Septic arthritis is a major problem in equine medicine.
Direct culture is often unrewarding. The use of
enrichment culture is important, and optimally synovial
fluid samples should be inoculated into blood
culture broth shortly after collection. Samples in
blood culture broth are incubated for up to one week,
thereby greatly increasing sensitivity. Sterile technique
is critical because this enrichment process can
detect very low numbers of bacteria, including contaminants.
Empirical therapy is important because
of the low sensitivity of direct culture, the time delay
associated with enrichment culture and possible
consequences of disease. Gram staining of synovial
fluid should be performed to provide basic information
about the likely pathogen. Prompt treatment
is required, including antimicrobials and ancillary
procedures such as joint lavage, to reduce the risk of
performance- or life-threatening damage within the
joint. A distinct advantage in the treatment of septic
arthritis is the ease of local (intra-articular) therapy
in most situations. Intra-articular injection of antimicrobials
is a very common practice when treating
septic arthritis because of the ability to provide very
high drug levels at the infected site. This is an easy
procedure for most joints, and is often combined
with joint lavage. Concerns regarding the potential
for development of chemical arthritis following
injection of antimicrobials have been addressed;
however, this has not been demonstrated to be a
clinically relevant concern, particularly considering
the severe potential sequelae associated with septic
arthritis. Some antimicrobials are irritating and may
produce chemical synovitis, so only drugs known to
be safe and effective (e.g. amikacin, gentamicin, ceftiofur,
cefazolin, sodium/potassium penicillin) should
be injected into joints. Since antimicrobials injected into joints will be absorbed into the circulation, the
total amount injected should be considered, particularly
when multiple joints are being treated and when
the same drug is being used parenterally. In situations
where neonatal foals are being treated for multiple
septic joints, aminoglycosides should not be used
both parenterally and intra-articularly because excessive
drug levels may result.
Septic arthritis is a major problem in equine medicine.Direct culture is often unrewarding. The use ofenrichment culture is important, and optimally synovialfluid samples should be inoculated into bloodculture broth shortly after collection. Samples inblood culture broth are incubated for up to one week,thereby greatly increasing sensitivity. Sterile techniqueis critical because this enrichment process candetect very low numbers of bacteria, including contaminants.Empirical therapy is important becauseof the low sensitivity of direct culture, the time delayassociated with enrichment culture and possibleconsequences of disease. Gram staining of synovialfluid should be performed to provide basic informationabout the likely pathogen. Prompt treatmentis required, including antimicrobials and ancillaryprocedures such as joint lavage, to reduce the risk ofperformance- or life-threatening damage within thejoint. A distinct advantage in the treatment of septicarthritis is the ease of local (intra-articular) therapyin most situations. Intra-articular injection of antimicrobialsis a very common practice when treatingseptic arthritis because of the ability to provide veryhigh drug levels at the infected site. This is an easyprocedure for most joints, and is often combinedwith joint lavage. Concerns regarding the potentialfor development of chemical arthritis followinginjection of antimicrobials have been addressed;however, this has not been demonstrated to be aclinically relevant concern, particularly consideringthe severe potential sequelae associated with septicarthritis. Some antimicrobials are irritating and mayproduce chemical synovitis, so only drugs known tobe safe and effective (e.g. amikacin, gentamicin, ceftiofur,cefazolin, sodium/potassium penicillin) shouldbe injected into joints. Since antimicrobials injected into joints will be absorbed into the circulation, thetotal amount injected should be considered, particularlywhen multiple joints are being treated and whenthe same drug is being used parenterally. In situationswhere neonatal foals are being treated for multipleseptic joints, aminoglycosides should not be usedboth parenterally and intra-articularly because excessivedrug levels may result.
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