Septic arthritis - Revision history

Danbot: Strip excess bold

2026-03-22T09:31:45Z

Strip excess bold

Danbot: Major expansion: arthrocentesis interpretation, empiric antibiotics, gonococcal specifics, peer-reviewed references

2026-03-21T18:32:44Z

Major expansion: arthrocentesis interpretation, empiric antibiotics, gonococcal specifics, peer-reviewed references

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Rossdonaldson1: /* EvaluationCarpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96. */

2019-12-11T03:31:57Z

EvaluationCarpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.

← Older revision		Revision as of 03:31, 11 December 2019
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	==Evaluation<ref>Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.</ref>==		==Evaluation<ref>Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.</ref>==
			[[File:SepticJointFluid.jpg\|thumb\|Synovial fluid from a septic knee]]
	===Work-Up===		===Work-Up===
	*Arthrocentesis with synovial fluid analysis		*Arthrocentesis with synovial fluid analysis

Rossdonaldson1 at 06:34, 3 July 2019

2019-07-03T06:34:04Z

← Older revision		Revision as of 06:34, 3 July 2019
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			''This page is for <u>adult</u> patients; for pediatric patients see [[septic arthritis (peds)]].''
	==Background==		==Background==
	*Most important diagnostic consideration in acute joint pain (can destroy joint in days)		*Most important diagnostic consideration in acute joint pain (can destroy joint in days)

Rossdonaldson1: Rossdonaldson1 moved page Septic arthritis (general) to Septic arthritis

2019-07-03T06:33:01Z

Rossdonaldson1 moved page Septic arthritis (general) to Septic arthritis

← Older revision	Revision as of 06:33, 3 July 2019
(No difference)

Rossdonaldson1: /* Disposition */

2019-07-03T06:08:23Z

Disposition

← Older revision		Revision as of 06:08, 3 July 2019
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	==Disposition==		==Disposition==
	*Admit all ~~to ortho~~		*Admit all

	==See Also==		==See Also==

Rossdonaldson1: /* Management */

2019-07-03T06:07:39Z

Management

← Older revision		Revision as of 06:07, 3 July 2019
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	==Management==		==Management==
	~~===[[Arthrocentesis]]===~~
	*Treatment based on diagnostic studies
	===[[Antibiotics]]===		===[[Antibiotics]]===
	{{Septic Arthritis Antibiotics}}		{{Septic Arthritis Antibiotics}}

	===Consultation===		===Consultation===
	*Consult ortho for joint irrigation in OR if joint aspirate is indicative of infection		*Consult ortho for joint irrigation in OR if joint aspirate is indicative of infection

Rossdonaldson1: /* EvaluationCarpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96. */

2019-07-03T06:06:50Z

EvaluationCarpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.

← Older revision		Revision as of 06:06, 3 July 2019
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	==Evaluation<ref>Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.</ref>==		==Evaluation<ref>Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.</ref>==
	*The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is 27%
	===Work-Up===		===Work-Up===
	*Arthrocentesis with synovial fluid analysis		*Arthrocentesis with synovial fluid analysis

Kearny89: /* Consultation */

2019-06-10T23:55:35Z

Consultation

← Older revision		Revision as of 23:55, 10 June 2019
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	===Consultation===		===Consultation===
	*Consult ortho for joint irrigation in OR if joint aspirate is indicative of infection		*Consult ortho for joint irrigation in OR if joint aspirate is indicative of infection
			**Benefit of serial aspirations vs arthroscopy vs irrigation and debridement is unclear

	==Disposition==		==Disposition==

Kearny89: /* Evaluation */

2019-06-04T01:48:16Z

Evaluation

← Older revision		Revision as of 01:48, 4 June 2019
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	{{Differential Diagnosis Monoarthritis}}		{{Differential Diagnosis Monoarthritis}}

	==Evaluation==		==Evaluation<ref>Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011;18(8):781-96.</ref>==
			*The prevalence of nongonococcal septic arthritis in ED patients with a single acutely painful joint is 27%
	===Work-Up===		===Work-Up===
	*Arthrocentesis with synovial fluid analysis		*Arthrocentesis with synovial fluid analysis

← Older revision		Revision as of 09:31, 22 March 2026
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	*Bacterial infection of a joint space — a '''true orthopedic emergency'''		*Bacterial infection of a joint space — a '''true orthopedic emergency'''
	*Rapid cartilage destruction occurs within hours if untreated<ref name="mathews">Mathews CJ, et al. Bacterial septic arthritis in adults. ''Lancet''. 2010;375(9717):846-855. PMID 20206778.</ref>		*Rapid cartilage destruction occurs within hours if untreated<ref name="mathews">Mathews CJ, et al. Bacterial septic arthritis in adults. ''Lancet''. 2010;375(9717):846-855. PMID 20206778.</ref>
	*~~'''~~Staphylococcus aureus~~'''~~ is the most common pathogen in adults (~50%)		*Staphylococcus aureus is the most common pathogen in adults (~50%)
	*~~'''~~Neisseria gonorrhoeae~~'''~~ is the most common cause in sexually active young adults		*Neisseria gonorrhoeae is the most common cause in sexually active young adults
	*Knee is the most commonly affected joint (~50%)		*Knee is the most commonly affected joint (~50%)
	*Mortality: 5-15% overall; higher in elderly and prosthetic joints		*Mortality: 5-15% overall; higher in elderly and prosthetic joints
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	==Clinical Features==		==Clinical Features==
	*~~'''~~Acute monoarticular~~'''~~ joint pain, swelling, warmth, erythema		*Acute monoarticular joint pain, swelling, warmth, erythema
	*Pain with both active ~~'''~~and~~'''~~ passive range of motion (distinguishes from periarticular pathology)		*Pain with both active and passive range of motion (distinguishes from periarticular pathology)
	*Effusion		*Effusion
	*Fever (present in ~60%, absence does not exclude)		*Fever (present in ~60%, absence does not exclude)
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	**Lower counts do not exclude — partially treated or early infection may have lower counts		**Lower counts do not exclude — partially treated or early infection may have lower counts
	**Gram stain positive in ~50% of non-gonococcal cases		**Gram stain positive in ~50% of non-gonococcal cases
	*~~'''~~Labs~~'''~~: CBC, ESR, CRP, blood cultures (positive in ~50%), lactate		*Labs: CBC, ESR, CRP, blood cultures (positive in ~50%), lactate
	*If gonococcal suspected: GC/CT NAAT (urine, cervix/urethra, pharynx, rectum)		*If gonococcal suspected: GC/CT NAAT (urine, cervix/urethra, pharynx, rectum)
	*~~'''~~Imaging~~'''~~:		*Imaging:
	**X-ray: evaluate for effusion, osteomyelitis, fracture		**X-ray: evaluate for effusion, osteomyelitis, fracture
	**Ultrasound: guide arthrocentesis, confirm effusion		**Ultrasound: guide arthrocentesis, confirm effusion
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	==Management==		==Management==
	*'''Empiric IV antibiotics''' after arthrocentesis (do NOT delay if aspiration will be delayed):		*'''Empiric IV antibiotics''' after arthrocentesis (do NOT delay if aspiration will be delayed):
	**~~'''~~Vancomycin~~'''~~ 15-20 mg/kg IV (covers MRSA) PLUS		**Vancomycin 15-20 mg/kg IV (covers MRSA) PLUS
	**~~'''~~Ceftriaxone~~'''~~ 2 g IV (covers gram-negatives and gonococcus)		**Ceftriaxone 2 g IV (covers gram-negatives and gonococcus)
	**If prosthetic joint: add ~~'''~~Vancomycin~~'''~~ + ~~'''~~Cefepime~~'''~~ or ~~'''~~Meropenem~~'''~~		**If prosthetic joint: add Vancomycin + Cefepime or Meropenem
	*~~'''~~Orthopedic consultation~~'''~~ for:		*Orthopedic consultation for:
	**Joint washout/irrigation (arthroscopic or open)		**Joint washout/irrigation (arthroscopic or open)
	**Prosthetic joint infections require urgent surgical intervention		**Prosthetic joint infections require urgent surgical intervention
	*~~'''~~Gonococcal arthritis~~'''~~: Ceftriaxone 1 g IV/IM daily + treat for chlamydia		*Gonococcal arthritis: Ceftriaxone 1 g IV/IM daily + treat for chlamydia
	*Pain management: IV analgesics, joint immobilization, ice		*Pain management: IV analgesics, joint immobilization, ice

	==Disposition==		==Disposition==
	*~~'''~~Admit~~'''~~ all confirmed or suspected septic arthritis		*Admit all confirmed or suspected septic arthritis
	*Orthopedic surgery consultation for joint washout		*Orthopedic surgery consultation for joint washout
	*Gonococcal arthritis: may be managed with close outpatient follow-up after initial IV antibiotics in select cases		*Gonococcal arthritis: may be managed with close outpatient follow-up after initial IV antibiotics in select cases