Septic arthritis | Right Decisions

Update your RDS mobile app to v4.7.2 to download toolkits even when website is down.

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. You will see that each toolkit has a small QR code icon in the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively update to the latest release - RDS app version 4.7.1 - to see this improvement.

Updating to this latest version of the RDS app is also strongly recommended to get the full benefits of the new resilience arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Do not start antibiotic therapy until samples obtained.

Discuss all cases with microbiology and orthopaedics/rheumatology

Required investigations

Blood cultures x 2 sets from separate sites
Joint aspirate fluid sent for culture (contact microbiology to arrange urgent Gram stain)

Antibiotic recommendation

Recommended total duration: 4 weeks

Recommended antibiotic	Flucloxacillin 2g every 6 hours IV
Penicillin Allergy OR previous MRSA colonisation or infection	Vancomycin IV (use NHS Lothian Calculator on AMT intranet page); aim trough levels 15-20mg/L

These groups are at a higher risk of Gram-negative infection

elderly
frail
recurrent UTI
recent urological or abdominal surgery

Discuss with microbiology early if concerns regarding Gram negative infection.

CONSIDER

Gentamicin IV Use NHS Lothian Calculator located AMT intranet page

IV to oral switch

Depends on microbiological investigations and whether septic arthritis is confirmed

Notes

Intravenous therapy recommended for a prolonged proportion of treatment.
In stable patients consider referral to OPAT.
Likely organisms: Staphylococcus aureus, Streptococci, Enterobacteriacae, Neisseria gonorrhoea
Where gonococcal infection is suspected take appropriate samples (genital, urine, throat, rectal as required) for combined Chalmydia/Gonorrohoeal NAAT testing (get the right sampling kit) - joint fluid can be tested by PCR for gonorrhoea in discussion with microbiology.