Infectious arthritis: tailoring initial treatment to clinical findings.

Infectious arthritis causes substantial morbidity and mortality. In patients with monoarticular involvement, careful history taking and attention to the clinical presentation aid in timely diagnosis. Certain factors (eg, patient age, structural changes in the joint, presence of chronic disease) provide clues to the likely infectious agent. Antibiotic treatment should be instituted immediately after culture specimens are obtained, and the choice of agent can be modified when antibiotic sensitivities are known. Surgical intervention may be necessary if medical therapy fails. An aggressive approach to evaluation and treatment is warranted when polyarticular infection is suspected.