudation of fluid within the joint.
 Joint cartilage is destroyed by inflammatory grannulation tissue and
lysosomal enzymes in the joint exudate.
Destruction of the joints and loss of joint movement(ankylosis).

8. Clinical Features
) In a typical acute form:
-Severe throbing pain
-Swelling
-Redness of the affected joint associated with high grade fever and
malaise.
-Unable to use affected limb
In subacute phase:
-- Not allowing to touch the affected joint
-Low grade fever

9. Clinical Features
) Not moving the affected limb properly due to pain on movement
Joint Swelling just one joint
Psuedoparalysis
Joint tenderness

10. Diagnosis
 mainly clinical examination
Aspiration of joint fluid for cell count, examination of crystal under the
microscope, gram stain & culture.
Blood Culture
Blood: Neutrophil leukocytosis, ESR increased

11. Diagnosis
 X-Ray of affected joint: shows
joint space soft tissue

12. Treatment
 Antibiotic:
- In joint infections, parenteral antibiotics - at least 2 weeks.
-Infection with either methicillin-resistant S aureus or methicillin-
susceptible S aureus - at least 4 full weeks IV antibiotic therapy.
-Orally administered antimicrobial agents are almost never indicated in
the treatment of S aureus infections.
-Gram-negative native joint infections with a pathogen i.e sensitive to
quinolones can be treated with oral ciprofloxacin for the final 1-2 weeks
of treatment.
-2-week course of intravenous antibiotics is sufficient to treat
gonococcal arthritis.
-Drugs Used: Ceftriazone, Cifrofloxacin, Cefixime, Oxacillin,
Vancomycin

13. Contd……….
Joint immobilization and physical therapy
-Resting, keeping the joint still, raising the joint and using cold
compresses may help relieve pain.
-Immobilization of the joints to control the pain.
-Exercising the affected joint helps the recovery process.
 Arthrocentesis
-If synovial fluid builds up quickly due to the infection, a needle may be
inserted into the joint often to aspirate the fluid.
Severe cases may need surgery to drain the infected joint fluid.
Physical Therapy
-Usually, immobilization of the infected joint to control pain is not
necessary after the first few days.
-If the patient's condition responds adequately after 5 days of
treatment, begin gentle mobilization of the infected joint.

14. Contd…..
- Most patients require aggressive physical therapy to allow maximum
postinfection functioning of the joint.
-The joint should bear no weight until the clinical signs and symptoms of
synovitis have resolved.
Synovial Fluid Drainage:
-In general, use a needle aspirate initially,repeating joint taps frequently
enough to prevent significant reaccumulation of fluid.
-Aspirating the joint 2-3 times a day may be necessary during the first
few days.
-If frequent drainage is necessary, surgical drainage becomes more
attractive.
- Gonococcal-infected joints rarely require surgical drainage.

15. Contd…..
Indication for Surgical drainage:
-The appropriate choice of antibiotic and vigorous percutaneous
drainage fails to clear the infection after 5-7 days.
-The infected joints are difficult to aspirate (eg, hip).
-Adjacent soft tissue is infected.
Prognosis
-Recovery is good with prompt antibiotic treatment. If treatment is
delayed, permanent joint damage may result.
Complications
Deformity & stiffness
Pathological dislocation Osteoarthritis

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