III. Labs

  1. Synovial Fluid (obtain in all suspected cases)
    1. Normal Synovial Fluid cell count in >50% of Septic Arthritis cases
    2. Gram Stain Test Sensitivity is only 50% (high False Negative Rate)
    3. Synovial Fluid is the gold standard for diagnosis

IV. Management

  1. Obtain Synovial Fluid culture and start empiric antibiotics
  2. Total antibiotic course: 6 weeks
  3. Initial empiric management
    1. Cephaloporin sensitive
      1. Ceftriaxone 50-75 mg/kg up to 2 g/dose OR
      2. Ceftriaxone 75-100 mg/kg in high S. Pneumoniae resistance regions
    2. Cephalosporin resistance
      1. Clindamycin 10-15 mg/kg/dose (preferred) OR
      2. Vancomycin 15 mg/kg/dose (if systemic Sepsis or Clindamycin reactions)

V. References

  1. Welsh and Welsh (2016) Crit Dec Emerg Med 30(11): 15-23

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