J Clin Rheumatol. 2017 Dec;23(8):435-442. doi: 10.1097/RHU.0000000000000588.
Septic arthritis refers to an infection in a joint due to a bacterial, mycobacterial, or fungal cause. Joint infections are a serious cause of morbidity and mortality and constitute a true musculoskeletal emergency. The estimated incidence of septic arthritis in the general population is between 2 and 6 cases per 100,000 people per year. The most common presentation is an acute monoarthritis. Identification of organisms in the synovial fluid is the criterion standard for diagnosis. Synovial fluid aspiration should be performed prior to initiating antibiotics. While no diagnostic cutoff exists for synovial fluid white blood cell count, increasing leukocytosis is associated with a higher likelihood of an infectious cause of arthritis, and patients commonly present with values greater than 50,000/μL. The cornerstones of treating septic bacterial arthritis are adequate drainage and antimicrobials. Joint drainage is always recommended in septic arthritis; however, no clear guidelines or strong evidence exist to guide the preferred method of drainage. Options for joint drainage include daily needle aspiration, arthroscopy, or open surgical drainage via arthrotomy.
脓毒性关节炎是指由于细菌、分枝杆菌或真菌感染引起的关节感染。关节感染是发病率和死亡率的一个严重原因，构成了真正的肌肉骨骼急症。估计普通人群中脓毒性关节炎的发病率为每年每 100,000 人中有 2 至 6 例。最常见的表现是急性单关节炎。在开始使用抗生素之前，应在关节液中鉴定出病原体。虽然关节液白细胞计数没有诊断截止值，但白细胞增多与关节炎的感染性原因的可能性更高相关，并且患者通常的白细胞计数值大于 50,000/μL。治疗脓毒性细菌性关节炎的基石是充分引流和使用抗生素。在脓毒性关节炎中始终建议进行关节引流；但是，目前尚无明确的指南或强有力的证据来指导引流的首选方法。关节引流的选择包括每日针吸、关节镜检查或通过关节切开术进行开放性手术引流。
