Septic Arthritis - Diagnosis and Management Summary Clinical Exam: hot, swollen, pain with passive AND active ROM +/- fever, chills, malaise Ddx: cellulitis, bursitis, tendonitis, osteoarthritis, gout, pseudogout, osteomyelitis, trauma, avascular necrosis, Lyme disease, viral arthritis Workup: arthrocentesis w/ fluid culture, Gram stain, cell count, and crystal evaluation • labs and imaging unlikely to be beneficial in septic arthritis diagnosis Treatment: admission for parenteral Abx, Orthopedics consults for possible washout • Healthy Adults/ChiIdren = staphylococcus, streptococcus, N. gonorrhoeae Vancomycin + Ceftriaxone • HIV or IVDU = staphylococcus, gram negative bacilli Vancomycin + Cefepime OR Ciprofloxacin • Sickle Cell = Salmonella, staphylococcus Vancomycin + Ciprofloxacin OR Imipenem Clinical Pearls: • Atraumatic, hot, swollen, painful = bacterial nongonococcal septic arthritis until proven otherwise • ESR -90% sensitive in pediatrics but NOT adults • Consider gonococcal arthritis in sexually active with migratory arthritis (therefore oral, cervical, anal Cxs) • *** If unable to rule out septic arthritis, patient admitted for treatment until cultures results *** MH/CCF/CWRU EM Res @MetroHealth_EM #Septic #Arthritis #Diagnosis #Management #Summary
