Therapy for septic arthritis
G. Ho Jr and E. Y. Su
The usefulness of the results of serial cultures of synovial fluid in
assessing the response to medical therapy of acute bacterial joint
infections was examined. A five-year retrospective survey disclosed 32
synovial fluid culture-proved cases of septic arthritis in adults. Thirteen
of the patients had well-documented evidence of (1) duration of articular
symptoms (presumably reflecting the presence of infection) and (2)
subsequent time required to sterilize the synovial fluids (as determined by
serial synovial fluid cultures). We found a positive correlation between
duration of symptoms and length of time during which serial cultures of
synovial fluids remained positive after initiation of treatment. In the
seven patients with good outcome, cultures remained positive for 2.4+/-1.9
days, as opposed to 8.2+/-2.4 days in the six patients with poor results.
The time required to sterilize the synovial fluid appears to be a reliable
indicator of response to therapy and an accurate predictor of outcome. Our
data show that the rapidity in achieving synovial fluid sterility is of
paramount importance in the successful treatment of infection, preservation
of articular integrity, and restoration of joint function.
