septic arthritis: quick hits

26 Aug

RAGING HYPOTHETICAL:

Your next patient is a 54 y.o. male who presents to with complaints of swelling in the right elbow while he was at a party a few days prior.  

He also feels feverish since the onset of swelling, though he denies any pain in the elbow or any recent injury.  

Do you want to tap the joint?  What are you looking for?

 

QUICK PEARLS:

the most common organisms involved in septic arthritis:

  • The most common overall cause of septic arthritis is Staphylococcus aureus 
  • Neisseria gonorrhea is the most common organism in young sexually active adults. 
  • Special populations and their common organisms include:
    • History of leukemia – Aeromonas spp.
    • IV drug users – Serratia spp (especially sternoclavicular and SI joints).
    • Sickle cell — higher Salmonella spp osteoarthritis 

Common characteristics of septic arthritis include

  • fever,
  • limited range of motion of the joint,
  • erythema
  • tenderness of the joint,
  • warmth over the joint.

Joint aspiration should usually show greater than 50K WBCs but sensitivity is only 64%.

ESR has sensitivity of 96% but is non specific.

Culture is definitive but is often negative in gonococcal septic arthritis.

Treatment is with vancomycin and and 3rd generation cephalosporin most commonly.

 

Submitted by J. Stone.

 

References: (Tintinalli’s Emergency Medicine, Ch 281 – Acute disorders of the joints and bursae); picture

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