What is the workup and treatment of Gram stain negative septic arthritis of native joints?

Updated: Oct 02, 2020
  • Author: John L Brusch, MD, FACP; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

Answer

Diagnosis of the septic joint is challenging in patients with underlying inflammatory disease and a negative Gram stain. [9] In these cases, measurement of serum procalcitonin (PCT) should be considered. [10] This test appears to be more useful in ruling in than in excluding the diagnosis of septic arthritis.. However, the specificity of PCT is quite low. There is growing interest in the diagnostic usefulness of C-reactive protein (CRP), whose value will likely be in documenting therapeutic response through serial measurements. [11]

Vancomycin 15 mg/kg IV q12h plus ceftriaxone 1 g IV q24h (or cefepime 1-2 g IV q8h if Pseudomonas is suspected)


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