II. Causes: General

  1. Staphylococcus aureus
    1. Most common cause of Septic Arthritis in all ages

III. Causes: Septic Arthritis Causes based on age

  1. Infant (age <3 months, contiguous spread from Osteomyelitis)
    1. Staphylococcus aureus (common)
    2. Neisseria gonorrhoeae (common)
    3. Enterobacteriaceae
    4. Group B Streptococcus
  2. Children (age 3 months to 14 years)
    1. No cause identified in one third of cases
    2. Staphylococcus aureus (27%)
    3. Streptococcus (14%)
      1. Streptococcus Pyogenes
      2. Streptococcus Pneumoniae
    4. HaemophilusInfluenzae (<3% of cases, much less common in U.S. since start of Hib Vaccine)
    5. Gram Negative Bacilli
      1. Kingella kingae (preschool children
  3. Adults with STD risk
    1. Neisseria gonorrhoeae (most common)
      1. See Gonococcal Arthritis
      2. Gonorrrhea is a still a leading cause in young adults with Septic Arthritis
      3. More common in women by a factor 3-4
      4. Typically Migratory Arthritis
    2. Staphylococcus aureus
    3. Streptococcus
    4. Gram Negative Bacilli
    5. Syphilis
  4. Adults with no STD risk
    1. Staphylococcus aureus (50%)
    2. Streptococcus species
    3. Gram Negative Bacilli

IV. Causes: Iatrogenic or Trauma related Septic Arthritis

  1. Joint aspiration or injection
    1. Staphylococcus aureus
  2. Joint Trauma or wound
    1. Gram Negative Bacilli
    2. Anaerobic Bacteria
    3. Staphylococcus aureus
    4. Polymicrobial infections
  3. Joint prosthesis
    1. Early infection
      1. Staphylococcus epidermidis
    2. Late Infection
      1. Gram Positive Cocci
      2. Anaerobic Bacteria
  4. Umbilical catheter (UAC or UVC) use in the newborn
    1. Risk of septic hip

VI. Causes: Chronic Monoarticular Arthritis

VII. Causes: Acute Polyarticular Septic Arthritis

VIII. Causes: Septic Arthritis related to Occupation or Travel

IX. References

  1. Gilbert (2012) Sanford Guide to Antimicrobials
  2. Stimmler (1996) Postgrad Med 99(4):127-39 [PubMed]

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