Septic arthritis: current diagnostic and therapeutic algorithm

@article{Mathews2008SepticAC,
  title={Septic arthritis: current diagnostic and therapeutic algorithm},
  author={Catherine J. Mathews and Gerald Coakley},
  journal={Current Opinion in Rheumatology},
  year={2008},
  volume={20},
  pages={457–462}
}
Purpose of reviewTo propose and discuss an evidence-based algorithm for the diagnosis and treatment of bacterial septic arthritis. Also, to review the recent literature on emerging management strategies and discuss the potential impact of these developments on clinical practice. Recent findingsEvidence-based guidelines have recently been published to assist in the diagnosis and management of suspected and confirmed septic arthritis. All suspected septic joints should be aspirated and the… 
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167 Citations
Highly Influential Citations
6
Background Citations
55
Methods Citations
4
Results Citations
3

167 Citations

Citation Type

Citation Type

Septic arthritis in children in resource limited and non-resource limited countries: an update on diagnosis and treatment
TLDR
Results from three randomized controlled trials suggest that the addition of systemic steroids may accelerate clinical improvement and the predictive value of serum markers is still under debate and the proposed diagnostic algorithms for SA are not sufficiently validated in children.
A Retrospective Review of Native Septic Arthritis in Patients: Can We Diagnose Based on Laboratory Values?
TLDR
No synovial cell count level was highly effective in discriminating patients with a positive culture for septic arthritis from patients with negative cultures and there were no other statistically significant differences between patients regarding ESR, CRP, WBC, or cell count aspiration at the time of diagnosis.
Peripheral Bacterial Septic Arthritis: Review of Diagnosis and Management.
TLDR
Joint drainage is always recommended in septic arthritis; however, no clear guidelines or strong evidence exist to guide the preferred method of drainage.
Novel therapeutic interventions towards improved management of septic arthritis
TLDR
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, and 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.
Pneumococcal septic arthritis in adults: clinical analysis and review
TLDR
Streptococcus pneumoniae is now being increasingly recognized as a common agent of SA, particularly in patients with advanced age and comorbidities.
Application of a Novel Diagnostic Rule in the Differential Diagnosis between Acute Gouty Arthritis and Septic Arthritis
TLDR
A novel diagnostic rule for gout without synovial fluid analysis was developed and showed relevant performances, and it was found that patients with acute gout had significantly more 'high', and less 'low' probabilities compared to those with septic arthritis.
Synovial fluid tests
Early diagnosis of septic arthritis in immunocompromised patients.
Corticosteroids for septic arthritis in children.
TLDR
Two randomised controlled trials with patients from two months to 18 years of age with a diagnosis of septic arthritis who were receiving corticosteroids in addition to antibiotic therapy or as an adjuvant to other therapies such as surgical drainage, intra-articular puncture, arthroscopic irrigation, or debridement were performed.
Septic Arthritis Due to Haemophilus influenzae Serotype f in a Patient With Waldenström Macroglobulinemia: Case Report and Review of the Literature
TLDR
Physicians must be mindful of this invasive pathogen’s role in septic arthritis and the need for immediate surgical intervention and antibiotic administration so as to decrease associated morbidity and mortality.
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References

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TLDR
No investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor, and key unanswered questions remain surrounding the medical and surgical management of the infected joint.
Does this adult patient have septic arthritis?
TLDR
Clinical findings identify patients with peripheral, monoarticular arthritis who might have septic arthritis, but the synovial WBC and percentage of polymorphonuclear cells from arthrocentesis are required to assess the likelihood of septicthritis before the Gram stain and culture test results are known.
Diagnostic utility of laboratory tests in septic arthritis
Background: Septic arthritis remains a challenging diagnosis in which the doctor often relies on laboratory tests. Objective: To examine the diagnostic utility of three ancillary tests—namely, white…
Addition of corticosteroids to antibiotic treatment ameliorates the course of experimental Staphylococcus aureus arthritis.
TLDR
Systemic corticosteroid administration along with antibiotic therapy had beneficial effects on the course and outcome of S aureus arthritis.
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TLDR
A short course of dexamethasone reduced residual joint dysfunction and shortened significantly the duration of symptoms in children with documented hematogenous septic arthritis.
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TLDR
These results confirm the importance of obtaining synovial fluid and blood for culture before starting antimicrobial treatment and suggest that important predictors of death are: confusion at presentation, age ⩾65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity.
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TLDR
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TLDR
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TLDR
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TLDR
It is shown that tuberculosis arthritis and polyarticular septic arthritis is necessary in patients with HIV and a CD4 count < 200/mm3 and a high index of suspicion for Mycobacterium is necessary for them to be diagnosed with AIDS.
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