Bacterial Arthritis; Causes, Symptoms, Diagnosis, Treatment

Bacterial Arthritis/Septic arthritis is a bacterial, viral, or fungal infection in one or more of your joints. The germ can travel to the joint from another part of your body. A puncture wound near the joint can bring the germ directly into the joint. Septic arthritis usually affects large joints, such as in the knee, hip, shoulder, ankle, and elbow. Septic arthritis needs immediate medical care to prevent permanent joint damage.

Alternative Names of Septic Arthritis

Bacterial arthritis; Non-gonococcal bacterial arthritis.

Types of Septic Arthritis

The term “suppurative arthritis” is a near synonym for septic arthritis. (“Suppurative” refers to the production of pus, without necessarily implying sepsis.)

ICD-10 uses the term “pyogenic arthritis”. Pyogenic also refers to the production of pus.

Reactive arthritis refers to arthritis caused by an immune consequence of an infection, but not directly attributable to the infection itself.

Septic arthritis is usually caused by bacteria, but may be caused by viral, mycobacterial, and fungal pathogens as well. A broader term is “infectious arthritis”, which describes arthritis caused by any infectious organism.Viruses can cause arthritis, but it can be hard to determine if the arthritis is directly due to the virus or if the arthritis is reactive.

Septic/suppurative arthritis and “bacterial arthritis” are sometimes considered equivalent, but there are exceptions. For example, Borrelia burgdorferi can cause infectious arthritis, but is not associated with suppurative arthritis

According to Severity of infectious

There are generally two types of infectious arthritis: acute and chronic.

Acute – Caused by bacteria that begins quickly. It accounts for 95 percent of infectious arthritis. It can affect healthy people as well as people at high risk for getting an infection. Cartilage found within joints and required for normal function can become damaged within hours or days. Sometimes, infections of this caliber can occur away from the joints, in areas such as the genital organs or digestive organs, and are reactions to another infection and is called reactive arthritis.

Chronic Begins gradually over several weeks and accounts for five percent of infectious arthritis and most often affects people who are at high risk. Most commonly infected joints include the knee, shoulder, wrist, hip, elbow, and the joints in the fingers. Most bacterial, fungal and mycobacterial infections affect only one joint or, occasionally, several joints.

Joint of Septic Arthritis

Joints are the areas where two bones meet. Most joints are mobile, allowing the bones to move. Joints consist of the following:

  • Cartilage – A type of tissue that covers the surface of a bone at a joint. Cartilage helps reduce the friction of movement within a joint.
  • Synovial membrane – A tissue called the synovial membrane lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
  • Ligaments –Strong ligaments (tough, elastic bands of connective tissue) that surround the joint to give support and limit the joint’s movement.
  • Tendons – Tendons (another type of tough connective tissue) on each side of a joint that attach to muscles that control the movement of the joint.
  • Bursas – Fluid-filled sacs between bones, ligaments, or other adjacent structures that help cushion the friction in a joint.
  • Synovial fluid – A clear, sticky fluid secreted by the synovial membrane.
  • Femur –  The thigh bone.
  • Tibia – The shin bone.
  • Patella – The knee-cap.
  • Meniscus – A curved part of cartilage in the knees and other joints.

Causes of Septic Arthritis

Septic arthritis is most commonly caused by bacteria that travel through the blood stream to an area in the body. They are either staphylococcal or streptococcal.

  • Joint surgery, including knee or hip replacement
  • Bacterial infection elsewhere in the body
  • Having a long-term condition such as diabetes or rheumatoid arthritis
  • Using injected drugs
  • Taking immune system suppressing medication
  • Trauma and injury to the joint
  • Medicines that affect your immune system, including steroid medicines
  • An immune deficiency disorder, such as AIDS
  • IV drug use, or alcoholism
  • Joint disease, injury, or surgery
  • An artificial joint in your knee or hip
  • A medical condition such as diabetes, sickle cell disease, or cancer
  • An open wound that may allow bacteria to enter the bloodstream
  • A bacterial infection, such as strep throat
  • Liver failure, or dialysis for kidney failure

Causes: Septic Arthritis Causes based on age

Infant (age <3 months, contiguous spread from Osteomyelitis)

  • Staphylococcus aureus (common)
  • Neisseria gonorrhoeae (common)
  • Enterobacteriaceae
  • Group B Streptococcus

Children (age 3 months to 14 years)

  • No cause identified in one third of cases
  • Staphylococcus aureus (27%)
  • Streptococcus (14%) > Streptococcus Pyogenes & Streptococcus Pneumoniae
  • HaemophilusInfluenzae (<3% of cases, much less common in U.S. since start of Hib Vaccine)
  • Gram Negative Bacilli

Adults with STD risk

Neisseria gonorrhoeae (most common)

  • Gonococcal Arthritis
  • Gonorrrhea is a still a leading cause in young adults with Septic Arthritis
  • More common in women by a factor 3-4
  • Typically Migratory Arthritis
  • Staphylococcus aureus
  • Streptococcus
  • Gram Negative Bacilli
  • Syphilis

Adults with no STD risk

  • Staphylococcus aureus (50%)
  • Streptococcus species
  • Gram-Negative Bacilli

Causes: Iatrogenic or Trauma-related Septic Arthritis

Joint aspiration or injection

  • Staphylococcus aureus

Joint Trauma

  • Gram-Negative Bacilli
  • Anaerobic Bacteria
  • Staphylococcus aureus

Joint prosthesis

  • Early infection  >Staphylococcus epidermidis
  • Late Infection > Gram-Positive Cocci & Anaerobic Bacteria

Umbilical catheter (UAC or UVC) use in the newborn

  • Risk of septic hip

 Causes: Septic Arthritis related to Comorbid Medical Conditions

Intravenous Drug Abuse

  • Atypical Gram-Negative Bacilli (e.g. Pseudomonas)

Rheumatoid Arthritis

  • Staphylococcus aureus
  • Streptococcus
  • Gram-Negative Bacilli

Systemic Lupus Erythematosus or Sickle Cell Anemia

  • Salmonella


  • Staphylococcus aureus
  • Streptococcus
  • Gram-Negative Bacilli


  • Staphylococcus aureus
  • Mycobacterium species
  • Fungus
  • Gram-negative Bacteria

Causes: Chronic Monoarticular Arthritis

  • Brucella
  • Nocardia
  • Mycobacterium
  • Fungus

Causes: Acute Polyarticular Septic Arthritis

  • Neisseria gonorrhoeae (most common)
  • Lyme Disease
  • Acute Rheumatic Fever
  • Viral Hepatitis
  • Parvovirus B19
  • Syphilis

Causes: Septic Arthritis related to Occupation or Travel

  • Gardening or agricultural
    • Sporothrix schenckii
    • Brucella
  • Marine-related
    • Mycobacterium marinum
  • Immigrant
    • Mycobacterium tuberculosis

Other infections, such as those caused by viruses and fungi, can also cause arthritis. Viruses include

  • Hepatitis A, B, and C
  • Parvovirus B19
  • Herpes viruses
  • HIV (AIDS virus)
  • HTLV-1
  • Adenovirus
  • Coxsackie viruses
  • Mumps

Fungi that can cause arthritis include Histoplasma, coccidiomycosis, and Blastomyces. These infections are usually slower to develop than bacterial infections.

Symptoms of Septic Arthritis

The symptoms may include:

  • severe pain that worsens with movement
  • swelling of the joint
  • warmth and redness around the joint
  • a fever
  • chills
  • fatigue
  • weakness
  • decreased appetite
  • a rapid heart rate
  • irritability

Rapid onset monoarticular joint inflammation

  • Joint Pain with motion (Test Sensitivity 100%, but poor Specificity)
  • Joint Swelling
  • Joint warmth (unreliable)
  • Joint erythema
  • Significantly decreased joint range of motion
  • Significantly decreased weight bearing on infected joints
  • Limb paralysis from inflammatory neuritis
  • Joint with overlying Cellulitis (significantly increased risk of Septic Joint)

Joints affected by Bacterial Infection

  • Septic Arthritis is polyarticular in 10-20% of cases
  • Septic Knee (50% of cases)
  • Septic Hip (15% of cases, especially in young children)
  • Septic Ankle (9% of cases)
  • Septic elbow (8% of cases)
  • Septic wrist (6% of cases)
  • Septic Shoulder (5% of cases)

Joints affected by Intravenous Drug Abuse

  • Sacroiliac joint
  • Sternoclavicular joint
  • Symphysis pubis
  • Vertebral disc spaces

Diagnosis of Septic Arthritis

  • Removal of joint fluid – This is done to examine for white blood cells and bacteria.
  • Blood tests – These tests are done to detect bacteria.
  • Phlegm, spinal fluid, and urine tests – These tests are done to detect bacteria and find the source of infection.
  • X-ray – A diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film
  • Bone scan – A nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints to detect bone diseases and tumors to determine the cause of bone pain or inflammation.
  • Magnetic resonance imaging (MRI) – A diagnostic procedure that uses a combination of large magnets, radio frequencies, and a computer to produce detailed images of organs and structures within the body.
  • Radionuclide scans – Nuclear scans of various organs to determine blood flow to the organs.

Labs: General


  • None of these labs (CBC, ESR nor CRP) absolutely excludes Septic Arthritis at any level
    1. These labs may all be normal or even low despite Septic Arthritis
    2. Lab markers are useful as a baseline to follow response to therapy
  • Arthrocentesis is the only accurate method to exclude Septic Arthritis

Erythrocyte Sedimentation Rate (ESR)

  1. ESR typically > 25 mm/hour in pediatric Septic Arthritis

C-Reactive Protein (C-RP)

  • C-RP typically >20 mg/L in pediatric Septic Arthritis
  • Closely mirrors infectious, inflammatory process
  • Test Sensitivity: 95% in children

Complete Blood Count

  • WBC Count typically >12,000 in pediatric Septic Arthritis

Other tests in severe cases or as directed by history

  • Blood Culture
    • Bacteremia is present in up to one-third of cases of Septic Arthritis
  • Complete Metabolic Panel
    • Typically obtained in severe Septic Arthritis, to establish end-organ injury, Renal Dosing of antibiotics
    • May also evaluate Pseudogout
  • Uric Acid
    • Evaluate differential diagnosis
  • STD Testing
    • Gonorrhea (PCR from Urethra or Cervix, or Throat Culture)
    • Syphilis

 Labs: Synovial Fluid Exam via arthrocentesis

Arthrocentesis with synovial fluid analysis

  • Synovial fluid culture only (not 100% sensitive)
  • CBC


  • Sn 94% (with 15mm/h cut-off)


  • Sn 92% (with 20mg/L cut-off)
  • Blood Culture
  • Gonorrhea culture (urethral/cervical/pharyngeal/rectal)


  • Helpful for excluding other diagnoses (e.g. trauma, osteo)


  • Consider mycobacterial or fungal arthritis
  • Leukemia history: predisposed to Aeromonas infections

Arthrocentesis of synovial fluid

Synovium Normal Noninflammatory Inflammatory Septic
Clarity Transparent Transparent Cloudy Cloudy
Color Clear Yellow Yellow Yellow
WBC <200 <200-2000 200-50,000 >1,100 (prosthetic joint)

>25,000; LR=2.9

>50,000; LR=7.7

>100,000; LR=28

PMN <25% <25% >50% >64% (prosthetic joint)


Culture Neg Neg Neg >50% positive
Lactate <5.6 mmol/L <5.6 mmol/L <5.6 mmol/L >5.6 mmol/L
LDH <250 <250 <250 >250
Crystals None None Multiple or none None

Synovial Fluid Testing

Synovial Fluid White Blood Cell Count

  • Non-inflammatory Arthritis: 200-2000 White Blood Cells
  • Inflammatory Arthritis: 2000 to 50,000 White Blood Cells
  • Infectious Arthritis: >50,000 White Blood Cells
  • However Exercise caution, as Septic Arthritis may occur at lower WBC Counts

Synovial FluidGram Stain

  • Falsely negative in 20-40% of Septic Arthritis patients

Synovial Fluid culture

  • Imperative to obtain (Gram Stain alone is insufficient)

Best inoculated into the  Blood Culture medium (less contamination, better yield than solid plating)

Synovial Fluid Crystal Exam

  • Evaluates for the alternative, inflammatory Arthritis (e.g. gout, Pseudogout)
  • Avoid Joint FluidGlucose and protein (not useful)

Bacterial Arthritis

  • Opaque to turbid Synovial Fluid
  • Synovial Fluid WBC
    • Non-prosthetic joint: >50,000 White Blood Cells (or >90% PMNs)
      1. Likelihood Ratio: 4.7 for Septic Arthritis
    • Prosthetic joint: >1700 White Blood Cells per mm3 (or >65% PMNs)
  • Gram Stain
    • Test Sensitivity: 29-60%
  • Bacterial Culture
    • Test Sensitivity: 30-50% (75% if polyarticular)
    • Guides antibiotic therapy when positive
  • Synovial lactate
    • Synovial lactate >10 mmol/L has a very high Likelihood Ratio for Septic Arthritis (rules in Septic Arthritis)
  • Gonococcal Arthritis

Clear to opaque Synovial Fluid

    • Synovial Fluid WBC: 30,000 to 100,000 (>80% PMNs)
    • Gram Stain Positive in <25% of cases
    • Culture positive in <50% of cases
  • Tuberculous Arthritis
    • Opaque Synovial Fluid
    • Synovial Fluid WBC: 10,000 to 20,000 (>50% PMNs)
    • Gram Stain Positive in <20% of cases
    • Culture positive in 80% of cases


Joint Xray

  1. Early changes
    • Distention of joint capsule
    • Joint Dislocation
  2. Late changes
    • Joint space destruction
    • Epiphyseal cartilage resorption
    • Metaphysis erosion

Joint Ultrasound

  • Bedside Ultrasound using high frequency linear probe (9-15 MHz)
  • Indentifies effusion
    • Have patient move joint to distinguish effusion (re-distributes) from synovial thickening (static)
  • Guides aspiration
    • Especially helpful in Hip Joint evaluation and needle aspiration
    • See Hip Ultrasound (Anterior Hip in Long Axis or LAX)
  1. Advanced imaging
    • CT or MRI joint for unclear diagnosis
    • CT-guided aspiration may also be considered if Ultrasound-guided aspiration results in dry tap

 Imaging: Possibly Infected Prosthetic Joint

  • Nuclear scan
    1. Negative Nuclear scan excludes septic prosthetic joint
  • Pet Scan
  • Avoid CT Scan or MRI in infected prosthetic joint
    1. Does not distinguish infected prosthetic joint from other causes of pain

Principles of diagnosis and management of acute nongonococcal septic arthritis

Indicators at presentation
  • Recent onset of fever and malaise
  • Local pain, warmth, swelling, and decreased range of motion in the involved joint
  • The presence of any risk factors as determined by a detailed history
Diagnosis by synovial fluid testing
  • Synovial culture and Gram stain
  • Leukocyte counts in excess of 50,000/mm3
  • Glucose level of <40 mg/dl or less than half that seen in the serum
  • High concentration of lactate
  • >90% polymorphonuclear leukocytes
Lack of bifringent crystals (Note: simultaneous crystalline and bacterial arthritis has been reported)
Other laboratory indicators
  • May have an elevated erythrocyte sedimentation rate, C-reactive protein levels, and/or peripheral leukocyte levels
  • Sputum, urine, and blood cultures may be warranted; blood cultures are positive in 50% of cases
  • Antibiotics adjusted based on culture and sensitivity results
  • Adequate drainage of joint
  • Needle aspiration
  • Arthroscopic drainage
  • Open drainage in difficult and deep joints
  • Monitoring of synovial fluid leukocyte counts and cultures
  • Acute phase of disease — patient rest and optimal joint position
  • Following the acute phase — early physical therapy and aggressive mobilization

 Treatment of Septic Arthritis

  • Rest your painful joint as directed. You may need to keep the joint still when it is painful to prevent more damage.
  • Elevate the joint to reduce swelling and pain. Keep the joint above the level of your heart as often as possible.
  • Apply ice to the joint to reduce swelling and pain. Ice may also help prevent tissue damage. Use a cold compress, or put crushed ice in a bag. Cover it with a towel and apply it to your joint for 15 to 20 minutes every hour, or as directed.
  • Exercise as directed. Exercise may help keep your joints flexible and reduce pain. Ask your healthcare provider how much exercise to get each day and which exercises are best for you.

Treatment by Drug

  • Aspiration is a procedure used to drain fluid from your joint. Your healthcare provider may use a needle to drain the fluid.
  • Antibiotics prevent or fight an infection caused by bacteria.

The initial choice of antibiotics for therapy of infectious arthritis (adult doses)

Organism Antibiotics of the first choice Alternative antibiotics
Methicillin resistant
    Staphylococcus aureus Vancomycin 1 g every 12 h or SXTa or minocycline ± rifampin
linezolid 600 mg every 12 h
  • Coagulase-negative  Staphylococcus spp.
Vancomycin 1 g every 12 h or SXT or minocycline ± rifampin, clindamycinb
linezolid 600 mg every 12 h
    Staphylococcus aureus Nafcillin 2 g every 6 h or Cefazolin, vancomycin
clindamycin 900 mg every 8 h
  • Coagulase-negative Staphylococcus spp.
Nafcillin 2 g every 6 h or Cefazolin, vancomycin
clindamycin 900 mg every 8 h
Group A streptococcus, S. pyogenes Penicillin G 2 million every 4 h or Clindamycin, cefazolin
ampicillin 2 g every 6 h
Group B streptococcus,

S. agalactiae

Penicillin G 2 million every 4 h or Clindamycin, cefazolin
ampicillin 2 g every 6 h
    Enterococcus spp. Ampicillin 2 g every 6 hc or Ampicillin-sulbactam, linezolid
vancomycin 1 g every 12 h
    Escherichia coli Ampicillin-sulbactam 3 g every 6 h Cefazolin, levofloxacin, gentamicin, SXT
    Proteus mirabilis Ampicillin 2 g every 6 h or Cefazolin, SXT, gentamicin
Levofloxacin 500 mg daily
    Proteus vulgaris, Proteus rettgeri, Morganella morganii Cefotaxime 2 g every 6 h, imipenem 500 mg every 6 h, or levofloxacin 500 mg daily Mezlocillin, gentamicin, or ticarcillin-clavulanate
    Serratia marcescens Cefotaxime 2 g every 6 h Levofloxacin, gentamicin, imipenem
    Pseudomonas aeruginosa Cefepimed 2 gm every 12 h or Ticarcillin-clavulanate, tobramycin, amikacin, ciprofloxacine
Piperacillind 3 gm every 6 h or
Imipenem 500 every 6 h
    Neisseria gonorrhea Ceftriaxone 2 g daily or Levofloxacin, ampicillin
Cefotaxime 1 g every 8 h
    Bacteroides fragilis group Clindamycin 900 mg every 8 h or Ampicillin-sulbactam, ticarcillin-clavulanic acid
metronidazole 500 mg every 8 h
aSXT, sulfamethoxazole-trimethoprim.
bIf sensitive to clindamycin.
cIn a serious Enterococcus infection, ampicillin plus an aminoglycoside is used.
dIn a serious infection, those drugs should be used with an aminoglycoside.
increasing resistance of the quinolones including ciprofloxacin.
Suggested empirical antibiotic treatment of suspected septic arthritis

Antibiotic choiceNo

Patient group
  • risk factors choicepical organisms
Flucloxacillin 2 g qds IV. Local policy may be to add fusidic acid 500 mg tds po, or gentamicin IV.
If penicillin is allergic, clindamycin 450–600 mg qds, or 2nd or 3rd generation cephalosporin may be given
  • High risk ofGram negative sepsis (elderly, frail, recurrent UTI, recent abdominal surgery)
2nd or 3rd generation cephalosporin (eg, cefuroxime 1.5 g tds). Local policy may be to add flucloxacillin. Discuss allergic patients with microbiology–Gram stain may influence the choice of antibiotic
  • MRSA risk (known MRSA, recent inpatient, nursing home resident, leg ulcers or catheters, or other risk factors determined locally)
Vancomycin plus 2nd or 3rd generation cephalosporin
  • Suspected gonococcus or meningococcus
Ceftriaxone, or similar drugs depending on local policy/resistance
  • IV drug users
Discuss with microbiologist
  • ITU patients, known colonization of other organs (eg, cystic fibrosis)
Discuss with microbiologist

ITU, intensive therapy unit; IV, intravenous; MRSA, methicillin‐resistant Staphylococcus aureus; qds, four times in a day; UTI, urinary tract infection; tds, thrice a day.

The antibiotic choice will need to be modified in the light of results of Gram stain and culture. It should also be reviewed locally by microbiology departments.

  • Prescription pain medicine may be given. Ask your healthcare provider how to take this medicine safely.
  • NSAIDs –  such as ibuprofen, help decrease swelling, pain, and fever. This medicine is available with or without a doctor’s order. NSAIDs can cause stomach bleeding or kidney problems in certain people. If you take blood thinner medicine, always ask your healthcare provider if NSAIDs are safe for you. Always read the medicine label and follow directions.
  • Arthroscopy is a procedure used to remove infected lining from a joint.
  • Septic Arthritis management requires two components
    • Thorough Joint Fluid drainage of purulent fluid
    • Antimicrobial management to cover the causative organisms

Antibiotics are started after obtaining joint culture and Blood Culture

  • Septic Arthritis Causes for antibiotic considerations
  • Gram Stain of fluid may assist antibiotic selection
  • Empirically antibiotics based on age and risk factors (see below) until culture results available
  • Antibiotics do not need to be injected into joints
  • Joint cultures are recommended before antibiotics in most cases even if 24-48 hour antibiotic start delay
  • Antibiotics may be considered prior to arthrocentesis ONLY if
    • Strong suspicion of Septic Arthritis AND
    • Consultant agrees that antibiotics should be started before the culture has been obtained AND
    • Procedure is delayed >24-48 hours
    • Difficult arthrocentesis requiring intervention radiology or rheumatology
  • Adjunctive Corticosteroids
    • Discuss with consultant (orthopod)
    • Associated with decreased duration and Disability in studies of pediatric Septic Arthritis

Surgical Treatment of

Urgent orthopedic Consultation is indicated in all cases of suspected Septic Arthritis

  • Serial Joint aspiration
    • Repeat for reaccumulation of fluid as needed up to once to twice daily
    • Consider saline lavage
  • Arthroscopy
    • Preferred in Shoulder and Knee Joints (better visualization and irrigation, less post-op morbidity)
  • Open Surgical drainage indications
    • Difficult joint aspiration access (e.g. hip)
    • Persistent fever and symptoms >24 hours
    • Leukocytosis persists beyond 48 to 72 hours
    • Repeat blood or joint cultures positive >48 hours
  •  Infected joint prosthesis
    • Prosthesis may be salvaged if infection <1-2 weeks
    • Many infected prostheses may still need to be removed
    • Surgically debride the infection
    • Treat with parenteral combination antibiotic therapy for 4 weeks (equivalent outcome to 6 week course)
    • Use Rifampin as part of antibiotic regimen

Management: Antibiotics for Infants (age <3 months)

  • Empiric antibiotics (2 drug regimen)
    • Drug 1: Vancomycin 40 mg/kg divided q6-8 hours IV
    • Drug 2: Cefotaxime 50 mg/kg IV q8 hours
  • Modify antibiotic selection based on Blood Culture (positive in a majority of cases)
  • Assume Osteomyelitis of adjacent bone (occurs in two thirds of cases)

Management: Antibiotics for Children (3 months to 14 years)

  • Primary regimen , Two drug regimen (most cases)
    • Drug 1: Vancomycin 40 mg/kg divided q6-8 hours IV
    • Drug 2: Cefotaxime 50 mg/kg IV q8 hours
    1. One drug regimen (if Gram Stain only with Gram Negative organisms) >Cefotaxime 50 mg/kg IV q8 hours
  • Alternative regimen (2 drug regimen)
    • Drug 1: Aztreonam 30 mg/kg IV q6 hours
    • Drug 2: Choose one
      • Clindamycin 7.5 mg/kg IV q6 hours or
      • Linezolid 10 mg/kg IV q8 hours
  • Modify antibiotic selection based on Blood Culture
  • Duration of therapy is typically 30 days
    • Ten days may be adequate in quickly resolving symptom, signs and C-RP

Management: Antibiotics for Adolescents and Adults (age over 14 years)

Acute monoarticular with STD risk

Gram Stain clear or with Gram Negative diplococci

  • Ceftriaxone 1 gram IV q24 hours or
  • Cefotaxime 1 gram IV q8 hours or
  • Ceftizoxime 1 gram IV q8 hours
  • Gram Stain with Gram Positive Cocci
    • Vancomycin 15-20 mg/kg IV q8-12 hours
  • Gram Stain with Gram Negative Bacilli
    • Cefepime 2 grams q8 hours IV or
    • Meropenem 1 gram q8 hours IV

Acute monoarticular without STD risk

Gram Stain Negative (2 drug regimen)

  • Drug 1: Vancomycin 15-20 mg/kg IV q8-12 hours
  • Drug 2: Choose one
    • Ceftriaxone 1 gram IV q24 hours or
    • Cefepime 2 grams IV q8 hours
    • Alternative: Ciprofloxacin 400 mg q12 hours or Levofloxacin 750 mg IV q24 hours
  • Gram Stain with Gram Positive Cocci
    • Vancomycin 15-20 mg/kg IV q8-12 hours
  • Gram Stain with Gram Negative Bacilli
    • Cefepime 2 grams q8 hours IV or
    • Meropenem 1 gram q8 hours iv
  • Pseudomonas suspected
    • Cefepime OR
    • Piperacillin-Tazobactam
  • Polyarticular Arthritis
    • Ceftriaxone 1 gram IV q24 hours

 Management: Iatrogenic Infection (Joint Injection or prosthesis)

Empiric therapy before culture results

  • Option 1 (2 drug regimen)
    • Drug 1: Vancomycin
    • Drug 2: Ciprofloxacin, Aztreonam, or Gentamycin

Option 2 (2 drug regimen)

  • Drug 1
    • Ciprofloxacin 750 PO bid or
    • Ofloxacin 200 mg PO tid
  • Drug 2: Rifampin 900 mg PO qd

Ciprofloxacin and Rifampin sensitive by culture

  • Option 1 (2 drug regimen)
    • Drug 1: Ciprofloxacin or Ofloxacin
    • Drug 2: Rifampin 900 mg PO qd
  1. Option 2 (2 drug regimen)
    • Drug 1: Oxacillin 2 grams IV every 4 hours
    • Drug 2: Rifampin 900 mg PO qd
  • Ciprofloxacin or Rifampin resistance by culture
    • Vancomycin and
    • Rifampin (if sensitive)

Management: Antibiotic Course

Nongonococcal Bacterial Infection

  • Parenteral antibiotics for 2 to 4 weeks
  • Oral antibiotics for 2 to 4 week

Home Remedies of  Bacterial Arthritis

Listed below are some effective arthritis home remedies which are found to be useful in arthritis cure and arthritis pain relief. Natural treatment for arthritis is also without side effects.

  • As part of the dietary regimen, it is imperative that patients of arthritis choose a diet that will contribute to the alkaline content of blood. Diet rich in raw vegetables, sprouts, and juicy fruits should be opted for in place of one rich in animal protein, carbohydrate and fat.
  • Sometimes in course of therapy, patients are recommended diet solely consisting of raw vegetables and fruits.
  • Seawater has been found effective in relieving painfulness and stiffness of the affected joints. The iodine content of sea water not only helps to balance the pH of the body but also positively influences the thyroid functioning. Thus bathing in seawater can be recommended for patients struck by arthritis.
  • As an alternative, the patient may be advised to take a dip into warm water enriched with common salt.
  • Special care should be taken to expose oneself to sunlight and ambiance marked by proper ventilation.
  • Drinking water stored in copper content proves to be beneficial from the point of view of arthritis patients as traces of copper accumulation making its way to the system contributes to strengthening the skeletal and muscular system.
  • Calcium supplements, as well as calcium, is taken as ‘calcium lactate’ serves to strengthen bones and muscles.
  • Garlic with its multi-sided medicinal qualities is also useful for arthritis. Consumption of two to three cloves of garlic work wonders against inflammation leading to aching joints.
  • Besides garlic, ginger is also effective from the point of view of rheumatic arthritis. Consumption of at least thirty to fifty grams of ginger serves to reduce the painful conditions.
  • Juice extracted from potato is similarly beneficial if consumed before breakfast. One may also soak sliced potato along with its peel in a bowl filled with water for drinking the water used for soaking potato slices.
  • Water soaking sesame seeds can be had early in the morning along with the seed being soaked. The remedy will make your joint pains infrequent.
  • Pineapple juice is also an effective natural option on account of its ‘bromelain’ content which serves to reduce swelling and pain.
  • Though animal protein is not recommended the Omega3 fatty acids of certain oily fish proves to be beneficial from the viewpoint of arthritis. Supplements of the same or food rich in Omega 3 fatty acid can be taken.
  • One tablespoon measure of cod liver oil may be added to a glass filled with orange juice. The said mixture will assure you of the requisite nutrients in forms of Vitamin C and Omega 3 fatty acid.
  • Juice extracted from raw vegetables such as celery, spinach, and carrot blended in equal measure is also one of the healthy options which serve to clear the blood of the accumulated deposits.
  • Coconut water and milk of the same are equally beneficial as natural remedial measures
  • While the consumption of tea and coffee should be reduced, as an alternative option you may go for herbal tea. Herbal tea based on alfalfa has been found to be beneficial from the point of view of arthritis.
  • Regular consumption of banana is also beneficial because Vitamin B content of the fruit acts against the stiffness of joints.
  • Soup made out of green gram is another of your naturally nourishing options which work wonders if consumed regularly with crushed cloves of garlic.
  • For soothing and instantaneous relief from joint pains; application of tolerably warm coconut or mustard oil enriched with crushed camphor proves to be relieving.
  • Circulation around the affected tissues can be enhanced with the help of massaging of herbal oils such as lemon, rosemary, lavender, and chamomile. Thus gentle massaging of the mentioned oils will prove to be relieving.
  • Gentle massaging of castor oil is also similarly beneficial.
  • Applying mildly hot compresses of apple vinegar before pushing off to bed can also serve to keep your joints warm and soothing.

Homeopathic Remedies of Septic Arthritis


  • Sudden onset after exposure to cold dry air. Pains, with formication and numbness.
    Rheumatic inflammation of joints; pains intolerable. Intense bright-red swelling of parts. Sensitive to contact. High fever. Worse at night. With the rheumatism anxiety, fear, restlessness is well marked in aconite. Arthritic and rheumatic drawing and tearing pains, especially in the limbs. Acute and violent pulling in the joints and the bones, mitigated by the heat of a bed. The greater the suffering the greater the anguish, restlessness and fear of death. Mentally restless, but physically too weak to move. Indicated by its periodicity and time aggravation: after mid-night, and from 1-2 a.m. And by its intense restlessness, mental and physical: its anxiety and prostration.


  • Joints swollen, red, hot, shining. Exquisitely sensitive to touch or jar. Red streaks radiate from inflamed joint. Recurrent fever with pains attacking nape of neck.
    Pains in the joints and bones. Rheumatic pains (in the joints) flying from one place to another. The pains are aggravated, chiefly at night, and in the afternoon towards three or four o’clock. The least touch, and sometimes also the slightest movement, aggravates the sufferings. Some of the symptoms are aggravated, or make their appearance after sleep. Jerking in the limbs, muscular palpitations and shocks of the tendons. St.Vitus dance. Sensation in the muscles, as if a mouse were running over


  • Over-sensitiveness of the senses to external impressions. Rheumatic and gouty pains in the limbs, with tension, worse from motion and contact. Tension, drawing pains, acute pullings and shootings, especially in the limbs, and chiefly during movement, with insupportable pains on being touched, sweat of the part affected, and trembling of that part when the pains diminish. Stiffness and shootings in the joints, on being touched and when moved. In the evening, pain, as from fatigue, in the limbs, with paralytic weakness.


  • Arthritic and rheumatic drawing and tearing pains, especially in the limbs. Acute and violent pulling in the joints and the bones, mitigated by the heat of a bed. Contraction of the tendons, and stiffness in the flexor muscles of the limbs. Cramp-like Contraction of several limbs.

Risk factors of Septic Arthritis

Risk factors for septic arthritis include

  • Existing joint problems. Chronic diseases and conditions that affect your joints — such as osteoarthritis, gout, rheumatoid arthritis or lupus — can increase your risk of septic arthritis, as can an artificial joint, previous joint surgery and joint injury.
  • Taking medications for rheumatoid arthritis. People with rheumatoid arthritis have a further increase in risk because of medications they take that can suppress the immune system, making infections more likely to occur. Diagnosing septic arthritis in people with rheumatoid arthritis is difficult because many of the signs and symptoms are similar.
  • Skin fragility. Skin that breaks easily and heals poorly can give bacteria access to your body. Skin conditions such as psoriasis and eczema increase your risk of septic arthritis, as do infected skin wounds. People who regularly inject drugs also have a higher risk of infection at the site of injection.
  • Weak immune system. People with a weak immune system are at greater risk of septic arthritis. This includes people with diabetes, kidney and liver problems, and those taking drugs that suppress their immune systems.
  • Joint trauma. Animal bites, puncture woods or cuts over a joint can put you at risk of septic arthritis


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