How should septic arthritis be diagnosed and treated?

• A. Oral antibiotics only.
• B. Immobilize and rest.
• C. Wait and see.
• D. Urgent joint aspiration for Gram stain and culture; empiric IV antibiotics; early joint drainage and targeted therapy based on culture results.

Answer: (D)

Septic arthritis is an emergency that requires immediate action to prevent joint damage and sepsis. The best approach is to obtain synovial fluid by urgent joint aspiration and perform Gram stain and culture to identify the offending organism. While awaiting results, start empiric IV antibiotics that cover the most common pathogens (notably Staphylococcus aureus, including MRSA in many settings, and other typical gram-positives and gram-negatives depending on the patient’s risk factors). In addition, remove infected material from the joint through early drainage or surgical debridement to achieve source control. Once culture results come back, tailor the antibiotic therapy to the specific organism and its susceptibilities, and adjust duration and route as appropriate.

Oral antibiotics alone would not rapidly eradicate infection within the joint and delay in aggressive therapy increases the risk of cartilage destruction and systemic spread. Immobilization or rest without addressing the infection does not treat the underlying process and can contribute to poor outcomes. Waiting and “watchful waiting” allows the infection to worsen.