What is the main initial management step for septic arthritis identified by high leukocyte count in synovial fluid?

The main initial management step for septic arthritis, especially when a high leukocyte count in the synovial fluid suggests infection, is the initiation of empirical antibiotics. This is a critical step because timely treatment with the appropriate antimicrobial agents can significantly reduce the risk of joint damage and improve outcomes for the patient.

Septic arthritis typically occurs in the context of an infection that can lead to inflammation of the joint. The presence of a high leukocyte count, particularly with a predominance of neutrophils, indicates a likely bacterial infection. Starting empirical antibiotics early helps to combat the infection before the specific organism is identified through cultures. The choice of antibiotics may be guided by the patient's clinical condition, age, and any potential risk factors for specific pathogens, but initiation should not be delayed while awaiting culture results.

Other management steps, while important, do not take precedence over starting antibiotics when septic arthritis is suspected. For example, intravenous fluid therapy may be beneficial in managing overall hydration and supporting the patient but does not address the underlying infection directly. Orthopedic referral may be necessary for further intervention but typically follows the initiation of antibiotic treatment. Physical therapy is not an immediate management step for septic arthritis since the treatment focus initially is on eradicating the infection and addressing inflammation.