Septic arthritis resident survival guide: Difference between revisions

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=== Antimicrobial Regimen – Empiric Therapy: ===
=== Antimicrobial Regimen – Empiric Therapy: ===
<small>
{| class="wikitable"
! style="width: 20%;" | '''Newborn (&lt; 1 week)'''
! style="width: 20%;" | '''Newborn (1–4 weeks)'''
! style="width: 20%;" | '''Infants (1–3 months)'''
! style="width: 20%;" | '''Children (3 months–14 years)'''
! style="width: 20%;" | '''Adults'''
|-
| valign = top |
'''High Risk for MRSA'''
* '''Preferred Regimen'''
** [[Vancomycin]] 18 mg/kg/day IV q12h {{and}}
** [[Cefotaxime]] 50 mg/kg IV q12h
'''Low Risk for MRSA'''
** [[Cefotaxime]] 50 mg/kg IV q12h {{and}}
** [[Nafcillin]] 25 mg/kg IV q8h or [[Oxacillin]] 25 mg/kg IV q8h
| valign = top |
'''High Risk for MRSA'''
* '''Preferred Regimen'''
** [[Vancomycin]] 22 mg/kg/day IV q12h {{and}}
** [[Cefotaxime]] 50 mg/kg IV q8h
* '''Alternative Regimen'''
** [[Clindamycin]] 5 mg/kg IV q8h
'''Low Risk for MRSA'''
* '''Preferred Regimen'''
** [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
** [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
* '''Alternative Regimen'''
** [[Clindamycin]] 5 mg/kg IV q6h
| valign = top |
'''High Risk for MRSA'''
* '''Preferred Regimen'''
** [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
** [[Cefotaxime]] 50 mg/kg IV q8h
'''Low Risk for MRSA'''
* '''Preferred Regimen'''
** [[Cefotaxime]] 50 mg/kg IV q8h {{and}}
** [[Nafcillin]] 37 mg/kg IV q6h {{or}} [[Oxacillin]] 37 mg/kg IV q6h
* '''Alternative Regimen'''
** [[Clindamycin]] 7.5 mg/kg IV q6h
| valign = top |
'''Preferred Regimen'''
* [[Vancomycin]] 40 mg/kg/day IV q6–8h {{and}}
* [[Cefotaxime]] 50 mg/kg IV q8h
| valign = top |
'''Monoarticular'''
* '''At risk for sexually-transmitted disease'''
**'''Preferred Regimen'''
*** [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
**'''Alternative Regimen'''
*** [[Vancomycin]] 1 g IV q12h
* '''Not at risk for sexually-transmitted disease'''
**'''Preferred Regimen'''
*** [[Vancomycin]] 1 g IV q12h {{and}}
*** [[Ceftriaxone]] 1 g IV q24h {{or}} [[Cefotaxime]] 1 g IV q8h {{or}} [[Ceftizoxime]] 1 g IV q8h
**'''Alternative Regimen'''
*** [[Vancomycin]] 1 g IV q12h {{and}}
*** [[Ciprofloxacin]] 400 mg IV q12h {{or}} [[Levofloxacin]] 750 mg IV q 24 h
'''Polyarticular'''
*'''Preferred Regimen'''
** [[Ceftriaxone]] 1 g IV q24h
|}
</small>


=== Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy: ===
=== Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy: ===

Revision as of 21:08, 30 March 2018

Vertigo
Resident Survival Guide
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Iqra Qamar M.D.[2], Aditya Ganti M.B.B.S. [3]

Overview

Causes

FIRE

Diagnosis

Treatment

Empiric treatment should be commenced as soon as possible after culture samples have been obtained. The choice of empiric antibiotics should be determined on the basis of:[1][2][3]

If the patient fails to respond to initial treatment, consider:[1]

  • Misidentification of causative pathogen
  • Infection with atypical pathogen
  • Concurrent osteomyelitis
  • Occult nidus of infection

Intra-articular antibiotics are not useful as it may increase infection rate and also causes chemical synovitis and cartilage toxicity.[4]

Methicillin-resistant Staphylococcus aureus (MRSA)

Patient at high risk of methicillin-resistant Staphylococcus aureus (MRSA) include:[5][6]

  • Known MRSA colonization or infection
  • Recent hospitalization
  • Nursing-home resident
  • Presence of leg ulcers
  • Indwelling catheters
 
 

Antimicrobial Regimen – Empiric Therapy:

Newborn (< 1 week) Newborn (1–4 weeks) Infants (1–3 months) Children (3 months–14 years) Adults

High Risk for MRSA

Low Risk for MRSA

High Risk for MRSA

Low Risk for MRSA

High Risk for MRSA

Low Risk for MRSA

Preferred Regimen

Monoarticular

Polyarticular

Antimicrobial Regimen – Synovial Fluid Gram Stain-Based Therapy:

Antimicrobial Regimen – Pathogen Based Therapy:

Duration of Antimicrobial Therapy:

Do's

Don'ts

References

  1. ↑ 1.0 1.1 Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15 (4):527-44. PMID: 12364368
  2. ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 978-1455748013.
  3. ↑ Mathews, Catherine J.; Weston, Vivienne C.; Jones, Adrian; Field, Max; Coakley, Gerald (2010-03-06). "Bacterial septic arthritis in adults". Lancet. 375 (9717): 846–855. doi:10.1016/S0140-6736(09)61595-6. ISSN 1474-547X. PMID 20206778.
  4. ↑ Stutz G, Kuster MS, Kleinstück F, Gächter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8 (5):270-4. DOI:10.1007/s001670000129 PMID: 11061294
  5. ↑ Liu, Catherine; Bayer, Arnold; Cosgrove, Sara E.; Daum, Robert S.; Fridkin, Scott K.; Gorwitz, Rachel J.; Kaplan, Sheldon L.; Karchmer, Adolf W.; Levine, Donald P.; Murray, Barbara E.; J Rybak, Michael; Talan, David A.; Chambers, Henry F.; Infectious Diseases Society of America (2011-02-01). "Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 52 (3): –18-55. doi:10.1093/cid/ciq146. ISSN 1537-6591. PMID 21208910.
  6. ↑ Sharff KA, Richards EP, Townes JM (2013) Clinical management of septic arthritis. Curr Rheumatol Rep 15 (6):332. DOI:10.1007/s11926-013-0332-4 PMID: 23591823
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