Real-world management of native knee septic arthritis at a university hospital, 2018–2025: A retrospective cohort with comparative surgical outcomes and development of a weighted-incidence syndromic combination antibiogram

In routine care, arthroscopic irrigation and debridement achieves infection control with lower resource use than open arthrotomy and should be the preferred first-line surgical strategy for most presentations. Open arthrotomy remains important for anatomically complex or advanced disease, and aspiration-only strategies should be limited to carefully selected, closely monitored patients. A locally calibrated WISCA can support rational empiric choices and timely de-escalation alongside early source control.