Bacterial Arthritis - Treatment

Medical therapy:It includes appropriate joint drainage, antibiotics and joint immobility. Antibiotics are administered for at least two weeks.Methicillin-resistant Staphylococcus aureus infection require treatment for 4 weeks. Oral antibiotic therapy is never indicated in Staphylococcus aureus infection. Gram-negative infection is treated with oral ciprofloxacin 1-2 weeks. gonococcal arthritis intrevenoasa antibiotic therapy is sufficient for 2 weeks.Initial choice of antibiotic is empirical, depending on the characteristics of pathogens. Pseudomonas and Enterobacteriaceele are most resistant to multiple antibiotics.Many strains of group B streptococci are resistant to penicillin and gentamicin.The choice of drainage, percutaneous or surgical is still debated.Thoroughly vacuum 2-3 times per day during the first few days. If drainage is often necessary to choose the path of surgery. If joint after 5 days of treatment does not answer: persistent fever, purulent recovery, positive culture abodr recommend therapy.
Surgical therapy:Surgical drainage is indicated:"When antibiotics and percutaneous drainage can not remove purulent in 5-7 days-Affected joint is difficult to aspirate: tireAdjacent soft-tissue infection.Routine arthroscopic lavage is rarely indicated. By this technique to look inside joints, drains pus, and broke debrideaza adhesion.Gonococcal require surgical drainage of infected joints. If infection is reinlocuieste prosthetic device. It is antibiotic therapy for 6 months and then another device reimplanteaza methylmethacrylate cement impregnated with gentamicin, tobramycin.
Physical Therapy:Immobilization of the affected joint to control pain is not necessary after the first few days. Initial physical therapy consists of maintaining the joint in functional position and practice of passive exercise. The joint should not support any weight until signs and symptoms do not resolve the synovitis. Aggressive physical therapy is needed to achieve maximum benefits.
Prevention:Antistaphylococcal antibiotic prophylaxis has been found to reduce wound infection through joint surgery. Cement treated with antibiotics decreases perioperative infections. Use of antibiotic prophylaxis on the same theoretical basis as well as valvular heart disease.
Prognosis:Antibiotic therapy has reduced morbidity and mortality of the disease. The mortality rate is below 10%. Approximately 60% of patients recover completely. Prompt treatment limiting long-term destruction. Patients who are asymptomatic more than 7 days before diagnosis tended to report severe joint damage.Staphylococcus aureus and gram-negative bacilli tend to be more destructive. Children with septic arthritis of the hip shows the long-term disability. The prognosis is better for older children. Long term complications can occur pri growth disorders, fibrous or bony ankylosis or osteonecrosis of the femoral head.50% of adults with septic arthritis have significant sequelae or chronic pain by reducing motion after infection.
Negative prognostic factors for predicting suppurative arthritis include:Over 60 years-old-Hip or shoulder infectionRheumatoid arthritis, this-Positive elements in synovial cultures after 7 days of therapy-Delay over 7 days of therapy.30% of cases become chronic reactive arthritis.