Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- hot, swollen, tender, restricted joint
Otros factores de diagnóstico
- history of intravenous drug use
- history of diabetes
- history of cutaneous lesions
- prosthetic joint
- history of rheumatoid arthritis or osteoarthritis
- acute onset of symptoms
- fever
- low socioeconomic status
- history of alcohol use disorder
- history of previous corticosteroid injection
Factores de riesgo
- underlying joint disease
- joint prostheses
- immunosuppression
- intravenous drug use
- diabetes
- alcohol use disorder
- skin lesions
- previous intra-articular corticosteroid injection
- recent joint surgery
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- synovial fluid Gram stain and culture
- synovial fluid white cell count
- blood culture
- serum white cell count
- erythrocyte sedimentation rate
- CRP
- plain radiograph
- ultrasound
- synovium biopsy for Mycobacterium tuberculosis
Pruebas diagnósticas que deben considerarse
- synovial glucose, LDH, lactate, procalcitonin
- synovial polymerase chain reaction (PCR)
- serum procalcitonin
- Neisseria gonorrhea culture and nucleic acid amplification testing
- MRI
- cardiac ultrasound
Algoritmo de tratamiento
prosthetic joint: suspected infection
native joint: suspected infection with negative Gram stain (or Gram stain not available)
native joint: suspected infection with Gram-positive stain and no risk factors for resistant microorganisms
native joint: suspected infection with Gram-positive stain and risk factors for resistant microorganisms
native joint: suspected infection with Gram-negative stain
native joint: confirmed MSSA infection
native joint: confirmed MRSA infection
native joint: confirmed streptococcal infection
native joint: confirmed gram-negative rods infection
native joint: confirmed gonococcal or meningococcal infection
native joint: infection with fungi/tuberculosis/other organisms
Colaboradores
Autores
Blerta Green, MD
Fellow in Rheumatology
Section of Rheumatology, Allergy, and Immunology
Yale University School of Medicine
New Haven
CT
Divulgaciones
RTS declares that he has no competing interests.
Robert T. Schoen, MD, MBA
Clinical Professor of Medicine
Section of Rheumatology, Allergy, and Immunology
Yale University School of Medicine
New Haven
CT
Divulgaciones
RTS declares that he has no competing interests.
Francine Touzard Romo, MD
Associate Professor of Medicine
Division of Infectious Diseases
Warren Alpert Medical School
Brown University
Providence
Rhode Island
Divulgaciones
FTR declares that she has no competing interests.
Revisores por pares
Andrew Keat, MBBS
Consultant Physician and Rheumatologist
Northwick Park Hospital
Harrow
UK
Divulgaciones
AK declares that he has no competing interests.
Cheryl Main, MD, FRCPC
Medical Microbiologist
Infectious Disease Consultant
Hamilton Regional Laboratory Medicine Program
Hamilton Health Sciences
Hamilton
Canada
Divulgaciones
CM declares that she has no competing interests.
John Ross, MD
Brigham and Women’s Hospital
Hospitalist Section
Boston
MA
Divulgaciones
JR declares that he has no competing interests.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18. Resumen
Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.Texto completo Resumen
Ravn C, Neyt J, Benito N, et al. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect. 2023;8(1):29-37.Texto completo Resumen
Benito N, Martínez-Pastor JC, Lora-Tamayo J, et al. Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed). 2024 Apr;42(4):208-14.Texto completo Resumen
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].Texto completo
Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].Texto completo
Le Vavasseur B, Zeller V. Antibiotic therapy for prosthetic joint infections: an overview. Antibiotics (Basel). 2022 Apr 5;11(4):486.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
Diferenciales
- Osteoarthritis
- Psoriatic arthritis
- Rheumatoid arthritis
Más DiferencialesGuías de práctica clínica
- Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)
- Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT
Más Guías de práctica clínicaFolletos para el paciente
Septic arthritis
Más Folletos para el pacienteVideos
Aspiration and injection of the knee: animated demonstration
Aspiration and injection of the shoulder animated demonstration
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