Management of Acute Native Joint Bacterial Arthritis in Adults in 2020 - A Short Narrative, Practical State-of-the-Art Review

Native joint bacterial arthritis is a common infection among adults and children. A solely conservative management, without any articular drainage/lavage, increases the risk of recurrence. In contrast, the type of initial lavage/drainage can be surgical (arthrotomy or arthroscopy) or non-surgical (iterative arthrocenteses). Up to date, no superiority has been shown for any of these approaches in relation to recurrence risk and postinfectious mechanical damage. Furthermore, an initial synovectomy, or the number of iterative drainages does not influence outcome in most cases. Nowadays, an antibiotic regimen of three to four weeks, with early oral therapy, is standard in most settings of the world. In arthritis cases involving the hand and wrist, a shorter systemic antibiotic treatment such as two weeks is sufficient. The outcome of infection is impacted by of mechanical sequelae in up to 40% of cases. These sequels are predominantly joint stiffness and/or osteoarthritis, which are difficult to treat.