Septic arthritis

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.

Do not aspirate a prosthetic joint. Refer the patient to an orthopaedic surgeon.

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.

Septic arthritis is defined as the infection of 1 or more joints caused by pathogenic inoculation of microbes. It occurs either by direct inoculation or via haematogenous spread.