Arthritis, Septic
Basics
Description
Description
- Bacteria can be introduced into a joint by:
- Hematogenous spread (most common)
- Invasive procedures
- Contiguous infection (e.g., osteomyelitis, cellulitis)
- Direct inoculation such as plant thorns or nails
- Acute inflammatory process results in migration of WBCs into joint
- Synovial hyperplasia, cartilage damage, and formation of a purulent effusion
- Irreversible loss of function in up to 50%
- Mortality rate reported as high as 11%
Pediatric Considerations
- Hip infections are most common:
- Often in patients with otitis media, upper respiratory tract infections, or history of femoral venipuncture
- Complications of septic arthritis (SA) of hip in children: Avascular necrosis, epiphyseal separation, pathologic dislocation, and arthritis
- 50% occur in children <3 yr old
- Infants present with irritability, fever, and loss of appetite
- Older children present with fever, and a limp or refusal to bear weight or use joint
Etiology
Etiology
- Risk factors:
- Old age, infancy
- Rheumatoid arthritis and degenerative joint disease
- Intravenous drug user (IVDU), endocarditis
- Females (gonococcal [GC] infection)
- Immunosuppression (AIDS, diabetes, chemotherapy, steroid therapy)
- Repeated joint injections, pre-existing joint diseases, trauma, or prosthesis
- Skin infection, cutaneous ulcers
- No bacterial pathogen is identified in 10–20%
- Most common organisms:
- Staphylococcus aureus in adults, hip infections (80%), and patients with rheumatoid arthritis or diabetes
- Multidrug-resistant S. aureus (MRSA) has been noted in some studies to be the most common organism in community-onset adult SA
- Neisseria gonorrhoeae most common in young, healthy, sexually active patients (incidence has decreased over the past decades due to a decrease in the incidence of mucosal GC infections)
- Other pathogens: Group A β-hemolytic and group B, C, and G Streptococci:
- Gram-negative rods (e.g., Pseudomonas aeruginosa, Escherichia coli) in 10% of cases
- Neisseria meningitidis (12% of patients with meningococcal meningitis)
- Common in old age, infancy, immunosuppression, and IVDU (Pseudomonas)
- Anaerobes: Diabetes, prosthetic joints
- Mycobacterial and fungal causes: Atypical (e.g., in advanced HIV); more indolent course
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Citation
Schaider, Jeffrey J., et al., editors. "Arthritis, Septic." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307251/all/Arthritis__Septic.
Arthritis, Septic. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307251/all/Arthritis__Septic. Accessed December 1, 2024.
Arthritis, Septic. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307251/all/Arthritis__Septic
Arthritis, Septic [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 01]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307251/all/Arthritis__Septic.
* Article titles in AMA citation format should be in sentence-case
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T1 - Arthritis, Septic
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ED - Wolfe,Richard E,
BT - 5-Minute Emergency Consult
UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307251/all/Arthritis__Septic
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