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. […] After synovial fluid has been obtained, empiric antibiotic therapy should be initiated if there is clinical concern for septic arthritis. Oral antibiotics can be given in most cases because they are not inferior to intravenous therapy. Total duration of therapy ranges from two to six weeks; however, certain infections require longer courses. […] 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.

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

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

  Septic arthritis can quickly and severely damage the cartilage and bone within the joint, so prompt treatment is crucial. […] Treatment involves draining the joint with a needle or during surgery. Antibiotics also are usually needed. […] If treatment is delayed, septic arthritis can lead to joint degeneration and permanent damage. If septic arthritis affects an artificial joint, complications may include joint loosening or dislocation.

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

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

  Doctors rely on joint drainage and antibiotic drugs to treat septic arthritis. […] Removing the infected joint fluid is crucial. Drainage methods include: […] To select the most effective medication, your doctor must identify the microbe causing your infection. Antibiotics are usually given through a vein in your arm at first. Later, you may be able to switch to oral antibiotics. […] If an artificial joint is infected, treatment often involves removing the joint and temporarily replacing it with a joint spacer a device made with antibiotic cement. Several months later, a new replacement joint is implanted. […] If a replacement joint can’t be removed, a doctor may clean the joint and remove damaged tissue but keep the artificial joint in place. Intravenous antibiotics are followed by oral antibiotics for several months to prevent the infection from coming back.

• #4 Septic Arthritis: What Is It, Symptoms, Treatment & Causes

  https://my.clevelandclinic.org/health/diseases/22418-septic-arthritis

  Septic arthritis is usually treated with antibiotics. […] The following treatments are used for septic arthritis: Surgery: Removal of the inflamed tissue (surgical debridement) and IV (intravenous) antibiotics are necessary in most cases. […] All cases of septic arthritis need to be treated with antibiotics. Your healthcare provider may give you antibiotics through an IV and/or in pill form. […] Septic arthritis cannot go away on its own since its an infection. Bacterial infections need to be treated with antibiotics. […] If you’re experiencing signs and symptoms of septic arthritis, contact your healthcare provider right away or go to the nearest hospital. Septic arthritis can lead to serious complications and can be life-threatening if it’s not treated. […] The length of time it takes for septic arthritis to fully heal depends on what caused your infection and your overall health. You may have to take antibiotics for a few weeks.

• #5 Septic Arthritis Medication: Antibiotics, Cephalosporins, 3rd Generation, Oxazolidinones, Glycopeptides, Lipopeptides, Antibiotic, Fourth generation cephalosporin, Tetracycline

  https://emedicine.medscape.com/article/236299-medication

  The empiric choice of antibiotic therapy is based on results of the Gram stain, the clinical picture, and the medical background of the patient. […] Evidence exists that earlier initiation of an appropriate antibiotic regimen produces better functional results. Generally, treatment is administered intravenously for 3 to 4 weeks. […] No indication exists for direct installation of antibiotics into the joint cavity. Such a practice may increase the inflammatory surge that can add to permanent joint damage. […] Documenting the efficacy of the antibiotic regimen by serial improvement and eventual normalization of inflammatory markers is key in managing PJI.

• #6 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 should be treated with drainage or debridement and 14 days of intravenous antibiotics followed by oral antibiotics, totaling three to four weeks of therapy. […] Cohort studies demonstrated that medical management is not inferior to surgical management of septic arthritis. However, 30% of cases ultimately required surgical management, including about one-half of shoulder and hip arthritis cases, because of poor response to medical therapy. […] Optimal duration of treatment for nongonococcal septic arthritis is uncertain but is at least two weeks for small joints; at least six weeks is more commonly prescribed for all joints. […] Septic arthritis caused by methicillin-resistant S. aureus requires drainage or debridement and three to four weeks of antibiotics.

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

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

  Septic arthritis treatment and management involves surgical drainage and lavage of the joint and high-dose intravenous antibiotics. […] 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. […] The antibiotic should at least cover S. aureus and Streptococcus spp. A microbiologist should also be consulted, as the choice of therapy should be based on resistance patterns in the local hospitals and community. […] Antibiotics are given intravenously initially (usually for 2-3 weeks) before being switched to oral (often for at least a further 2-4 weeks). […] Recommended antibiotic treatments include: Seek specialist advice if prostheses are present. […] If meticillin-resistant S. aureus (MRSA) is suspected, vancomycin (teicoplanin may also be used) for 4-6 weeks (longer if infection complicated).

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

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

  If gonococcal arthritis or Gram-negative infection is suspected, cefotaxime (ceftriaxone may also be used). Treat Gram-negative infections for 4-6 weeks (longer if infection complicated). Treat gonococcal infection for two weeks. […] There is no benefit in injecting antibiotics intra-articularly. […] If the septic arthritis fails to respond to five days of treatment with an appropriate antibiotic (as evidenced by persistent fever, positive cultures or synovial purulence), the therapeutic approach should be reassessed. […] Repeated percutaneous aspiration may be required if the infection does not respond to antibiotic treatment. […] Surgical drainage may be required in any infected joint which does not respond to medical treatment. […] The limb should be splinted in the position of function (knees in extension, elbows at 90, wrists in neutral to slight extension, hips in balanced suspension in neutral rotation).

• #9 Antibiotics for septic arthritis: Types, other treatments, and more

  https://www.medicalnewstoday.com/articles/septic-arthritis-antibiotics

  Many cases of septic arthritis occur due to a bacterial infection. This means that antibiotics are a standard method of treatment for the condition. […] Antibiotics play an important role in treating septic arthritis since most cases occur due to a bacterial infection. Which antibiotic a doctor recommends may vary based on the type of bacteria and a persons tolerance of the medication. […] The exact antibiotics a doctor recommends to treat septic arthritis will vary based primarily on the underlying infection. […] In most cases, a person will receive about 2 weeks of IV antibiotics. Following this, they will continue to take oral antibiotics for 12 weeks, depending on a doctors instructions. […] A type of septic arthritis called Gonococcal arthritis often responds well to ceftriaxone.

• #10 Antibiotics for septic arthritis: Types, other treatments, and more

  https://www.medicalnewstoday.com/articles/septic-arthritis-antibiotics

  A doctor will typically closely monitor the progress of treatment with antibiotics. […] Usually, a doctor will start a broad-spectrum antibiotic treatment to manage the infection. […] Common antibiotics a healthcare professional may recommend include: nafcillin, oxacillin, vancomycin. […] A doctor may recommend vancomycin for Gram-positive bacteria, which includes any strains of bacteria that appear in a Gram stain test. […] For Gram-negative bacteria, a healthcare professional may recommend cephalosporin antibiotics. […] Septic arthritis has two main treatments: antibiotics in IV form followed by oral form and draining of the affected joint. […] A person will likely need physical therapy following treatment. […] Rapid identification and treatment are important to restore joint function and prevent permanent damage to the joint.

• #11 Septic Arthritis 2 – OrthoPaedia

  https://www.orthopaedia.com/septic-arthritis-2/

  Septic arthritis should be treated urgently. The treatment for septic arthritis of any joint is drainage of the fluid and initiation of antibiotic coverage. One treatment approach is surgical: joint irrigation and drainage via arthroscopy or (less commonly) open arthrotomy. Another option is drainage via serial needle aspirations. Both approaches are demonstrably effective. […] Empiric antibiotics need to be started after joint aspiration is completed. Vancomycin provides broad coverage for gram positive bacteria. If the gram negative bacteria are suspected or identified on gram stain, a 3rd or 4th generation cephalosporin should be added. If the patient has a history of IV drug abuse and Pseudomonas coverage is needed, a 3rd or 4th generation cephalosporin with an aminoglycoside like gentamicin should be administered. Antibiotics can be tailored to a specific pathogen if and when one is identified on synovial fluid cultures. […] The correct duration of antibiotic treatment is not known with certainty. Many physicians treat septic arthritis with intravenous antibiotics for 2 weeks followed by another 2 weeks of oral therapy. Physical therapy is often recommended to regain strength and full range of motion.

• #12 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

  We recommend that the definitive antibiotic regimen be based on the identified pathogen and its antimicrobial susceptibility or, if no pathogen is identified, on the most likely causative organism(s). […] We suggest starting antimicrobial therapy intravenously. […] It is recommended to switch to oral antibiotics after a few days of intravenous antibiotics in adults without endocarditis, with negative blood cultures and with clinical and laboratory improvement. […] Total duration of antimicrobial treatment in adults without endocarditis: For large peripheral joints after drainage, we suggest 3-4 weeks for S. aureus and gram-negative bacilli, 2-3 weeks for streptococcal arthritis and 1-2 weeks for gonococcal arthritis. […] We recommend 2-3 weeks for all uncomplicated SA in children, and 3-4 weeks for SA with osteomyelitis.

• #13 Septic Arthritis: Symptoms, Diagnosis, and Treatment

  https://www.webmd.com/arthritis/septic-arthritis-symptoms-diagnosis-and-treatment

  Septic arthritis treatments include using a combination of powerful antibiotics as well as draining the infected synovial fluid from the joint. It’s likely that antibiotics will be administered immediately to avoid the spread of the infection. Intravenous (IV) antibiotics are given, usually requiring admission to the hospital for initial treatment. The treatment, however, may be continued on an outpatient basis at home with the assistance of a home health nursing service. […] Initially, empiric antibiotics are chosen to cover a wide range of infections. If the bacteria can be identified, antibiotics specific to that organism are used. It may take four to six weeks of treatment with antibiotics to ensure complete eradication of the infectious agents. […] Drainage of the infected area is critical for rapid clearing of the infection. Drainage is performed by removing the fluid with a needle and syringe. Often the draining occurs daily or with multiple surgical procedures. The exact method depends on the location of the joint.

• #14 Septic Arthritis Treatment & Management: Approach Considerations, Antibiotic Therapy, Joint Immobilization and Physical Therapy

  https://emedicine.medscape.com/article/236299-treatment

  In native joint infections, antibiotics usually are administered parenterally for at least 2 weeks. […] More data are emerging to support shortened antibiotic courses for septic arthritis of native joints. […] The DATIPO study compared the efficacy of 6 weeks versus 12 weeks of antibiotic therapy in patients with PJI who had undergone appropriate surgical procedures to eradicate associated osteomyelitis and soft tissue infection or joint replacement by 1 or 2 stage procedure. […] Remaining therapeutic challenges include types of antibiotics; total duration of their administration, including both IV and PO routes; and treatment of late PJI. […] In summary, the study emphasized the importance of implant removal. Optimal duration of therapy needs to balance the increased risk for side effects related to prolonged exposure to these agents against treatment failure.

• #15 Septic arthritis – Knowledge @ AMBOSS

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

  Antibiotic coverage should be guided by Gram stain results on SFA. […] In patients with negative Gram stain but a high likelihood of septic arthritis, select empiric antibiotics based on clinical features and patient history. […] Empiric antibiotic therapy is not routinely recommended for PJIs. […] The total duration of antibiotic therapy is variable and should be adjusted according to signs of clinical and laboratory evidence of improvement. […] Native joint infections: Nongonococcal arthritis: 4-6 weeks, Gonococcal arthritis: typically 7 days. […] PJI: weeks to months. […] Early mobilization, physiotherapy.

• #16 Septic Joint

  https://mobile.fpnotebook.com/Rheum/ID/SptcJnt.htm

  Urgent orthopedic Consultation is indicated in all cases of suspected Septic Arthritis. […] Serial Joint Aspiration may be repeated for reaccumulation of fluid as needed up to once to twice daily. […] Arthroscopy is preferred in Shoulder and Knee Joints for better visualization and irrigation, with less post-op morbidity. […] Open Surgical drainage is indicated for difficult Joint Aspiration access, persistent fever and symptoms, leukocytosis, or repeat blood or joint cultures positive. […] Treat with Parenteral combination Antibiotic therapy for 4 weeks, which is equivalent in outcome to a 6-week course. […] Duration of therapy is typically 30 days, with ten days being adequate in quickly resolving symptoms, signs, and C-RP.

• #17 Surgery for septic arthritis: Types and recovery

  https://www.medicalnewstoday.com/articles/septic-arthritis-surgery

  Septic arthritis is an infection in the joint area. Alongside antibiotic treatment, minimally invasive or more major surgery could be part of a persons treatment. […] Sometimes, antibiotics are enough to clear an infection. Other times, a doctor may need to use surgical procedures alongside antibiotics to treat septic arthritis. […] If these methods are not effective, surgery may be necessary to drain fluid and remove damaged or infected tissue. Some people may require an arthroplasty or joint replacement surgery. […] Below are some procedures doctors may use to help treat septic arthritis: […] Arthrocentesis is a minor procedure that involves removing fluid from the joint capsule with a thin, hollow needle. […] Arthroscopic surgery is a minimally invasive surgery that involves small incisions and special equipment. It aims to remove infected tissue and clean and drain the joint.

• #18 Surgery for septic arthritis: Types and recovery

  https://www.medicalnewstoday.com/articles/septic-arthritis-surgery

  An arthrotomy is an open procedure. It is more invasive than arthroscopic surgery but has similar goals. […] If a person has an infection in artificial joints, they might need arthroplasty or joint replacement surgery. […] Sometimes, a doctor may recommend arthroplasty for people with septic arthritis in natural joints. If the infection is permanent or has caused significant damage, this surgery type can be helpful. […] Recovery after septic arthritis surgery can depend on many factors, including: the procedure a person has, a persons overall condition, other individual factors. […] Physical therapy and rehabilitation can be essential for recovery after any treatment for septic arthritis. […] When antibiotics alone cannot treat septic arthritis, a person may require surgery. […] A doctor may use a needle and syringe to remove liquid from the joint capsule. Other times, a surgeon may use arthroscopic or open surgery to drain the joint and remove infected tissue. […] Joint replacement surgery could be necessary for a person with infected artificial joints, permanent infection, or significant joint damage. […] Early diagnosis and treatment, along with postsurgery physical therapy, are important for improving outlook.

• #19 Septic Arthritis Treatment & Management: Approach Considerations, Antibiotic Therapy, Joint Immobilization and Physical Therapy

  https://emedicine.medscape.com/article/236299-treatment

  Medical management of infectious arthritis should be focused on adequate and timely drainage of the infected synovial fluid; administration of appropriate antibiotic(s); and debridement of any associated osteomyelitis or soft tissue infection with immobilization of the joint to control pain. The major challenges are duration of oral and intravenous antibiotic administration, especially in the setting of PJI. […] Acute PJI ( 3 wks in duration) can be cured medically if it is of the early type or secondary to hematogenous spread without any evidence of periarticular soft-tissue involvement or joint instability. […] Overall, the mean length of hospitalization for septic arthritis is 11.5 days. However, outpatient antibiotic therapy in stable patients can significantly reduce hospital stays.

• #20 Septic Arthritis Treatment & Management: Approach Considerations, Antibiotic Therapy, Joint Immobilization and Physical Therapy

  https://emedicine.medscape.com/article/236299-treatment

  Debridement and retention of the prosthesis can be considered in patients who develop periprosthetic joint infection (PJI) within 30 days of implantation or in those whose PJI presented within 3 weeks of the development of symptoms, if the prosthesis appears to be well fixed and is without a sinus tract. […] The success rate for this approach is approximately 95% for both hip and knee joints. […] An intermediate method is to exchange the new joint for the infected joint in a 1-stage surgical procedure with concomitant antibiotic therapy. […] Strictly adhere to sterile procedures whenever the joint space is invaded (eg, in aspiration or arthroscopic procedures). […] Antibiotic prophylaxis with an anti-staphylococcal antibiotic has been demonstrated to reduce wound infections in joint replacement surgery.

• #21 Septic Arthritis Treatment & Management: Approach Considerations, Antibiotic Therapy, Joint Immobilization and Physical Therapy

  https://emedicine.medscape.com/article/236299-treatment

  Antibiotics have a role in suppressing associated chronic osteomyelitis and chronically infected prosthetic material that cannot be removed for various reasons. […] The use of fluoroquinolones for an extended period should be considered when the removal of an infected prosthesis is not possible. […] Usually, immobilization of the infected joint to control pain is not necessary after the first few days. […] If the patient’s condition responds adequately after 5 days of treatment, begin gentle mobilization of the infected joint. […] The choice of the type of drainage, whether percutaneous or surgical, has not been resolved completely. […] Surgical drainage is indicated when one or more of the following occur: The appropriate choice of antibiotic and vigorous percutaneous drainage fails to clear the infection after 5 to 7 days.

• #22 Septic Arthritis – What You Need to Know

  https://www.drugs.com/cg/septic-arthritis.html

  Septic arthritis needs immediate medical care to prevent permanent joint damage. […] Aspiration is a procedure used to drain fluid from your joint. Your healthcare provider may use a needle to drain the fluid. […] Antibiotics prevent or fight an infection caused by bacteria. […] Prescription pain medicine may be given. […] NSAIDs, such as ibuprofen, help decrease swelling, pain, and fever. […] Arthroscopy is a procedure used to remove infected lining from a joint. […] Surgery may be needed to drain the fluid if other methods are not successful.

• #23 Physiotherapy in Septic Arthritis Rehabilitation

  https://www.physiotattva.com/blog/physiotherapy-in-septic-arthritis-rehabilitation-a-path-to-recovery

  Septic arthritis, an acute and potentially severe joint infection, demands comprehensive rehabilitation for optimal recovery. Physiotherapy plays a crucial role in managing this condition, focusing on restoring joint function, reducing pain, and preventing complications. […] The rehabilitation journey for septic arthritis begins post-treatment to ensure the affected joint regains its mobility, strength, and stability. Physiotherapists employ tailored exercises that gradually increase joint range of motion without exacerbating inflammation. […] Physiotherapy in septic arthritis rehabilitation not only aids in physical recovery but also supports patients in regaining confidence and functionality, facilitating a smoother return to daily life post-infection. […] Physiotherapy in septic arthritis focuses on restoring joint function post-treatment. Once infection control measures are underway, physiotherapists design exercises to improve joint mobility gradually.

• #24 Managing Your Septic Arthritis – Symptoms & Treatment | Carle.org

  https://carle.org/conditions/septic-arthritis

  Three stages of therapy are needed: antibiotics, joint drainage, and restoring normal motion to the joint. […] Antibiotics are usually given through a vein for the first 2 weeks and then by mouth for 2 to 4 weeks or more. […] Joint fluid should generally be drained to help resolve the infection. Most joints can be drained by sticking a needle into the joint and taking fluid out. This procedure is called arthrocentesis. Other joints are harder to drain this way and instead need drainage by an operation. […] After the first few days of treatment, people with joint infections should start therapy to restore normal joint motion. Physical therapists help with restoring normal movement. Therapy should continue until after the pain leaves and the joint works normally.

• #25 Physiotherapy in Septic Arthritis Rehabilitation

  https://www.physiotattva.com/blog/physiotherapy-in-septic-arthritis-rehabilitation-a-path-to-recovery

  Physiotherapy aids in regaining optimal joint function, promoting recovery, and reducing the risk of long-term joint complications. […] Physiotherapy in septic arthritis aids in restoring joint function, preventing stiffness, and strengthening muscles, pivotal for recovery, optimizing mobility, and reducing long-term joint issues post-infection. […] Range of motion exercises in joint recovery involve gentle movements that gradually increase joint flexibility without exacerbating inflammation. […] Strengthening exercises post-septic arthritis focus on targeted muscle groups around the affected joint. […] Manual therapy methods, including gentle joint mobilization or manipulation, soft tissue massage, and stretching, aid in reducing discomfort, improving joint flexibility, and promoting tissue healing, enhancing overall pain management and joint recovery.

• #26 Septic Arthritis

  https://www.physio.co.uk/what-we-treat/rheumatology/septic-arthritis.php

  Physiotherapy can help in the following ways: Increase strength, Improve range of movement, Reduce pain, Help pace your activities, Reduce stiffness, Help you return to work/ your normal activities, Increase cardiovascular levels. […] The physiotherapy you receive depends on your symptoms and the severity of the septic arthritis. […] Physiotherapy may include: Cryotherapy (ice), Strengthening exercises, Range of movement exercises, Gentle joint mobilisations, Cardiovascular activities, Hydrotherapy, Provision of specialist equipment to help you around the home, Temporary splinting of joints to avoid unwanted movements, Pacing advice, Pain control modalities. […] Treatment includes a course of antibiotics and draining infected fluid from the joint. Following this, it is important that a comprehensive rehabilitation programme is started to prevent any long term complications. Physiotherapy is a very successful way to maximise your recovery from septic arthritis and help you return to a normal active lifestyle.

• #27 Novel therapeutic interventions towards improved management of septic arthritis | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04383-6

  Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. […] The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates. […] The classical mode of action of these peptides includes direct killing via both membrane targeting as well as non-membrane targeting routes. […] AMPs can thus work both as anti-bacterial killing peptides as well as participating in normalization of the deranged immune that causes significant tissue damage (even after acute episode has subsided) and thus represent an ideal option in the fight against management and treatment of SA.

• #28 Novel therapeutic interventions towards improved management of septic arthritis | BMC Musculoskeletal Disorders | Full Text

  https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-021-04383-6

  The use of lytic bacteriophages to kill pathogenic bacteria is referred to as phage therapy. […] Phages can also be administrated intravenously during this emergency period in order to provide more effective control of the infection process and associated sepsis as demonstrated in past studies. […] In SA, killing the bacteria may not be the sole option for successful disease management and strategies aimed to abrogate the progressive bone destruction by balancing the heightened immune response is equally important. […] Therefore, one approach directed towards neutralization of key MMPs and studying the effect on disease progression seems worth exploring. […] These findings clearly indicate that neutralisation of MMP-2 represents a potential target to prevent joint destruction and regulate the cytokine levels during the arthritic episode. […] The suggested non-antibiotic approaches against SA have shown promise in various in vitro and non-human model based studies.

• #29 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

  In children with confirmed SA, early administration of a short course of intravenous corticosteroids may accelerate clinical recovery and reduce hospital stay. […] Joint drainage to treat SA can be performed by closed-needle aspiration, arthroscopy or arthrotomy. […] We suggest joint drainage by arthrotomy as the first option for hip and shoulder SA in young children, and after more conservative procedures have failed. […] Outpatient follow-up with oral antimicrobial therapy is suggested once a favourable clinical and analytical evolution is established.

• #30 Septic arthritis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/septic-arthritis?lang=us

  Septic arthritis can cause rapid chondrolysis and destructive arthropathy. […] Prompt treatment can avoid permanent damage to the joint which may result in chronic deformity, mechanical arthritis and even death. […] The treatment principle for septic arthritis is prompt drainage of purulent fluid and appropriate antibiotics. […] If the patient is hemodynamically stable then attempts should be made to obtain a sample of joint fluid for microscopy and culture prior to starting treatment with antibiotics. This will allow focussed treatment of the infection. […] With smaller joints needle drainage or aspiration to decompress the joint followed by antibiotics may be adequate. For larger joints or persistent infection, surgical debridement and washout will be required. […] If unrecognised and left untreated, septic arthritis can result in irreversible joint damage within 48 hours of the onset of infection due to the proteolytic enzymes of the white blood cells that flood the infected synovial space. Osteonecrosis is also an important sequela of septic arthritis due to effusion and an increase in intra-articular pressure which compromises blood circulation. […] Conversely, approximately 90% of patients with septic arthritis will recover with appropriate antibiotic treatment. Therefore, timely diagnosis and treatment are critical.

• #31 Septic Arthritis Treatment & Management: Approach Considerations, Antibiotic Therapy, Joint Immobilization and Physical Therapy

  https://emedicine.medscape.com/article/236299-treatment

  Treat any infection promptly to lessen the chance of bloodstream invasion. […] The risk for repeat arthroplasty performed for septic arthritis is six times that of repeat arthroplasty for other indications. […] For various reasons, joint infection may fail to respond to combined surgical and antibiotic therapy.

• #32 Septic Arthritis: What It Is, Causes, Symptoms, Treatment

  https://www.verywellhealth.com/septic-arthritis-7570269

  Surgery is typically done in cases in which the septic arthritis is causing severe pain, reduced joint mobility, and inability to bear weight on the affected joint. […] If a prosthetic joint is infected, treatment includes removing and replacing it with a new implant. If the prosthetic joint does not need to be removed, it is cleaned out and any damaged tissue is removed. The prosthetic joint is left in place. […] Septic arthritis needs to be treated. Anyone experiencing signs of the condition should contact their healthcare provider or go to the nearest emergency department. […] Septic arthritis is treated with antibiotics and the removal of excess joint fluid, but some people may need surgery to clean out the affected joint or remove damaged tissue. Treatment is crucial because septic arthritis can lead to irreversible joint damage or life-threatening sepsis.

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

  https://bestpractice.bmj.com/topics/en-gb/486

  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. […] Continue intravenous therapy for 2 weeks and then switch to oral antibiotic therapy for a further 4 weeks.

• #34 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

  Executive summary: Guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT […] These guidelines for the diagnosis and treatment of septic arthritis in children and adults are intended for use by any physician caring for patients with suspected or confirmed septic arthritis. […] Joint drainage is recommended for peripheral bacterial arthritis (except for gonococcal and early mycobacterial infections, which do not usually require joint drainage) and for fungal arthritis. […] We recommend joint drainage of large peripheral joints with pyogenic arthritis as soon as possible. […] In haemodynamically stable patients without sepsis or septic shock and with clinical and laboratory findings of peripheral pyogenic arthritis, we recommend starting empirical antimicrobial therapy after obtaining blood cultures and SF aspirate.

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