By : Ryan GuzmanBy : Ryan GuzmanNita HardmanNita Hardman

Gloria Lao SinguanGloria Lao SinguanJohn Michael OlivaresJohn Michael Olivares

What is Septic Arthritis?What is Septic Arthritis?

Septic, or infectious, arthritis is infection of one or more joints by microorganisms.

septic arthritis, microbes are identifiable in an affected joint fluid.

Most commonly, septic arthritis affects a single joint, but occasionally more joints are involved.

What is Septic What is Septic Arthritis?Arthritis?

What Microbes Cause What Microbes Cause Septic Arthritis?Septic Arthritis?

The most common causes of septic arthritis are bacteria, including Staphylococcus aureus and Haemophilus influenzae

In certain "high-risk" individuals,

a) intravenous drug abusers and the elderly) E. coli and Pseudomonas spp.

What Microbes Cause What Microbes Cause Septic Arthritis?Septic Arthritis?

b) Neisseria gonorrhoeae in sexually active young adults

c) Salmonella spp. in young children or in people with sickle cell disease

Other bacteria that can cause septic arthritis include Mycobacterium tuberculosis and the spirochete bacterium that causes Lyme disease.

What Microbes Cause What Microbes Cause Septic Arthritis?Septic Arthritis?

Viruses that can cause septic arthritis include: hepatitis A, B, and C parvovirus B19 herpes viruses HIV (AIDS virus) HTLV-1, adenovirus coxsackie viruses mumps ebola

What Microbes Cause What Microbes Cause Septic Arthritis?Septic Arthritis?

Fungi that can cause septic arthritis include:

histoplasma coccidiomyces blastomyces

Who are at Risk of Who are at Risk of Developing Septic Developing Septic

Arthritis?Arthritis? taking medications that suppress the

immune system intravenous drug abuse past joint disease, injury, or surgery underlying medical illnesses including

diabetes, alcoholism, sickle cell disease, rheumatic diseases, and immune deficiency disorders

What are the Signs and Symptoms of Septic

Arthritis?

What are the Signs and Symptoms of Septic

Arthritis? Symptoms of septic arthritis include fever, chills, as well as joint pain, swelling, redness, stiffness, and warmth.

Joints most commonly involved are large joints, such as the knees, ankles, hips, and elbows

In people with risk factors for joint infection, unusual joints can be infected, including the joint where the collar bone (clavicle) meets the breastbone (sternum).

With uncommon microbes, such as Brucella spp., atypical joints can be infected, such as the sacroiliac joints.

How is Septic Arthritis Diagnosed?

How is Septic Arthritis Diagnosed?

X-ray studies of the joint can be helpful to detect injury of bone adjacent to the joint.

MRI scanning is very sensitive in evaluating joint destruction

Blood tests are frequently used to detect and monitor inflammation

These tests include the white blood cell count, sedimentation rate, and C-reactive protein

How is Septic Arthritis Diagnosed?

A blood culture is a laboratory test to check for bacteria or other microorganisms in a blood sample

Synovial fluid analysis or culture of joint fluid /Joint fluid analysis; Joint fluid aspiration

MEDICAL MANAGEMENT

Summary of recommendations for initial empirical Summary of recommendations for initial empirical antibiotic choice in suspected septic arthritisantibiotic choice in suspected septic arthritis

Patient Group Antibiotic Choice

No risk factors for atypical organisms

Flucloxacillin 2g qds iv. Local policy may be to add gentamicin iv.If penicillin allergic, Clindamycin 450-600mg qds iv. or 2nd or 3rd generation cephalosporin iv.

High risk of Gram –ve sepsis (elderly, frail, recurrent UTI, recent abdominal surgery)

2nd or 3rd generation cephalosporin eg cefuroxime 1.5g tds iv. Local policy may be to add flucloxacillin iv to 3rd generation cephalosporin.

MRSA risk ( known MRSA, recent inpatient, nursing home resident, leg ulcers or catheters, or other risk factors determined locally)

Vancomycin iv. plus 2nd or 3rd generation cephalosporin iv.

Summary of recommendations for initial empirical Summary of recommendations for initial empirical antibiotic choice in suspected septic arthritis ..(Cont)antibiotic choice in suspected septic arthritis ..(Cont)

Patient Group Antibiotic Choice

Suspected gonococcus or meningococcus

Ceftriaxone iv. or similar dependent on local policy / resistance

iv drug users Discuss with microbiologist

ITU patients, known colonisation of other organs (eg cystic fibrosis

Discuss with microbiologist

MEDICAL MANAGEMENT Analgesics, such as codeine, may be

prescribe to control pain NSAID may prescribe to limit joint

damage Arthrotomy or Arthrotoscopy is used to

drain the joint to remove dead tissue

Nursing ManagementNursing Management

Provide adequate rest Affected part should be immobilized,

elevated, and be given warm compresses to help relieve pain.

Perform ROM exercises for the affected joint aids to assist in the recovery process.

Nursing ManagementNursing Management

Explain the importance of observing weight bearing and activity restrictions

Demonstrate and encourage to the patient to practice safe use of ambulatory aids and assistive devices

Teach the patient to strategies to promote healing through aseptic dressing changes and proper wound care

Nursing DiagnosisNursing Diagnosis

Acute pain related to inflammation and swelling

Impaired physical mobility related to pain, use of immobilization devices and weight-bearing limitations

Risk for extension of infection: bone abscessformation

Deficient knowledge related to the treatment regimen