SEPTIC ARTHRIRIS (HIP)

INTRODUCTION:
Septic arthritis, also known as infectious arthritis, may represent a
direct invasion of joint space by various microorganisms, most commonly
caused by a variety of bacteria .However, viruses, mycobacteria, and fungi have
been implicated. Reactive arthritis is a sterile inflammatory process that usually
results from an extra-articular infectious process.
Bacteria are the most significant pathogens because of their rapidly
destructive nature. For this reason, the current discussion concentrates on the
bacterial septic arthritides. Failure to recognize and to appropriately treat septic
arthritis results in significant rates of morbidity and may even lead to death.
ETIOLOGY
Staphylococcus aureus infection is the cause of the vast majority of
cases of acute bacterial arthritis in adults and in children This pathogen is the
cause in 80% of infected joints affected by rheumatoid arthritis.
Streptococcal species, such as Streptococcus viridans, S pneumoniae,
and group B streptococci, account for 20% of cases. Aerobic gram-negative rods
are involved in 20-25% of cases Infection of the sternoclavicular and sacroiliac
joints with Pseudomonas aeruginosa or Serratia

PATHOPHYSIOLOGY
Route of Transmission:
1. Hematogenous
Most common
Bacteremia associated with URTI, Skin or GIT infections. Or
invasive procedures.
2. Direct Inoculation
Joint contamination by foreign object
3. Contiguous spread
Osteomyelitis due to several factors in infants

Bacteria deposits in synovium producing inflamation

Spreads to synovial fluid and multiplies

Products of inflamation destroys joint components

(Swollen, painful joint)

SEPTIC ARTHRITIS

CLINICAL MANIFESTATION

Infants
More septicaemia
Rather than joint pain
Baby is irritable & refuses to feed
Tachycardia with fever
Joints are inflamed
Pseudoparalysis
Check umbilical cord and IV site for infection
Children
Acute pain in single large joint(esp hip)
Pseudoparesis
Child is ill, rapid pulse and swinging fever
Overlying skin looks red & superficial joint swelling may be obvious
Local warmth and marked tenderness
All movements are restricted by pain or spasm.
Look for source of infection
.
DIAGNOSTIC METHOD
1 Obtain at least 2 sets of blood cultures to rule out a bacteremic origin of
the septic.
2. Plain radiography is of limited value in evaluating a joint for infection

3. soft-tissue swelling is the most common finding.

4.the x-ray
MANAGEMENT
I MEDICAL MANAGEMENT
a) SURGICAL TEATMENT
Arthrotomy-Surgical opening and depritment
b) ANTIBIOTIC PROPHYLAXIS - with an antistaphylococcal antibiotic has
been demonstrated to reduce wound infections in joint replacement
surgery.
II.NURSING MANAGEMENT