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

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Spreads to synovial fluid and multiplies

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Products of inflamation destroys joint components

(Swollen, painful joint)

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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