Health Worlds

Septic arthritis should be treated?The treatment of acute septic arthritis must follow the following principles: early, effective and adequate quantity of antibiotic treatment to control, destroy bacteria, eliminate the of infection, involved immobilization, the full and effective drainage of pus and reduce intra-articular pressure to reduce the harmful factors and sequelae of cartilage damage, systemic support treatment, enhance the body resistance, timely functional exercises.(1) early use of antibiotics in time: before the infection for organisms that antibiotics should be used, according to Gram stain smear of synovial fluid and clinical characteristics of pathogenic bacteria to preliminary estimates, if identified as Gram-positive bacteria, beginning with anti-penicillin enzyme penicillin, methicillin resistant if (b methicillin) advantage of Staphylococcus aureus, with vancomycin to determine the Gram-negative bacteria, the beginning of aminoglycoside antibiotics and the use of anti-Pseudomonas penicillin or third generation cephalosporin treatment, Once the bacteria, antibiotic susceptibility tests come to reconsider the dosage of antibiotics and early use of antibiotics not only can quickly control the infection, but also to reverse the disease and reduce complications.
(2) route of administration: intravenous acute need, the dose should be sufficient treatment for 10 days to 2 weeks, administered several times a day at intervals of 6 to 8 hours, anti


biotics can easily penetrate from the blood circulation synovial fluid, the study shows that without the antibiotic directly into the joint cavity, synovial fluid can also result in effective bactericidal concentration, thus reducing the injection of new risk factors of infection, but also reduce the resulting high local drug concentration the possibility of chemical synovitis, antibiotics do not affect serum protein binding of drug infiltration of joints, articular administration does not affect the efficacy of an antibiotic when the permeability is poor, can use other more easily into the joint cavity antibiotics only when necessary to consider the local intra-articular medication, use 1 or 2 times a day, the role of aminoglycoside antibiotics at pH6.5 when the lower, so in order to make local administration more effective, must be removed to reduce the pH value of the pus exudates.
(3) treatment plan: the microbial infection is confirmed, must be based on the results of susceptibility testing to develop a precise treatment plan, can continue to use the initial antibiotics, can also be more appropriate antibiotics, in the synovial fluid and serum in the determination of drugs antibacterial effect, should be emphasized that the drug must meet the bactericidal effect rather than inhibition, intravenous administration to maintain the clinical signs and arthritis conversion to normal until the course of treatment should be repeated bacterial culture of synovial fluid, if want to extend the application of antibiotics, antibiotics can be placed subcutaneous reservoirs, into the large central vein, such as the subclavian vein for continuous administration, infection control, may oral antibiotics, oral antibiotics in synovial fluid concentrations after the peak value of serum peak concentration of 60% to 80%, if only oral administration, have to use a series of synovial fluid antibiotic concentrations were measured to monitor the early oral effects are not reliable, due to sepsis patients often nausea, vomiting and gastrointestinal disorders, antibiotic treatment should be continued until 2 weeks after symptoms disappear.
(4), serum sickness caused by antibiotics is not a common complication of drug therapy, almost all of the antibiotics as a semi-antigen reaction can occur, the treatment process, the joints, fever, flushing and skin rashes and other symptoms develop, it must repeated identification of infection or multiple arthritis serum sickness, must carefully check the intra-articular bacteria, for smear and bacterial culture and for cell count and glucose levels were determined, when necessary, for different classes of antibiotics.
(5) synovitis after infection: septic arthritis of the tissue damage produced by bacterial virulence factors directly caused, but also by the host response to bacterial antigens indirectly caused by the bactericidal effect of antibiotics did not clear the bacteria in the product, these substances can persist in the joints, so that inflammation persists, Yu.D and Kuipers reported by the YU Zhi He spp, Salmonella spp, Yersinia spp and Campylobacter are caused by septic arthritis and spondyloarthropathies (such as ankylosing spondylitis, Wright syndrome) have the same clinical model, it must pay attention to the treatment of synovitis after infection, treatment Shike Jia with non-steroidal anti-inflammatory drugs, but must be treated with antibiotics plus a few days before , early does not promote the use of non-specific anti-inflammatory drugs, because they have a cooling effect, this must be strictly controlled intra-articular corticosteroid injection of the drug indication, culture was negative, intra-articular inflammation for a few weeks, and not joint cut or do arthroscopy in patients with intra-articular injection may be considered, the application of antibiotics must be continued until symptoms of synovitis stops.
2. Immobilization after braking involved joints, reduce pain, inflammation, easy to limitations of septic arthritis of the hip, the general method of braking traction can also be fixed with the hip spica cast, septic arthritis of the knee, elbow go far in the distal limb septic arthritis, can be fixed plaster or brace fixed brace has the advantage of a fixed partial treatment does not affect, nor plaster as easily broken due to wet, to be repeatedly replaced joints should be made Activity in the functional position, in case of ankylosis, the joint stiffness in the functional position will be.
3. Articular drainage septic arthritis in one of the principles is the rapid, complete and fully draining purulent exudate, can reduce the pressure on and destruction of articular cavity to reduce the sepsis response, pus in the harmful media, on the joint rapid destruction of cartilage, the purpose of drainage is to remove these harmful substances, reduce joint damage, drainage can reduce the intra-articular pressure, relieve pain and other symptoms, but also reduced overall sepsis, drainage is sometimes life-saving emergency measures, joint drainage of the main drainage, simple incision and drainage and continuous irrigation suction drainage
(1) puncture and drainage: local anesthesia, in the joint from the skin the most shallow, with a thick needle (such as 9-gauge needle) piercing the joints, joint fluid aspirate, and a hand gently squeeze around the joints so that joint fluid concentration to the needle site as much as possible to exhaust all the synovial fluid, and then the needle, into the amount of normal saline or Ringer's solution to wash the joints, taking into liquid, so repeatedly washed several times, until the liquid became brighter until the suction and intra-articular injection of gentamicin may be directed to 80000 units, in the absence of surgical treatment of conditions, pus can be repeated puncture method, less destruction if the arthritis does not need for debridement, biopsy method can also be used to intra-articular into two nylon tube, through the nylon tube, a continuous infusion with saline, a continuous suction of joint fluid and injection of saline. children septic arthritis of the hip, take immediate incision and drainage, as other arthritis epiphyseal articular capsule attached to the shares of the same level, forming a seal to prevent with purulent material and bone, however, the hip joint capsule attaches the base of the femoral neck, loss of protection mechanism, and that the blood supply to the femoral head loosely around the neck, increasing the opportunities for direct invasion of bacteria and an increase in intra-articular pressure.
delayed diagnosis of septic arthritis or some stubborn bacteria such as Staphylococcus aureus or gram-negative bacillus infections.
drainage problems on the joint anatomy and the difficulty of adequate drainage of the joint.
the spof the surrounding tissue from the joint from infection.
osteomyelitis combined need for surgery.
insufficient drainage of joint decompression, such as the formation of adhesions or small cavity prevented adequate drainage, the child refused repeated puncture and so on.
Usually 4 to 7 days after treatment no improvement is required based on drainage surgery, surgery should be complete removal of abscess and necrosis of the synovium, but not damaged metaphysis of the blood supply, maintaining unobstructed drainage, so that the articular cartilage from exposure to toxic material, so common after suction.
(3) continuous irrigation suction: septic arthritis diagnosis, once established, it should be continuous irrigation and suction joint surgery on some of the more superficial joints, such as the knee, early in the inflammation can Arthroscopic washing and suction drainage tube inserted, in most cases, should be cut joints, clear inflammatory lesions, such as excision of inflammatory synovium, granulation tissue curettage, curettage of bone abscess, removal of all the loss of living tissue, Then place the two nylon tubes, tube, note the two canal side hole location, do not place the washing liquid to attract


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