Peripheral Bacterial Septic Arthritis

Abstract

Septic arthritis refers to an infection in a joint due to a bacterial, mycobacterial, or fungal cause. Joint infections are a serious cause of morbidity and mortality and constitute a true musculoskeletal emergency. The estimated incidence of septic arthritis in the general population is between 2 and 6 cases per 100,000 people per year. The most common presentation is an acute monoarthritis. Identification of organisms in the synovial fluid is the criterion standard for diagnosis. Synovial fluid aspiration should be performed prior to initiating antibiotics. While no diagnostic cutoff exists for synovial fluid white blood cell count, increasing leukocytosis is associated with a higher likelihood of an infectious cause of arthritis, and patients commonly present with values greater than 50,000/μL. The cornerstones of treating septic bacterial arthritis are adequate drainage and antimicrobials. Joint drainage is always recommended in septic arthritis; however, no clear guidelines or strong evidence exist to guide the preferred method of drainage. Options for joint drainage include daily needle aspiration, arthroscopy, or open surgical drainage via arthrotomy.

The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study

“…The choice of empirical antibiotics remains debatable as there have been no randomised controlled trials that compare antimicrobial regimens to date, with little evidence to guide optimal antibiotic duration. 28 The empirical agent of choice is dependent on clinical presentation and the presence of clinical risk factors such as immunocompromised states or history of intravenous drug abuse. Medical treatment is ultimately pathogen directed and guided by the results of gram stain and antimicrobial susceptibility testing on culture results.…”

“…Synovial drainage strategies in native joint sepsis are based on retrospective studies as there are no randomized controlled studies evaluating joint drainage procedures making it difficult to establish evidence-based recommendations for surgical management. 28 Limited data from small retrospective studies suggests that surgical management is not superior to medical management with closed-needle aspiration in terms of both morbidity and mortality. 29 , 30 Over 75% of native joint infections in this cohort had one or more joint drainage procedures via needle arthrocentesis and/or surgical drainage.…”

Cannabinoid-based therapy as a future for joint degeneration. Focus on the role of CB2 receptor in the arthritis progression and pain: an updated review

“…Joint inflammation is caused by bacteria, mycobacterial or fungi and the diagnosis is based on the synovial fluid analysis. The most common cause of septic arthritis is Staphylococcus aureus , which is responsible for 37–56% of cases [ 58 , 59 ]. The study of Konig et al proved the presence of autoantigens that are primary immune targets in RA in gingival crevicular fluid of patients with periodontal disease.…”

Modified Two-Stage Exchange for Periprosthetic Joint Infection in UKA

“…It also removes vascularized bone and tissue that may assist in eradication of the infection. As can be inferred from treatment of septic arthritis in the native knee, success without bone removal has already been demonstrated with open irrigation and debridement (I and D) alone, arthroscopic I and D, and even serial arthrocentesis [ 8 – 10 ]. Theoretically, the natural surfaces of the knee may be comparatively more resistant to persistent biofilms, and the remaining viable and vascular tissues may support increased local antibiotic delivery.…”