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Septic Arthritis in Sickle Cell Anemia

key information

source: Family Practice Notebook

year: 2018

summary/abstract:

Septic Arthritis in Sickle Cell Anemia:
II. Causes
Staphylococcus aureus (most common cause)
Streptococcus Pneumoniae
Salmonella

III. Labs
Synovial Fluid (obtain in all suspected cases)
1. Normal Synovial Fluid cell count in >50% of Septic Arthritis cases
2. Gram Stain Test Sensitivity is only 50% (high False Negative Rate)
3. Synovial Fluid is the gold standard for diagnosis

IV. Management

A. Obtain Synovial Fluid culture and start empiric antibiotics

B. Total antibiotic course: 6 weeks

C. Initial empiric management
1. Cephaloporin sensitive
a. Ceftriaxone 50-75 mg/kg up to 2 g/dose OR
b. Ceftriaxone 75-100 mg/kg in high S. Pneumoniae resistance regions

2. Cephalosporin resistance
a. Clindamycin 10-15 mg/kg/dose (preferred) OR
b. Vancomycin 15 mg/kg/dose (if systemic Sepsis or Clindamycin reactions)

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