5-Minute Clinical Consult
Arthritis, Septic
Arthritis, Septic is a topic covered in the 5-Minute Clinical Consult.
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Basics
Description
- Infection due to bacterial invasion of the joint space
- Systems affected: musculoskeletal
- Synonyms: suppurative arthritis; infectious arthritis; pyarthrosis; pyogenic arthritis; bacterial arthritis
Epidemiology
- May occur at any age; incidence is higher in very young and in the elderly.
- Prevalence: 27% of patients presenting with monoarticular arthritis have nongonococcal septic arthritis (1).
- Gender differences:
- Gonococcal: female > male
- Nongonococcal: male > female
Etiology and Pathophysiology
- Multiple pathogens
- Nongonococcal:
- Staphylococcus aureus (most common in adults)
- MRSA risk increased in elderly, intravenous drug users (IVDU), postsurgical
- Streptococcus spp. (second most common in adults)
- Gram-negative rods (GNR): IVDU, trauma, extremes of age, immunosuppressed
- Staphylococcus aureus (most common in adults)
- Neisseria gonorrhoeae (most common in young, sexually active adults)
- Other: rickettsial (e.g., Lyme), fungal, mycobacterial
- Risk by specific age (2):
- <1 month: S. aureus, group B streptococcus (GBS), GNR
- 1 month to 4 years: S. aureus, Streptococcus pneumoniae, Neisseria meningitidis
- 16 to 40 years: N. meningitidis, S. aureus
- >40 years: S. aureus
- Specific high-risk groups:
- Rheumatoid arthritis (RA): S. aureus
- IVDU: S. aureus, GNR, opportunistic pathogens
- Neonates: GBS
- Immunocompromised: gram-negative bacilli, fungi
- Trauma patients with open injuries: mixed flora
- Pathogenesis:
- Hematogenous spread (most common)
- Direct inoculation by microorganisms secondary to trauma or iatrogenesis (e.g., joint surgery)
- Adjacent spread (e.g., osteomyelitis)
- Pathophysiology:
- Microorganisms initially enter through synovial membrane and spread to the synovial fluid.
- Resulting inflammatory response releases cytokines and destructive proteases leading to systemic symptoms and joint damage.
Risk Factors
- Age >80 years
- Low socioeconomic status, alcoholism
- Cellulitis and skin ulcers
- Violation of joint capsule
- Prior orthopedic surgery
- Intra-articular steroid injection
- Trauma
- History of previous joint disease
- Inflammatory arthritis (RA: 10-fold increased risk)
- Osteoarthritis
- Crystal arthritides
- Systemic illness
- Diabetes mellitus, liver disease, HIV, malignancy, end-stage renal disease/hemodialysis, immunosuppression, sickle cell anemia
- Risks for hematogenous spread
- IVDU, severe sepsis/systemic infection
General Prevention
- Prompt treatment of skin and soft tissue infections.
- Control risk factors.
- Immunization (S. pneumoniae, N. meningitidis)
-- To view the remaining sections of this topic, please sign in or purchase a subscription --
Basics
Description
- Infection due to bacterial invasion of the joint space
- Systems affected: musculoskeletal
- Synonyms: suppurative arthritis; infectious arthritis; pyarthrosis; pyogenic arthritis; bacterial arthritis
Epidemiology
- May occur at any age; incidence is higher in very young and in the elderly.
- Prevalence: 27% of patients presenting with monoarticular arthritis have nongonococcal septic arthritis (1).
- Gender differences:
- Gonococcal: female > male
- Nongonococcal: male > female
Etiology and Pathophysiology
- Multiple pathogens
- Nongonococcal:
- Staphylococcus aureus (most common in adults)
- MRSA risk increased in elderly, intravenous drug users (IVDU), postsurgical
- Streptococcus spp. (second most common in adults)
- Gram-negative rods (GNR): IVDU, trauma, extremes of age, immunosuppressed
- Staphylococcus aureus (most common in adults)
- Neisseria gonorrhoeae (most common in young, sexually active adults)
- Other: rickettsial (e.g., Lyme), fungal, mycobacterial
- Risk by specific age (2):
- <1 month: S. aureus, group B streptococcus (GBS), GNR
- 1 month to 4 years: S. aureus, Streptococcus pneumoniae, Neisseria meningitidis
- 16 to 40 years: N. meningitidis, S. aureus
- >40 years: S. aureus
- Specific high-risk groups:
- Rheumatoid arthritis (RA): S. aureus
- IVDU: S. aureus, GNR, opportunistic pathogens
- Neonates: GBS
- Immunocompromised: gram-negative bacilli, fungi
- Trauma patients with open injuries: mixed flora
- Pathogenesis:
- Hematogenous spread (most common)
- Direct inoculation by microorganisms secondary to trauma or iatrogenesis (e.g., joint surgery)
- Adjacent spread (e.g., osteomyelitis)
- Pathophysiology:
- Microorganisms initially enter through synovial membrane and spread to the synovial fluid.
- Resulting inflammatory response releases cytokines and destructive proteases leading to systemic symptoms and joint damage.
Risk Factors
- Age >80 years
- Low socioeconomic status, alcoholism
- Cellulitis and skin ulcers
- Violation of joint capsule
- Prior orthopedic surgery
- Intra-articular steroid injection
- Trauma
- History of previous joint disease
- Inflammatory arthritis (RA: 10-fold increased risk)
- Osteoarthritis
- Crystal arthritides
- Systemic illness
- Diabetes mellitus, liver disease, HIV, malignancy, end-stage renal disease/hemodialysis, immunosuppression, sickle cell anemia
- Risks for hematogenous spread
- IVDU, severe sepsis/systemic infection
General Prevention
- Prompt treatment of skin and soft tissue infections.
- Control risk factors.
- Immunization (S. pneumoniae, N. meningitidis)
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Citation
Stephens, Mark B., et al., editors. "Arthritis, Septic." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816409/all/Arthritis__Septic.
Arthritis, Septic. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816409/all/Arthritis__Septic. Accessed January 22, 2020.
Arthritis, Septic. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816409/all/Arthritis__Septic
Arthritis, Septic [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2020 January 22]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816409/all/Arthritis__Septic.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC
T1 - Arthritis, Septic
ID - 816409
ED - Stephens,Mark B,
ED - Golding,Jeremy,
ED - Baldor,Robert A,
ED - Domino,Frank J,
BT - 5-Minute Clinical Consult, Updating
UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/816409/all/Arthritis__Septic
PB - Wolters Kluwer
ET - 27
DB - Medicine Central
DP - Unbound Medicine
ER -