Internal Medicine

0521779407-B01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:52

Bacterial Arthritis 217

➣Arthrotomy: consider especially for hips or shoulders, infection

in pts w/ RA, or joints responding poorly to other means

■Stop any immunosuppressive meds

■Establish a specific diagnosis based on cultures

■Obtain cultures from other potential sites of infection, esp. if N. gon-

orrhoeae suspected

■Avoid weight bearing in lower extremity joints, but physical therapy

helpful to avoid contractures

specific therapy

Indications

■All pts w/ septic arthritis require antibiotic therapy

Treatment Options

■Antibiotic therapy, initially vancomycin for gram-positive & ceftriax-

one for gram-negative, later guided by microbial sensitivity studies

■IV antibiotics initially; intra-articular antibiotic therapy not neces-

sary

■Optimal duration of parenteral therapy not clear; suggest 1 week for

N. gonorrhoeae, 3 weeks for S. aureus, 2 weeks for other infections;

subsequent oral antibiotics for a total of 4–6 weeks therapy suggested

by some for more virulent organisms & 2–4 weeks for less virulent

Side Effects & Complications

■Typical antibiotic complications need to be considered

follow-up

During Treatment

■Assessment daily or more often during initial stage of infection

■Repeat arthrocenteses indicate success of treatment w/ diminishing

synovial fluid volumes, diminished WBC counts, diminished neu-

trophil percentages, sterility of cultures

Routine

■Assessment for recurrent infection

■Physical therapy for possible contractures

complications & prognosis

Complications

■Infection-related

➣Osteomyelitis

➣Disseminated infection