Materiały źródłowe

• #1 Septic Arthritis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p589.html

  Septic arthritis must be considered and promptly diagnosed in any patient presenting with acute atraumatic joint pain, swelling, and fever. […] A delay in diagnosis and treatment can result in permanent morbidity and mortality. […] Physical examination findings and serum markers, including erythrocyte sedimentation rate and C-reactive protein, are helpful in the diagnosis but are nonspecific. Synovial fluid studies are required to confirm the diagnosis. […] Septic arthritis should be considered in adults presenting with acute monoarticular arthritis. […] A delay in diagnosis and treatment of septic arthritis can lead to permanent morbidity and mortality. […] The reported incidence of septic arthritis is four to 29 cases per 100,000 person-years, and risk increases with age, use of immunosuppressive medications, and lower socioeconomic status.

• #2 Septic Arthritis (Causes, Treatment, and Management)

  https://patient.info/doctor/septic-arthritis-pro

  The triad of fever, pain and impaired range of motion is typical septic arthritis. […] The antibiotic should at least cover S. aureus and Streptococcus spp. […] Treatment should be started empirically before the results of cultures are known, as evidence suggests that a better functional result is obtained the sooner an antibiotic is commenced. […] If the septic arthritis fails to respond to five days of treatment with an appropriate antibiotic, the therapeutic approach should be reassessed. […] Chondral damage is one of the major sequelae of septic arthritis, occurring even after prompt treatment of a septic joint. […] Repeated percutaneous aspiration may be required if the infection does not respond to antibiotic treatment. […] The limb should be splinted in the position of function.

• #3 Septic arthritis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000116

  Septic arthritis presents with a hot, swollen, acutely painful joint with restriction of movement. This presentation should be regarded as septic arthritis until proven otherwise, even in the absence of fever and irrespective of microbiology and blood test results. […] Take a synovial fluid sample, bloods, and any other relevant culture samples before starting empirical intravenous antibiotics, unless this would cause undue delay. […] Refer patients with suspected septic arthritis of the hip immediately to orthopaedics for ultrasound-guided joint aspiration and possible surgical debridement. […] Base antibiotic choice on individual patient demographic and clinical factors; then narrow your treatment when you get the microscopy and Gram stain results and aspirate the joint to dryness as often as necessary.

• #3 Septic arthritis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000116

  Continue intravenous therapy for 2 weeks and then switch to oral antibiotic therapy for a further 4 weeks. […] Key diagnostic factors: hot, swollen, painful, restricted joint; acute presentation. […] 1st investigations to order: synovial fluid microscopy, Gram stain, and polarising microscopy; synovial fluid culture and sensitivities; synovial fluid white cell count; blood culture and sensitivities; white cell count; erythrocyte sedimentation rate (ESR); CRP; urea and electrolytes; LFTs; plain x-ray; ultrasound. […] Investigations to consider: procalcitonin (PCT); MRI; synovial fluid polymerase chain reaction (PCR); swabs for microscopy, culture, and sensitivity; urine dipstick, microscopy, culture, and sensitivity; enzyme-linked immunosorbent assay (ELISA); synovial biopsy. […] Emerging tests: calprotectin.

• #4 Septic Arthritis – Clinical Features – Management – TeachMeSurgery

  https://teachmesurgery.com/orthopaedic/principles/septic-arthritis/

  Septic arthritis refers to the infection of a joint. It requires a high index of suspicion and can affect both native and prosthetic joints. […] The main risk factors for developing septic arthritis are increasing age, any pre-existing joint disease (e.g. rheumatoid arthritis), diabetes mellitus or immunosuppression, chronic kidney disease, hip or knee joint prosthesis, or intravenous drug use. […] Patients will most commonly present with a single swollen joint causing severe pain. Pyrexia will be in around 60% of affected individuals (although its absence should not rule out septic arthritis). […] Septic arthritis should be the main differential diagnosis in anyone presenting with a single, painful, swollen joint. […] The Kocher criteria can be used to differentiate between septic arthritis and transient synovitis in a child with a painful hip.

• #5 Septic arthritis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/septic-arthritis/

  Septic (infectious) arthritis is an infection of the joint space, which can occur in a native joint or a prosthetic joint. […] All patients with suspected septic arthritis should undergo prompt arthrocentesis for synovial fluid analysis. […] Any red, painful joint with a reduced range of motion should be considered infectious until proven otherwise. The absence of fever does not rule out a diagnosis of septic arthritis. […] Arthrocentesis with synovial fluid analysis and culture (gold standard) […] Maintain a high index of suspicion for septic arthritis in patients with underlying joint diseases (e.g., osteoarthritis, rheumatoid arthritis) who present with joint pain, as the signs and symptoms of an acute flare and an infection often overlap. […] Do not delay joint aspiration in suspected septic arthritis as early detection and treatment are imperative to prevent cartilage destruction. […] Synovial fluid analysis comprises a group of tests that examine synovial fluid to help differentiate between subtypes of arthritis. […] The total duration of antibiotic therapy is variable and should be adjusted according to signs of clinical and laboratory evidence of improvement.

• #6

  https://step2.medbullets.com/evidence/34913662

  Septic arthritis must be considered and promptly diagnosed in any patient presenting with acute atraumatic joint pain, swelling, and fever. […] Risk factors for septic arthritis include age older than 80 years, diabetes mellitus, rheumatoid arthritis, recent joint surgery, hip or knee prosthesis, skin infection, and immunosuppressive medication use. […] A delay in diagnosis and treatment can result in permanent morbidity and mortality. […] Physical examination findings and serum markers, including erythrocyte sedimentation rate and C-reactive protein, are helpful in the diagnosis but are nonspecific. […] Synovial fluid studies are required to confirm the diagnosis. […] History and Gram stain aid in determining initial antibiotic selection. […] Staphylococcus aureus is the most common pathogen isolated in septic arthritis; however, other bacteria, viruses, fungi, and mycobacterium can cause the disease.

• #7 Septic Arthritis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p589.html

  Before initiating antibiotic therapy in patients with suspected septic arthritis, analysis of synovial fluid obtained through arthrocentesis should be performed, including Gram stain, cultures, white blood cell count with differential, and crystal analysis. […] Initial empiric antibiotic therapy for adults with septic arthritis should cover Staphylococcus aureus and Streptococcus species. […] Oral antibiotics are not inferior to intravenous antibiotics for treatment of septic arthritis. […] Septic arthritis is diagnosed through laboratory testing, particularly synovial fluid studies. […] Analysis of synovial fluid obtained via arthrocentesis is necessary to differentiate septic arthritis from other forms of arthritis and to determine the causative pathogen. […] A white blood cell count less than 50,000 per L (50 109 per L) does not exclude septic arthritis.

• #8 Septic Arthritis | Choose the Right Test

  https://arupconsult.com/content/septic-arthritis

  Septic arthritis, also known as infectious arthritis, is a painful joint infection that can result in significant acute or chronic disability. […] Synovial (joint) fluid analysis that includes culture is the cornerstone of diagnosis and should be performed before antibiotic therapy is administered. […] Diagnosis of septic arthritis in patients with these risk factors is often difficult or delayed because symptoms may be confused with or suppressed by an underlying condition. As such, high clinical suspicion for septic arthritis is appropriate in high-risk populations to ensure timely diagnosis. […] Imaging should be used in addition to comprehensive clinical examination and laboratory testing for the diagnosis of septic arthritis. […] In most cases, there is no single laboratory test with sufficient sensitivity, specificity, and predictive value to diagnose septic arthritis definitively. […] Positive synovial fluid culture is considered diagnostic for septic arthritis. […] Blood cultures obtained during febrile episodes and before antimicrobial treatment may also help to establish the severity of disease, identify causative agents, and guide medical management.

• #9 Septic arthritis – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-and-joint-infections/diagnosis-treatment/drc-20350760

  The following tests typically help diagnose septic arthritis: […] Joint fluid analysis. Infections can alter the color, consistency, volume and makeup of the fluid within your joints. A sample of this fluid can be withdrawn from your affected joint with a needle. Laboratory tests can determine what organism is causing your infection, so your doctor will know which medications to prescribe. […] Blood tests. These can determine if there are signs of infection in your blood. A sample of your blood is removed from a vein with a needle. […] Imaging tests. X-rays and other imaging tests of the affected joint can assess damage to the joint or loosening of an artificial joint. A specialized scan that involves swallowing or injecting a small amount of a radioactive chemical may be used if your doctor suspects you have a prosthetic joint infection and it’s been more than a year since you’ve had surgery.

• #10 Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department – The Western Journal of Emergency Medicine

  https://westjem.com/articles/evaluation-and-management-of-septic-arthritis-and-its-mimics-in-the-emergency-department.html

  Serum blood tests are inadequate to rule out septic arthritis. Synovial fluid is the gold standard test for making the diagnosis of septic arthritis. […] A synovial white blood cell count (sWBC) 50 109/L is concerning for septic arthritis. […] Synovial culture is the single most important test and should be ordered on all patients from whom synovial fluid is collected. […] Rapid diagnosis and treatment reduce the risk of significant morbidity and mortality. […] Components of management include early recognition and treatment, with 1) joint aspiration, 2) antibiotics, and 3) orthopedic surgery consultation for possible operative management. […] Diagnostic aspiration is required, with the sample sent for synovial WBC, Gram stain, culture, and lactate. […] There are a significant number of mimics of septic arthritis, including abscess, cellulitis, gout, rheumatoid arthritis, osteomyelitis, malignancy, Lyme disease, and avascular necrosis.

• #11 Septic Arthritis of the Hand: Causes, Diagnosis, & Treatment

  https://www.theplasticsfella.com/septic-arthritis/

  Two to three weeks post onset one may see signs characteristic of osteomyelitis, such as osteolysis osteopenia, osteosclerosis, periosteal reaction, and sequestration. […] Can detect intra-articular effusion. […] If joint aspiration, request gram stain and culture, cell count, crystal analysis, protein level, and glucose level. […] When necessary can visualize joint effusion, its distribution, and the destruction of soft tissues and osteochondral structures of the joint.

• #12 Synovial Lactate and the Diagnosis of Septic Arthritis – Emergency Medicine

  https://emergencymedicine.wustl.edu/items/synovial-lactate-and-the-diagnosis-of-septic-arthritis/

  The interval LR for 0-10 mmol/L is zero versus 17.2 for 10-20 mmoL/L and infinity for synovial lactate 20 mmoL/L. […] Future studies should assess diagnostic accuracy in a consecutive sampling of ED patients with monoarticular arthritis in whom there is sufficient suspicion of non-GC septic arthritis to perform an arthrocentesis.

• #13 A narrative review of the last decade’s literature on the diagnostic accuracy of septic arthritis of the native joint | Journal of Experimental Orthopaedics | Full Text

  https://jeo-esska.springeropen.com/articles/10.1186/s40634-020-00315-w

  Previous literature has shown that the commonly held threshold of synovial WBC 50,000 is not sensitive enough to effectively rule out septic arthritis. […] This review confirms that for any suspected septic arthritis the first step should be aspiration for cell count, gram stain and culture. […] Notably, culture and gram stain are still the gold standard when it comes to accurately diagnosing septic arthritis of the native joint, however, while culture and gram stain are pending, there are additional tests that can help to either rule in or rule out septic arthritis if the preliminary cytology is not overly convincing. […] Test findings such as TNF-alpha 10, percent neutrophils 80, blood procalcitonin 0.39, synovial calprotectin 52mg/L, and neutrophil count 15,000 all have a negative likelihood ratio0.1 and can help to rule out the diagnosis of septic arthritis.

• #14 03. Acute Mono-Arthritis and Synovial Fluid Analysis | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/content/03-acute-mono-arthritis-and-synovial-fluid-analysis

  The synovial fluid leukocyte count seen with septic arthritis, crystal-induced arthritis, or other noninfectious inflammatory causes overlap considerably. As such, one must always consider septic arthritis. The higher the WBC count (50,000) and the greater the proportion of neutrophils (90%), the higher the likelihood of septic arthritis.

• #15 A narrative review of the last decade’s literature on the diagnostic accuracy of septic arthritis of the native joint | Journal of Experimental Orthopaedics | Full Text

  https://jeo-esska.springeropen.com/articles/10.1186/s40634-020-00315-w

  In order to help rule in the diagnosis of septic arthritis test findings such as synovial lactate/glucose ratio5, synovial lactate 10, synovial glucose 1.0, calprotectin 150mg/L, synovial leukocyte esterase ++ or +++ with glucose on dipstick, percent neutrophils 95, 50,000 leukocytes, or50,000 neutrophils, all in the absence of crystals have likelihood ratios 10.

• #16 Septic Arthritis: Diagnosis & Antibiotic Therapy – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2020-7-26-septic-arthritis-a-joint-too-far-5sz58/

  Send the synovial fluid for gram stain, culture, WBC count with differential, crystal assessment with polarizing microscope. […] Key findings: 20,000 WBCs with mostly neutrophils = strongly supportive of septic arthritis in the correct clinical context […] Gram stain is only positive in 30-50% […] Synovial fluid culture is positive in 60% of patients with nongonococcal arthritis […] Cultures are no help in most cases due to the organisms being S. aureus, but in rare cases they might grow strange, less common organisms. […] Cultures suck for N. gonorrhoeae, so nucleic acid amplification is preferred. […] Diagnosis: Clinical suspicion is important, as the blood work is of limited helpfulness.

• #16 Septic Arthritis: Diagnosis & Antibiotic Therapy – EM Board Bombs Podcast

  https://www.emboardbombs.com/study-guide/2020-7-26-septic-arthritis-a-joint-too-far-5sz58/

  It seems straightforward right? Swollen joint, painful and warm to touch, recent onset- tap it. Sounds easy, but it is often missed by providers. Why? Many think that septic arthritis is something other than septic arthritis, like rheumatoid arthritis, local trauma, or crystal-induced arthritis. Thats bad form. […] Diagnosis: Clinical suspicion is important, as the blood work is of limited helpfulness. […] Blood cultures are only positive in about 50% of cases. The WBC count, ESR, CRP are commonly ordered and can be elevated, but are nonspecific. […] X-rays should be performed, especially if recent manipulation or surgery of the join occurred. […] Ultrasound is more sensitive for effusions than x-rays. […] The real money is in the bedside arthrocentesis. It needs to be performed prior to antibiotic administration. Certain joints require radiographic guidance (i.e. hip or sacroiliac).

• #17 Septic Arthritis: Infection in Joints | BioFire Diagnostics

  https://www.biofiredx.com/blog/septic-arthritis/

  The United States sees roughly 20,000 cases of septic arthritis each year. Its a serious illness in native joints that can lead to cartilage damage, reduced mobility, and even death. Timely diagnosis and prompt treatment are key to minimizing joint damage. However, diagnosing septic arthritis can be challenging and time consuming, often leaving physicians to make treatment decisions without knowing the cause of the infection. […] Because septic arthritis can quickly lead to permanent cartilage damage and even death, rapid and appropriate therapy is essential. However, diagnosing septic arthritis isnt necessarily straightforward because the symptoms are similar to those of other joint diseases like rheumatoid arthritis, osteoarthritis, and gout. […] In order to test for the presence of pathogens, a sample of joint fluid is extracted with a needle in a procedure called arthrocentesis. This fluid, called synovial fluid, acts as a lubricant within a joint. A lab will try to culture pathogens from the sample to help pinpoint what is causing the infection. This usually takes 48-72 hours, but sometimes even longer depending on the pathogen.

• #17 Septic Arthritis: Infection in Joints | BioFire Diagnostics

  https://www.biofiredx.com/blog/septic-arthritis/

  Because it can take so long to get culture results and joint damage can occur rapidly clinicians generally prescribe broad-spectrum antibiotics while awaiting lab results. […] Newly granted an FDA De Novo authorization, the BIOFIRE Joint Infection (JI) Panel takes a syndromic testing approach to joint infection diagnostics. Instead of lengthy and laborious and often inconclusive send-out serial testing, the BioFire JI Panel identifies 39 clinically relevant targets, including 31 causative pathogens and 8 antimicrobial resistance markers. The test requires only 0.2 mL of synovial fluid and returns results in about an hour. […] Fast, accurate, and comprehensive testing with the BioFire JI Panel may offer several benefits. For example, it may help determine whether the joint is infected and may help reduce time to effective therapy by identifying pathogens faster.

• #18 Frontiers | An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1193645/full

  To provide the best possible care for these patients, doctors must have a comprehensive awareness of the patient’s medical history, the results of the physical exam, the diagnostic testing, and the available treatment options. […] Therefore, in the current review study, we aim to provide an up-to-date on the recent epidemiology, etiology, diagnosis, and best treatment option for acute septic arthritis for physicians constantly facing these conditions in their daily work at the hospital. […] The diagnosis of septic arthritis is typically straightforward based on clinical manifestations, laboratory findings, and MRI. […] Early and appropriate administration of antibiotics for 2-4 weeks is imperative. […] Arthroscopic surgery is a minimally invasive approach that yields favorable outcomes for treating septic arthritis. […] A cooperative effort among radiologists, orthopaedic surgeons, and other medical professionals is necessary to enhance patient outcomes.

• #18 Frontiers | An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review

  https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2023.1193645/full

  Acute septic arthritis must be extensively assessed, identified, and treated to prevent fatal consequences. […] This article focuses on bringing physicians up-to-date on the most recent findings and discussions about the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis. […] In addition to a patient’s medical history and physical examination, confirmation of a clinical diagnosis of septic arthritis needs the isolation of an infectious agent from synovial fluid. […] Antibiotic coverage should start in suspected cases when blood cultures and a serologic test and microscopic analysis of synovial fluid collected from the affected joint are the initial steps in diagnosing septic arthritis. […] Standard treatment consists of irrigation and debridement of the affected joint, followed by intravenous antibiotics.

• #19 Bacterial Arthritis – Rheumatology Advisor

  https://www.rheumatologyadvisor.com/ddi/bacterial-arthritis/

  Additional laboratory tests for diagnosing bacterial arthritis include: Complete blood count, Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Glucose, protein, and lactate analyses. […] Bear in mind that an elevated ESR and CRP support the diagnosis of bacterial arthritis but should not be considered definitive. […] Diagnosing bacterial arthritis requires a thorough medical history, physical examination, and arthrocentesis with synovial fluid analysis. […] If the white blood cell count is greater than 50,000 cells/mm, with a 90% neutrophil predominance for bacterial infection, it confirms the presence of bacterial infection. […] Other diagnostic methods include gram stain analysis, crystal analysis, and imaging studies. […] To identify a bacterial infection, doctors examine the synovial fluid white blood cell count and neutrophil predominance.

• #20 Septic Arthritis Imaging: Practice Essentials, Radiography, Ultrasonography

  https://emedicine.medscape.com/article/395381-overview

  Septic arthritis is a medical emergency associated with high rates of morbidity and mortality, especially when the diagnosis is delayed or the treatment is suboptimal. […] Septic arthritis is an emergency condition that needs to be diagnosed early by clinical examination and by radiologic imaging and laboratory workup. Early diagnosis can prevent complications that could ultimately lead to patient disability. […] Imaging is not the primary means of diagnosing septic arthritis. Clinical evaluation and joint fluid aspiration are the key to the diagnosis. […] Samples should be obtained in all suspected cases of septic arthritis. […] Fluid should be sent for Gram staining, culturing, glucose testing, leukocyte count, and differential determination. […] Conventional radiographic findings of septic arthritis may include soft tissue swelling and edema, capsular distention, or displacement of the articular structures, which may suggest the presence of joint effusion, but it has low sensitivity and specificity for acute infection.

• #20 Septic Arthritis Imaging: Practice Essentials, Radiography, Ultrasonography

  https://emedicine.medscape.com/article/395381-overview

  The imaging workup of either septic arthritis or osteomyelitis should include MRI. […] MRI provides better evaluation of the location and extent of disease. […] According to the ACR guidelines, MRI, because of its sensitivity to soft tissue and bone marrow pathology, has high accuracy in diagnosing infection, including septic arthritis, osteomyelitis, pyomyositis, and discitis, and could be considered as the initial imaging study. […] The characteristic findings are somewhat nonspecific by themselves, but they can be nearly diagnostic when correlated clinically. […] Poorly defined bony erosions are characteristic of septic arthritis and a helpful feature in differentiating septic arthritis from other diseases in the differential diagnosis.

• #21 Septic Arthritis – Core EM

  https://coreem.net/core/septic-arthritis/

  Arthrocentesis […] Definition: Bacterial infection of a joint space and its synovial fluid […] Diagnostic Testing […] Laboratory Analysis […] Serum lab tests cannot be used to rule in or out the diagnosis […] Imaging […] The role of X-ray is limited. It can assess for: Joint/bony destruction, Trauma or foreign body […] Most important synovial fluid studies: Cell count, Gram stain, aerobic and anaerobic cultures […] Synovial culture is positive in 90% of nongonoccal septic arthritis but only positive in 25-70% of gonococcal septic arthritis […] There is no absolute serum or synovial laboratory value to rule in or out septic arthritis […] The decision to start treatment in the ED for septic arthritis is based on overall clinical suspicion derived from patients risk factors, clinical picture, and synovial fluid cell count […] If suspicion is still high after equivocal or dry tap, admit the patient and initiate empiric IV antibiotics while the synovial culture results.

• #22 Differential Diagnosis and Treatment of Septic Arthritis in the Temporomandibular Joint: A Case Report and Literature Review

  https://www.journalomp.org/journal/view.html?doi=10.14476/jomp.2019.44.3.127

  Early differential diagnosis and proper management of the condition is required. […] To diagnose septic arthritis of the TMJ, signs of infection should be examined for differentiating from common TMDs or neoplasms through laboratory tests. […] The key point for diagnosing septic arthritis of the TMJ is needle aspiration of the joint space for detection of any abscess formed by the microbial organism. […] Early diagnosis performed by needle aspiration examination is required for early treatment and antibiotic selection. […] Imaging study is required for examination of the involved structures as well as determining the severity. […] CT provides more accurate images of abscess formation in the joint space, involved tissue changes, and bone destruction than radiography. […] Systemic administration of antibiotics is required to control the infection above all.

• #23 Kocher criteria for septic arthritis: What they are, drawbacks & more

  https://www.medicalnewstoday.com/articles/kocher-criteria-septic-arthritis

  The Kocher criteria is a clinical tool for distinguishing joint diseases, such as septic arthritis. […] Clinicians typically use the Kocher criteria for a septic arthritis diagnosis. This arthritis form is an infectious joint disease. […] The Kocher criteria for diagnosing septic arthritis is divided into the following variables: fever higher than 101.3F, ESR above 40 millimeters per hour (mm/hour), white blood cell (WBC) count greater than 12,000 cells/mm3, inability to bear weight on the affected side. […] Generally, people with at least one of these four criteria are likely to have septic arthritis. […] The Kocher criteria are primarily the ideal tool for assessing or diagnosing hip septic arthritis. […] The Kocher criteria is an essential clinical tool for identifying those at risk and those with septic arthritis. It helps to differentiate infectious causes of joint diseases, such as septic arthritis, from noninfectious ones, such as transient hip joint synovitis.

• #24 Septic Arthritis: Differential Diagnosis : Wheeless’ Textbook of Orthopaedics

  https://www.wheelessonline.com/arthritis/septic-arthritis-differential-diagnosis/

  – independent clinical predictors between septic arthritis and transient synovitis included history of fever, non-wt-bearing, ESR of at least forty mm/hr, and serum WBC of more than 12,000; […] – the predicted probability for septic arthritis were 93% if three of these variables were present and were over 99% if all 4 predictors were present; […] – the authors recommend careful observation without aspiration if none of the four independent predictors are present; […] – CT or MRI was diagnostic in all 4 patients, and staph aureus was the causative agent in each; […] – most patients can be managed without open surgical drainage, but needle aspirations may be helpful both therapeutically and diagnostically; […] – abdominal ultrasonography may serve as a screening examination.

• #25 Determining the accuracy of the leukocyte esterase reagent strip test in the rapid diagnosis of adult septic arthritis | Advances in Rheumatology | Full Text

  https://advancesinrheumatology.biomedcentral.com/articles/10.1186/s42358-024-00409-4

  When only (++) was considered positive, the sensitivity, specificity, and accuracy of the LE test for the detection of SA were 93.8% (95% CI: 81.8100%), 60% (95% CI: 42.477.5%), and 71.7% (95% CI: 58.584.9%), respectively. […] Our results show that with an AUC of 0.77, LE test can be a useful diagnostic method when used along with SF culture to provide a fast and sensitive diagnostic method for clinical decision making in the time it takes for culture results. […] The LE dipstick test can be a useful tool in screening patients with suspected septic arthritis due to its sensitivity, rapid results, and affordability. However, it should be used in adjunction with other laboratory tests and clinical evaluations to confirm or rule out a definitive diagnosis.

• #26 Acute Infectious Arthritis – Musculoskeletal and Connective Tissue Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/musculoskeletal-and-connective-tissue-disorders/infections-of-joints-and-bones/acute-infectious-arthritis

  Cultures are definitive, but are limited in the presence of prior antibiotic use. […] The presence of crystals does not exclude coexisting infectious arthritis. Initial synovial fluid analysis cannot differentiate between infectious and other inflammatory synovial fluid. […] If differentiation is impossible by clinical means or synovial fluid examination, infectious arthritis should be assumed and treated, pending culture results. […] Molecular testing (eg, polymerase chain reaction) may be used to directly detect organisms in clinical specimens. […] If gonococcal arthritis is suspected, blood and synovial fluid samples should be immediately plated on nonselective chocolate agar. […] Clinical response to antibiotics (anticipated within 5 to 7 days) can strongly support the diagnosis of gonorrhea.

• #27 A New Perspective on the Diagnosis of Septic Arthritis: High-Resolution Thermal Imaging

  https://www.mdpi.com/2077-0383/12/4/1573

  Aims: An increase in temperature in an area suspected of septic arthritis is a clinically important finding. The aim of this study is to evaluate temperature changes in septic arthritis with a high-resolution thermal camera. […] In the diagnosis of septic arthritis, thermal imagers can be used as a non-invasive diagnostic tool. A quantitative value can be obtained to indicate to a local temperature increase. […] The aim and hypothesis of this study is that a thermal camera can be used as a non-invasive auxiliary diagnostic tool in the diagnosis of septic arthritis. […] The data obtained in this study show that thermal imaging can be effective in the differential diagnosis of septic arthritis. In the diagnosis of septic arthritis, a thermal camera can be used as a non-invasive auxiliary diagnostic tool. A temperature increase, which is an important sign of septic arthritis, can be detected by using the thermal imaging, in addition to palpation, and a quantitative value for the temperature of the infected joint can be assigned using the device.

• #28 Septic arthritis – Wikipedia

  https://en.wikipedia.org/wiki/Septic_arthritis

  The differential diagnosis of septic arthritis is broad and challenging. First, it has to be differentiated from acute hematogenous osteomyelitis. […] In children, joint synovial fluid aspiration techniques aim at isolating the infectious organism by culture and sensitivity analysis. Cytological analysis of the joint aspirate can point to septic arthritis. However, a negative culture and sensitivity test does not rule out the presence of septic arthritis. […] The Gram stain can rule in the diagnosis of septic arthritis, however, cannot exclude it. […] Synovial fluid cultures are positive in over 90% of nongonoccocal arthritis; however, it is possible for the culture to be negative if the person received antibiotics prior to the joint aspiration. […] If the culture is negative or if a gonococcal cause is suspected, NAAT testing of the synovial fluid should be done. […] A lactate level in the synovial fluid of greater than 10 mmol/L makes the diagnosis very likely.

• #29 Septic arthritis – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/bone-and-joint-infections/symptoms-causes/syc-20350755

  Septic arthritis can also occur when a penetrating injury, such as an animal bite or trauma, delivers germs directly into the joint. […] Treatment involves draining the joint with a needle or during surgery. Antibiotics also are usually needed. […] See your doctor if you have severe pain in a joint that comes on suddenly. Prompt treatment can help minimize joint damage. […] Diagnosing septic arthritis in people with rheumatoid arthritis is difficult because many of the signs and symptoms are similar. […] If treatment is delayed, septic arthritis can lead to joint degeneration and permanent damage.

• #30 Native Joint Septic Arthritis

  https://www.mdpi.com/2079-6382/13/7/596

  Blood cultures are positive in about half of NJSA cases and help identify bacteremia. […] Peripheral blood tests, including WBC count, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), can support the diagnosis but are not specific. […] Imaging studies can also help diagnose NJSA. […] MRI, though more expensive, provides detailed images of joint structures and is useful for identifying early joint damage and soft tissue involvement. […] Improved diagnostic techniques have also led to better detection rates. […] Diagnosing NJSA in patients with underlying inflammatory arthritis such as rheumatoid arthritis or systemic lupus erythematosus presents significant challenges as these patients may be on biologic agents, corticosteroids, or other immunosuppressive therapies. […] Therefore, in patients with inflammatory arthritis on immunosuppressive therapy presenting with acute monoarthritis or polyarthritis, septic arthritis should be considered, with aggressive diagnostic workups conducted to differentiate it from an inflammatory flare.

• #31 Septic arthritis | Symptoms, causes, treatments

  https://versusarthritis.org/about-arthritis/conditions/septic-arthritis/

  If your symptoms suggest you have septic arthritis, your GP will refer you immediately to your local Accident and Emergency department (AE) for tests. […] If there is a delay, the infection can quickly damage parts of the joint. This may lead to pain that lasts for a long time and loss of mobility. […] In hospital they will try to work out exactly what the infection in your joint is and how best to treat it. This will be done with a blood test. […] You may also have a needle inserted into the joint, so a sample of the infected fluid can be tested. An x-ray or an MRI scan would give doctors a better picture of what is happening to the joint. […] These tests may show that your inflammation has been caused by a different condition and that you dont have septic arthritis.

• #32 Septic arthritis in children

  https://www.racgp.org.au/afp/2015/april/septic-arthritis-in-children

  Septic arthritis in children is an orthopaedic emergency that has serious consequences if not diagnosed promptly and treated effectively. […] The purpose of this article is to provide an overview of septic arthritis in children. […] Prompt diagnosis and treatment are critical in optimising patient outcomes. […] Unfortunately, diagnosing septic arthritis is not always straightforward. […] The purpose of this article is to provide an overview of the pathophysiology, diagnosis, treatment and long-term follow-up of septic arthritis in children. […] Children with septic arthritis generally present with an acute onset of joint pain, limited movement and fever. […] Any child presenting with symptoms and signs consistent with septic arthritis should be urgently referred to the emergency department (ED) of a hospital with an orthopaedic service.

• #32 Septic arthritis in children

  https://www.racgp.org.au/afp/2015/april/septic-arthritis-in-children

  In the ED, blood should be sent for a white cell count (WCC) and differential, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and cultures. […] Any child with a concerning presentation, raised inflammatory markers and a joint effusion should be kept fasting and immediately referred to an orthopaedic surgeon. […] The treatment of septic arthritis involves urgent surgical drainage and lavage of the joint. […] Once a synovial fluid sample has been obtained, high-dose, empirical, intravenous (IV) antibiotics are commenced. […] For an uncomplicated case of septic arthritis in a child, a 3-week course of oral antibiotics is generally sufficient. […] Ongoing follow-up with an orthopaedic surgeon for at least 2 years is recommended to monitor for long-term sequelae of septic arthritis.

• #33 Septic arthritis: how it differs from sepsis, what to look out for, and diagnosis and treatment decisions

  https://www.penningtonslaw.com/news-publications/latest-news/2021/septic-arthritis-how-it-differs-from-sepsis-what-to-look-out-for-and-diagnosis-and-treatment-decisions

  Taking a sample of fluid from the joint provides a more definitive assessment. […] If a diagnosis is delayed by more than a week, an x-ray may be of benefit as abnormalities can be revealed where the joint is deteriorating due to septic arthritis. […] Antibiotic therapy will be required, which is usually delivered intravenously into the body. […] Delay in the diagnosis of septic arthritis will increase the chance of a poor outcome. […] Up to 30% of patients diagnosed with septic arthritis will have long-term complications, and around 75% of those complications will occur where therapy is delayed more than 1-2 days.

• #34 Septic Arthritis (Causes, Treatment, and Management)

  https://patient.info/doctor/septic-arthritis-pro

  Septic arthritis is an infection producing inflammation in a native or prosthetic joint or more than one joint. Rapid diagnosis and treatment of an infected joint are essential in preserving orthopaedic function. […] The gold standard investigation is joint aspiration. […] One study found the levels of blood C-reactive protein (CRP) and the synovial fluid white blood cell count, percentage of polymorphonuclear cells and lactate to be the best inflammatory markers in predicting a diagnosis of septic arthritis. […] Septic arthritis should always be considered in patients presenting with one or a few acutely inflamed joints. The most important differential diagnosis is the crystal arthropathies. […] History and examination may not only yield clues as to the diagnosis of septic arthritis but also to the type of infection that is present.

• #35 Infectious (Septic) Arthritis – Rheumatology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.16.14.

  Infectious arthritis is acute or chronic arthritis caused by microorganisms invading the synovium. […] Diagnostic Tests […] 1. Laboratory tests in most patients reveal significantly elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels, leukocytosis (particularly in patients with bacterial arthritis), and hypochromic anemia (in patients with chronic arthritis, eg, tuberculous arthritis). […] Diagnosis is based on clinical features, synovial fluid examination (macroscopic assessment, Gram staining, cultures), and blood cultures. […] Diagnostic Criteria […] In patients with gonococcal arthritis perform screening for other sexually transmitted diseases, including syphilis, Chlamydia trachomatis, and HIV infections.

• #36 Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT | Enfermedades Infecciosas y Microbiología Clínica

  https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-executive-summary-guidelines-for-diagnosis-S0213005X2300188X

  A complete history and physical examination are recommended in all cases of suspected SA. This can help to differentiate between SA and other disorders and to identify pathogen-specific risk factors. […] Blood cultures are recommended in all patients with suspected SA and should be obtained prior to antibiotic administration whenever possible. […] Synovial fluid (SF) samples should be taken as soon as possible in all patients with suspected SA, preferably before initiating antimicrobial therapy. […] Recommended tests on SF: gross examination, leucocyte count and polymorphonuclear percentage. […] Plain radiographs of the affected joint at baseline are suggested in all patients. […] Joint drainage is recommended for peripheral bacterial arthritis and for fungal arthritis. […] We recommend joint drainage of large peripheral joints with pyogenic arthritis as soon as possible.

• #37 Developments in diagnosis and treatment of paediatric septic arthritis

  https://www.wjgnet.com/2218-5836/full/v13/i2/122.htm

  Acute septic arthritis in children is an orthopaedic emergency. A delay in diagnosis and inappropriate treatment can result in devastating damage to the joint with lifelong disability as a consequence. The clinical presentation can be a diagnostic challenge, especially in young children. A recent systematic review showed that joint tenderness and fever are important signals of septic arthritis. Ultrasound is helpful in detecting the presence of a joint effusion. Plain radiographs may show bone changes but magnetic resonance imaging is the most reliable imaging study for detecting concomitant osteomyelitis. The diagnosis of acute septic arthritis is highly suggestive when pus is aspirated from the joint, in case of a positive culture or a positive gram stain of the joint fluid, or if there is a white blood-cell count in the joint fluid of more than 50000/mm3.

• #38

  https://www.orthobullets.com/trauma/1058/septic-arthritis–adult

  Septic Arthritis is the inflammation of the joints secondary to an infectious etiology, most commonly affecting the knee, hip, and shoulder. […] Diagnosis is made with an aspiration of joint fluid with a WBC count 50,000 being considered diagnostic for septic arthritis. Lower counts may still indicate infection in the presence of positive gram stains or cultures results. […] Joint fluid aspirate is the gold standard for treatment and allows directed antibiotic treatment. […] Cell count with WBC 50,000 is considered diagnostic for septic arthritis, however lower counts may still indicate infection. […] Gram stains only identifies infective organism 1/3 of time. […] Delayed diagnosis can lead to profound, extensive cartilage damage within 8 hours.

• #39 Septic Arthritis: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2021/1200/p589.html

  Septic arthritis caused by methicillin-resistant S. aureus requires drainage or debridement and three to four weeks of antibiotics. […] A large cohort study showed that the 90-day mortality rate for septic arthritis is 7% and increases to 22% to 69% in patients 80 years and older. […] Oligoarticular septic arthritis is associated with higher mortality compared with monoarticular septic arthritis. […] Poor functional outcomes such as amputation, arthrodesis, prosthetic surgery, and severe functional deterioration occur in about 24% to 33% of patients with septic arthritis and are more likely with older age, preexisting joint disease, and synthetic intraarticular material.

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