septic arthritis (to behave)


I- Definition :

infectious arthritis, the presence of a microbe in articular level, it is not reaction. Done with the differential dg RAA where arthritis is secondary to molecular mimicry

II- Epidemiology :

Can affect anyone
– direct contamination : open fracture, arthroscopy, intra-articular injection
– indirect contamination : sepsis
– Terrain d’ID : diabetes, CTC-going, VIH… promotes infection

III- Clinique :

– Bacteria : staph (+++) door skin entry, strepto (ORL), pneumococcal, BGN (urinary infection), enterobacteria
– Can be secondary or origin of sepsis
– clinical Tb : sudden onset, oscillating fever, TIME, ADP-SPM (+/-)
– It mainly affects the large joints : surtt knee
– swollen knee, DLR, hot,movements sometimes limited lameness -The DLR is pulsatile, intense and permanent
– A clinical examination : already seen elements, Search the front door (ON) to guide the CEO vis-à-vis the bacteria involved, confirm or mono-articular ateinste, always evaluate the contralateral joint
– lesional Review : primary or secondary attack, ON, mono / multi-articular
A complete physical examination is mandatory
– Search arthritis ATCD : differentiate an AAF, lupus or association (Be careful : because if considered secondary to a pre-existing lupus and treated as such promotes the deepening immuno-depression)
– If suspected septic arthritis :
+ compulsory hospitalization
+ Put in condition
+ joint aspiration : for bacteriological study, can be performed under echo so deep or difficult joint puncture, the sample must be sent immediately to the laboratory but said if the PE found
+ Sampling at the EP
+ Blood culture in febrile peak, CRP (at 3 statistics), VS, Rx
+ According Tb : ASLO, parasitological stool, ECBU…
+ ATBpie from day to prevent joint destruction and systemic dissemination

IV- Treatment :

– ATBpie broad spectrum synergistic (old molecules are used in the foreground)
– Immobilize the knee plaster splint
– ATB : oxacilline en IV + aminoside (3-5j) → apyrexie : TRT continue pending batério
– Recovery therapy based on clinical status (right answer or nn) and depending on the Microbial
– If the patient responds well and the bacteriological returns for the bacteria referred : 21j TRT IV then piostacine by VO pdt 2-3mois

other seeds :
– Strepto : TRT pdt starting point 6 weeks
– TBC : TRT according nationnal pdt 6mos program or 12months. When the joint is peripheral : 9 month
– unusual germ : TRT viral infection makes disappear arthritis

TRT infection :
-meningoencephalitis : oligarthrite sometimes arthritis
-Gonocoque :
Oligarthrite sometimes arthritis
genital lesions
Skin lesions

NB : Biologically : infectious balance, hepatic, renal and haematological (mandatory)

Courses of Dr. Boudersa – Faculty of Constantine