Septic Arthritis

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    Septic Arthritis

    • ACUTE monoarticular arthritis is septic arthritis until proven otherwise. 
    • Requires URGENT medical management, ANTIBIOTICS ARE NOT ENOUGH. 
    • Investigations
      • Infection Picture (elevated WBCs, fever, soft BP)
    • Joint Aspiration
      • MUST BE PERFORMED to rule out infection
      • Send for (3 C's)
        • Cells (Count and Diff):
          • Inflammation > 2000/mm^3
          • Neutrophils >90% consistent with infection
          • Typically Infections Arthritis will have WBCs > 50,000
        • Crystals
          • Seeing rhomboid positive birefringent crystals (CPPD) is common, still rule out infection. (infection releases CPPD from cartilage)
        • Culture & Gram Stain
          • Gram Stain does not rule out infection (only positive 20% of septic arthritis), must cover with broad abx and await culture. 
    • Organisms:
      • MRSA & S. aureus
      • Klebsiella pneumoniae
      • Neisseria gonorrhoeae
    • Management:
      • Causes irreversible joint damage
      • Antibiotics (but not enough)
        • First Line: Vancomycin & Ceftriaxone
        • Vancomycin for MRSA, Ceftraixone for Gram +'s and Gram -'s (including N.gonorrhea)
      • Isolation of organism. 
      • Find the source (hematologic spread from somewhere like IVDU)
      • Frequent joint aspirations
      • Surgical consult
        • Possibility of surgical management
        • May need irrigation & debridement
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