Approach to patients with suspected septic arthritis and negative synovial fluid Gram stain

* With most bacterial organisms, particularly Staphylococcus aureus, the synovial fluid white blood cell count is typically >50,000 cells/microL (and often >100,000 cells/microL). However, lower counts may be observed in the setting of septic arthritis, especially for disseminated gonococcal infection or if antibiotics were administered prior to joint fluid sampling.
¶ If there is high suspicion for disseminated gonococcal infection (eg, tenosynovitis or dermatitis, evidence of urogenital, rectal or pharyngeal gonococcal infection), including empiric treatment for gonococcal infection is reasonable.
Δ Refer to separate UpToDate topic on disseminated gonococcal infection for details on treatment regimens.
◊ The duration of therapy for septic arthritis is tailored to individual clinical circumstances (refer to UpToDate topic on septic arthritis for further discussion).