Septic Arthritis - Diagnosis and Management Summary
Clinical ...

Septic Arthritis - Diagnosis and Management Summary

Clinical Exam: hot, swollen, pain with passive AND active ROM +/- fever, chills, malaise

Ddx: cellulitis, bursitis, tendonitis, osteoarthritis, gout, pseudogout, osteomyelitis, trauma, avascular necrosis, Lyme disease, viral arthritis

Workup: arthrocentesis w/ fluid culture, Gram stain, cell count, and crystal evaluation

 • labs and imaging unlikely to be beneficial in septic arthritis diagnosis

Treatment: admission for parenteral Abx, Orthopedics consults for possible washout

 • Healthy Adults/ChiIdren = staphylococcus, streptococcus, N. gonorrhoeae Vancomycin + Ceftriaxone

 • HIV or IVDU = staphylococcus, gram negative bacilli Vancomycin + Cefepime OR Ciprofloxacin

 • Sickle Cell = Salmonella, staphylococcus Vancomycin + Ciprofloxacin OR Imipenem

Clinical Pearls:

 • Atraumatic, hot, swollen, painful = bacterial nongonococcal septic arthritis until proven otherwise

 • ESR -90% sensitive in pediatrics but NOT adults

 • Consider gonococcal arthritis in sexually active with migratory arthritis (therefore oral, cervical, anal Cxs)

 • *** If unable to rule out septic arthritis, patient admitted for treatment until cultures results ***

MH/CCF/CWRU EM Res @MetroHealth_EM

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Contributed by

Dr. Gerald Diaz
Board Certified Internal Medicine Hospitalist, GrepMed Editor in Chief 🇵🇭 🇺🇸 - Sign up for an account to like, bookmark and upload images to contribute to our community platform. Follow us on IG: | Twitter:

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