Septic arthritis is defined as infection within the joint space of two bones. The major causative organisms include S. aureus and in the sexually promiscuous individual, Neisseria gonorrhoeae. Intravenous drug users are likely to develop septic arthritis within unusual joints (e.g., sternoclavicular, sacroiliac). Rheumatoid arthritis, presence of joint prosthe-ses, and steroid use are predisposing factors for development of septic arthritis.
Diagnosis is usually based on clinical presentation of a warm, swollen joint with limitation in range of motion. A joint aspiration should be completed and the synovial fluid sent for Gram stain with culture, WBC count with differential, and crystal analysis to rule out gout and pseudogout. Blood cultures should also be drawn before initiation of antibiotics.
Gonococcal arthritis usually presents as an acute arthritis involving one or more joints in a sexually active individual. Two thirds of patients have dermatitis with one or multiple, usually asymptomatic, lesions that progress from macular to papular and finally vesicular or pustular. Joint fluid, ure-thral, and rectal cultures should also be obtained. Treatment is generally with a third-generation cephalosporin intravenously until improvement, followed by oral therapy to complete a 1-week course of therapy.
Treatment of nongonococcal arthritis requires proper draining of the infected joint. This is often done surgically, although repeat needle drainage may also be successful if the joint is easily accessible. Treatment generally depends on the Gram stain and includes a third-generation cephalosporin, with the addition of vancomycin if gram-positive cocci in clusters are seen. Duration of therapy is 3 to 4 weeks.
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