Septik Artrit
Özet
Septik artrit, bakterilerin eklem aralığına girmesiyle oluşan ve her yaş grubunda görülebilen akut, yıkıcı bir eklem enfeksiyonudur. Hastalık sıklıkla hematojen yolla yayılır ve Stafilokok aureus en yaygın patojendir. Tanıda, pasif eklem hareketlerinde ağrı ve şişlik gibi klinik muayene bulgularının yanı sıra acil eklem sıvısı analizi, hücre sayımı, gram boyama, CRP ve sedimantasyon testleri kritik önem taşır. Eklem sıvısında yüksek lökosit ve nötrofil oranı septik artrit lehinedir. Tedavinin temelini gecikmeksizin uygun ampirik antibiyoterapiye başlanması, eklemin debridmanı, etkin drenajı ve ardından hareketsiz kılınması oluşturur. Erken tanı konulup hızla tedaviye başlanması kıkırdak harabiyetini, kalıcı deformiteleri ve morbiditeyi önlemede hayati bir role sahiptir.
Septic arthritis is an acute, destructive joint infection caused by bacterial invasion into the joint space, which can affect individuals of all ages. The disease most frequently disseminates via the hematogenous route, with Staphylococcus aureus being the most common pathogen. In diagnosis, along with clinical examination findings such as pain and swelling during passive joint movements, urgent synovial fluid analysis, cell count, gram staining, CRP, and sedimentation tests carry critical importance. A high leukocyte and neutrophil ratio in the synovial fluid favors septic arthritis. The cornerstone of treatment consists of initiating appropriate empirical antibiotic therapy without delay, joint debridement, effective drainage, and subsequent immobilization. Early diagnosis and prompt initiation of treatment play a vital role in preventing cartilage destruction, permanent deformities, and morbidity.
Referanslar
Mathews CJ, Weston VC, Jones A, et al. Bacterial septic arthritis in adults. The Lancet. 2010;375(9717): 846-855. doi: 10.1016/S0140-6736(09)61595-61596.
Singhal R, Perry DC, Khan FN et al. The use of CRP within a clinical prediction algorithm for the differentiation of septic arthritis and transient synovitis in children. The Journal of Bone and Joint Surgery. British volume 2011;93(11): 1556-1561. doi: 10.1302/0301-620X.93B11.26857.
Stimmler MM. Infectious arthritis: tailoring initial treatment to clinical findings. Postgraduate medicine. 1996;99(4): 127-31, 35-39.
McCutchan HJ, Fisher RC. Synovial leukocytosis in infectious arthritis. Clinical Orthopaedics and Related Research. 1990(257): 226-230.
Tarkowski A. Infection and musculoskeletal conditions: Infectious arthritis. Best Practice & Research Clinical Rheumatology. 2006;20(6): 1029-1044. doi: 10.1016/j.berh.2006.08.001.
Goodman SB, Schurman D. Management of pyarthrosis. Chapman’s orthopaedic surgery. 2001;3: 3561-3577.
Bartlett JG, Auwaerter PG, Pham PA. Johns Hopkins ABX Guide 2012: Jones & Bartlett Publishers; 2011.