Septic arthritis: clinical audits would help optimise the management

We audited management of septic arthritis (SA) in our institution comparing them with the British Society for Rheumatology (BSR) guidelines and also ascertained awareness regarding these guidelines among trainee doctors. All adult patients who were admitted to our institution between January 2005 and December 2006 with symptoms and signs of SA and had positive synovial fluid culture were included, and a structured proforma was used to extract the relevant information from the case notes and laboratory tests. Management of 21 patients with SA was audited. In several areas (such as appropriate samples for cultures prior to initiation of antibiotics and use of inflammatory markers in monitoring the response to treatment), management of both native and prosthetic joint SA fell short of compliance with the BSR guidelines. A total of 58% trainee doctors surveyed were unaware of these guidelines. Our audit identified deficiencies in standards of care of SA. Lack of awareness regarding these guidelines contributes to the suboptimal care of patients with SA. Wider dissemination of the BSR guidelines with similar audits being a starting point would help in optimising the management of SA.