septic arthritis 97-03
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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