Epidemiology
Etiology
- Staphylococcus aureus
- Most common in adults and children > 2 years
- Frequently found in patients with arthritis following invasive joint procedures
- Streptococci
- N. gonorrheae
- Most common in sexually active young adults
- Gram-negative rods esp. E. coli and P. aeruginosa
Pathophysiology
Clinical features
Diagnostics
Treatment
- Emergent Management
- This is an orthopedic emergency requiring immediate action to prevent joint destruction.
- Two priorities: Joint Drainage & IV Antibiotics.
- ALWAYS aspirate the joint (arthrocentesis) before giving antibiotics.
- Empiric IV Antibiotics (Start immediately after aspiration)
- General/Gram (+) cocci: Vancomycin (to cover MRSA, the most common cause).
- Sexually Active Young Adult: Ceftriaxone (for N. gonorrhoeae). Also treat for Chlamydia.
- Gram (-) Rods / Immunocompromised: Vancomycin + Anti-pseudomonal (e.g., Cefepime, Ceftazidime).
- Gram Stain Negative: Vancomycin + Ceftriaxone.
- Joint Drainage
- Serial Needle Aspiration: May be sufficient for easily accessible joints (e.g., knee).
- Surgical Washout (Arthroscopy or Arthrotomy): Required for hip joint, failure of needle aspiration, or thick purulence.
- Duration of Therapy
- Nongonococcal: ~3-4 weeks total. Start with IV and can switch to oral agents when improving.
- Gonococcal: Shorter course of ~7-14 days.