Pediatric Hospital Medicine

262 Part XI • Musculoskeletal

TABLE 43.8 SYNOVIAL FLUID ANALYSIS TYPICAL OF SEPTIC ARTHRITIS SYNOVIAL FLUID FINDINGS Color Serosanguinous Clarity Turbid White blood cells > 50,000-100,000/mm 3 Neutrophils (%) > 75 Culture Positive in 80% of cases Glucose < 40 mg/dL

Data from Swami SK, Eppes SC. Bone and joint infections. In: Zaoutis LB, Chiang VW. eds. Comprehensive Pediatric Hospital Medicine , 2nd ed. McGraw-Hill Education; 2017.

■ MANAGEMENT All patients with suspected joint infection should be hospitalized ini tially with prompt involvement of orthopedic surgery. Empiric IV an tibiotics should be initiated as soon as blood and synovial cultures are obtained. 2 The initial antibiotic choice should cover the most likely pathogens suspected, taking into consideration the local resistance patterns of such organisms and incorporating preliminary Gram stain results. Antibiotic coverage should be narrowed as soon as a specific organism is identified and susceptibilities are available. Clinical im provement is expected within 1 to 2 days of initiation of antibiotic ther apy and satisfactory joint irrigation and debridement, with as much as a 50% decrease in CRP levels. 4 Early transition from IV to oral an tibiotic therapy should be considered in immunocompetent and fully immunized children > 1 month of age demonstrating an uncomplicated clinical course with a reduction in inflammatory markers and a spe cific causative pathogen identified. 3 Total duration of antibiotic therapy should amount to 3 weeks. 3 Discharge criteria are summarized in Table 43.9. Table 43.10 out lines a high-value approach to diagnostic studies and management.

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