Fluid should be sent for gram stain, cell count, and culture. ESR is helpful not only in terms of thinking about an underlying septic joint but can be followed during treatment to confirm adequate therapy. Blood cultures should be ordered in any suspected case. An X-ray may demonstrate a septic arthritis if it has been present for over two weeks. Initial Treatment - The patient should be admitted to the hospital with initiation of intravenous antibiotics based upon gram stain and coverage for Staphylococcus aureus is mandatory if the gram stain has gram positive organisms or is equivocal.
Blood cultures are to be taken before antibiotics are started.
Patients with underlying rheumatoid arthritis who have had symptoms of septic arthritis for over a week should be considered for early arthroscopic lavage. Other - A poor joint outcome is more likely if the symptoms have been present for over 7 days making prompt diagnosis important.