Management of Septic Arthritis in Emergency Department
Mohammed H. Abushal *
Hip and Knee Reconstructive Orthopedic Consultant, University of Tabuk, Saudi Arabia.
Yazeed Ali S. Albalawi
Tabuk University, Saudi Arabia.
Muflih Abdullah S. Albalawi
Tabuk University, Saudi Arabia.
AlTurki Abdulrahman Mohammed
Tabuk University, Saudi Arabia.
Amal Sulaiman A. Albalawi
Tabuk University, Saudi Arabia.
Rola Ali S. Alotabi
Tabuk University, Saudi Arabia.
Abdulrahim Oudah A. Albalawi
Tabuk University, Saudi Arabia.
Sultan Suliman Q. Al-Ruwaili
Tabuk University, Saudi Arabia.
Zahraa Abbas A. Kassarah Al-nakhli
Tabuk University, Saudi Arabia.
Nada Saleem S. alhawiti
Tabuk University, Saudi Arabia.
Abdalah Emad Almhmd
Majmaah University, Saudi Arabia.
Naif Abdullah M. Alzahrani
Albaha University, Saudi Arabia.
Turki Abdullah A. Alzahrani
Albaha University, Saudi Arabia.
Hassan Ahmed A. Arishi
Jazan University, Saudi Arabia.
Musab Ismail Y. Ezzi
Prince Mohammed Bin Nasser Hospital, Saudi Arabia.
*Author to whom correspondence should be addressed.
Abstract
Bacterial arthritis is an inflammation of the joints caused by an infectious etiology, usually bacterial, but there are also fungi, mycobacteria, viruses, or other rare pathogens. Both healthy and predisposed people can be infected.
Nongonococcal infectious arthritis, usually a monoarticular disease, affects multiple joints in about 10% of patients and is a new form of septic arthritis. Without treatment, it can progress rapidly and cause irreversible damage to the joints. The overall incidence of bacterial arthritis is 2 to 6 per 100,000, depending on the presence of risk factors. Bacterial arthritis is more common in children than in adults. The incidence of septic arthritis peaks between the ages of 2 and 3 and is predominantly male (2: 1). Most septic joints develop as a result of hematogenous dissemination of the vascular synovium due to bacterial episodes. Osteoarthritis, rheumatoid arthritis, and corticosteroid therapy are the most common predisposing conditions. Typical symptoms of acute septic arthritis without gonorrhea include recent fever, malaise, and local findings of pain, warmth, swelling, and restricted mobility of the affected joint. Accurate history and assessment of risk factors can provide important clues for diagnosis. Careful assessment of risk factors can significantly change the likelihood of a provider developing septic arthritis prior to testing. Laboratory findings, diagnostic imaging, and synovial fluid assessment are all useful for diagnosis. Management components include early detection and treatment with joint aspiration, antibiotics, and orthopedic advice for possible surgical management. Widespread antibiotics are often needed due to the potential for rapid joint destruction. A combination of cefepime or anti-Pseudomonas aeruginosa beta-lactams and vancomycin is recommended to cover both Gram-negative and MRSA bacteria.
Keywords: Septic arthritis, joint inflammation, infectious etiology, monoarticular