Dr Lotman's comments warrant no response from any physician who has successfully treated acute septic arthritis without surgical intervention.In response to Dr Mylotte's letter, we are not sure what his concerns about our observations are. We have provided data indicating that the prolonged persistence of viable bacteria in an infected joint portends an unfavorable outcome. We share with him the concern that underlying joint disease, defects in local or systemic host defenses, and bacterial organisms per se are important variables that may contribute to the poor outcome of therapy for septic arthritis. In general, one cannot alter the status of the patient's underlying joint disease, defects in host defense, or the type of microorganism at the time of diagnosis of joint infection. However, avoiding delay in diagnosis and instituting therapy aimed at achieving synovial fluid sterility as rapidly as possible can favorably influence the treatment outcome. The
Ho G, Su EY. Management of Septic Arthritis-Reply. JAMA. 1982;248(3):308. doi:10.1001/jama.1982.03330030021010
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