Septic arthritis in adults

Septic arthritis in adults

• most common organism overall is Staphylococcus aureus
  Septic arthritis - most common organism: Staphylococcus aureus
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  Importance: 63
  • this may be from distant bacterial infections e.g. abscesses
• in young adults, Neisseria gonorrhoeae
  In young adults with septic arthritis, Neisseria gonorrhoeae is the most common organism found
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  Importance: 74
  is the most common organism (disseminated gonococcal infection)
  • whilst this is clearly related to sexual activity, overall epidemiological data suggests it is the most common cause in the 18-30 years group
• the most common cause is hematogenous spread
  hematogenous spread
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• in adults, the most common location is the knee
  knee
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• acute, swollen joint
  • restricted movement in 80% of patients
  • examination findings: warm to touch/fluctuant
• fever: present in the majority of patients

• synovial fluid sampling
  Synovial fluid sampling is the key investigation in patients with suspected septic arthritis
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  Importance: 76
  is obligatory
  • this should be done prior to the administration of antibiotics if necessary
  • may need to be done under radiographic guidance
  • shows a leucocytosis with neutrophil predominance
  • gram staining is negative in around 30-50% of cases
    Gram staining is negative in around 30-50% of cases of septic arthritis
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    Importance: 91
  • fluid culture is positive in patients with non-gonococcal septic arthritis
• blood cultures: the most common cause of septic arthritis is hematogenous spread
• joint imaging

• intravenous antibiotics which cover Gram-positive cocci are indicated. The BNF currently recommends flucloxacillin
  Septic arthritis: IV flucloxacillin
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  Importance: 87
  or clindamycin if penicillin allergic
  • antibiotic treatment is normally be given for several weeks (BNF states 4-6 weeks)
    several weeks (BNF states 4-6 weeks)
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  • patients are typically switched to oral antibiotics after 2 weeks
• needle aspiration should be used to decompress the joint
• arthroscopic lavage may be required