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Agarwal P, Agarwal N, Hansberry DR, Majmundar N, Goldstein IM. Sternoclavicular joint arthropathy mimicking radiculopathy in a patient with concurrent C4-5 disc herniation. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.100495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Affiliation(s)
- Zachary C Lum
- Adult Reconstruction, Department of Orthopaedics, University of California-Davis Medical Center, Sacramento, California
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103
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Panjwani T, Wong KL, Tan SHS, Liau G, Vaidya N, Krishna L. Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis. J ISAKOS 2019. [DOI: 10.1136/jisakos-2018-000269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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104
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Solow M, Sarraj M, Johal H, Al-Asiri J. A Case Report of Pneumococcal Septic Arthritis Following a Respiratory and Gastrointestinal Prodrome with Accompanying Literature Review. J Foot Ankle Surg 2019; 58:1293-1297. [PMID: 31679684 DOI: 10.1053/j.jfas.2018.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 02/03/2023]
Abstract
We report an uncommon case of septic arthritis of the ankle from a Streptococcus pneumoniae infection and provide an update of the literature reported since 2002. A 58-year-old female presented to the hospital with right ankle pain and an inability to bear weight. She reported a history of productive cough, vomiting, diarrhea, and subjective fevers 4 days earlier. Streptococcus pneumonia was identified in her ankle aspirate, and she was treated urgently with operative incision and debridement, followed by postoperative intravenous antibiotics. At her 7-week follow-up, she demonstrated complete resolution of symptoms and near-complete recovery of range of motion. This case demonstrates the importance of early identification, as the majority of patients recover fully with prompt treatment. The literature review included 44 cases of pneumococcal septic arthritis and found that the knee was the most commonly affected joint, followed by the shoulder and ankle. Blood cultures were positive for S. pneumoniae in 27 of 38 adults (71%) and 4 of 6 children (67%). Comorbid conditions were present in 32 of 38 adults (84%) and 4 of 7 children (57%), the most frequent of which were alcoholism and osteoarthritis in adults and malignancy or immunosuppression in children. Additionally, roughly half of included adults had an extra-articular focus of pneumococcal disease, most frequently pneumonia. Operative treatment was undertaken in 32 of 38 adults (84%) and all 7 children. Of adults with data available, 24 of 33 (73%) recovered with complete joint function, compared with 5 of 7 children (71%).
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Affiliation(s)
- Max Solow
- Medical Student, St George's University Medical School, St. George's, West Indies, Grenada
| | - Mohamed Sarraj
- Medical Student, McMaster University Medical School, Hamilton, Ontario, Canada
| | - Herman Johal
- Orthopedic Surgeon, Department of Orthopaedics, Department of Surgery, Center for Evidence-Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - Jamal Al-Asiri
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada.
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Ruksasakul R, Narongroeknawin P, Assavatanabodee P, Chaiamnuay S. Group B streptococcus is the most common pathogen for septic arthritis with unique clinical characteristics: data from 12 years retrospective cohort study. BMC Rheumatol 2019; 3:38. [PMID: 31535078 PMCID: PMC6745788 DOI: 10.1186/s41927-019-0084-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 08/25/2019] [Indexed: 01/17/2023] Open
Abstract
Background Group B Streptococcus (GBS) emerged as the frequent pathogen for septic arthritis. There was no study comparing risks, clinical presentations and outcomes between GBS septic arthritis and other bacterial septic arthritis. The aim of this study is to evaluate the differences in risks, clinical presentations, and outcomes of GBS septic arthritis and other bacterial septic arthritis, and identify independent risks and clinical presentations suggesting GBS septic arthritis. Method Medical records of patients diagnosed with non-gonococcal bacterial arthritis admitted in Phramongkutklao Hospital during 2006–2018 were reviewed. Associated risks, clinical presentations and outcomes were compared between GBS septic arthritis (GBS group) and other bacterial septic arthritis (other bacterial group). Result Two hundred and thirty one cases of non-gonococcal bacterial arthritis confirmed by positive joint fluid cultures and/or hemocultures were included. The three most common pathogens were GBS (37.7%), Staphylococcus aureus (23.4%) and Streptococcus viridans (7.4%). GBS group was more commonly found in rainy season than other bacterial group. Patients in GBS group were less likely to have underlying diseases and had more number of involved joints than those in other bacterial group. The clinical presentations more commonly found in GBS group than other bacterial group were oligo-polyarthritis, upper extremities joint involvement, axial joint involvement, tenosynovitis and central nervous system involvement. Multivariate analysis found the independent associated factors of GBS arthritis are tenosynovitis, oligo-polyarthritis and rainy season. Conclusions GBS is now the most common pathogen for bacterial septic arthritis. The independent associated factors of GBS arthritis were oligo-polyarthritis, tenosynovitis and rainy season. Electronic supplementary material The online version of this article (10.1186/s41927-019-0084-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rungkan Ruksasakul
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi road, Bangkok, Ratchathewi District 10400 Thailand
| | - Pongthorn Narongroeknawin
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi road, Bangkok, Ratchathewi District 10400 Thailand
| | - Paijit Assavatanabodee
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi road, Bangkok, Ratchathewi District 10400 Thailand
| | - Sumapa Chaiamnuay
- Rheumatic Disease Unit, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, 315 Ratchawithi road, Bangkok, Ratchathewi District 10400 Thailand
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106
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Jang YR, Kim T, Kim MC, Sup Sung H, Kim MN, Kim MJ, Kim SH, Lee SO, Choi SH, Woo JH, Kim YS, Chong YP. Sternoclavicular septic arthritis caused by Staphylococcus aureus: excellent results from medical treatment and limited surgery. Infect Dis (Lond) 2019; 51:694-700. [PMID: 31355687 DOI: 10.1080/23744235.2019.1639810] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background: Aggressive surgery such as en bloc joint resection is favored for treating uncommon sternoclavicular (SC) septic arthritis, based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with Staphylococcus aureus SC septic arthritis treated medically or with limited surgery. Methods: All adult patients with this septic arthritis at the Asan Medical Center between September 2009 and December 2016 were reviewed. Limited surgery was defined as simple incision, drainage, and debridement of the infected joint. Results: Of 22 patients enrolled, 11 received medical treatment only, and 11 underwent limited surgery, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes and liver cirrhosis, and none had intravenous drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscesses tended more often to undergo limited surgery than patients without such abscesses (73% vs. 27%, p = .09). The median duration of intravenous antibiotics was 35 days (IQR, 25-46 days). Treatment was successful in all cases. In a median 53-week follow-up (IQR, 8-171 weeks), there was no relapse of arthritis or joint deterioration. Conclusions: Medical treatment alone or with limited surgery could be successful therapeutic strategies for complicated S. aureus SC septic arthritis in selected patients.
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Affiliation(s)
- Young-Rock Jang
- a Department of Internal Medicine, Division of Infectious Disease, Gil Medical Center, Gachon University College of Medicine , Incheon , Republic of Korea
| | - Taeeun Kim
- b Department of Internal Medicine, Division of Infectious Diseases, Nowon Eulji Medical Center, Eulji University School of Medicine , Seoul , Republic of Korea
| | - Min-Chul Kim
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Heung Sup Sung
- d Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Mi-Na Kim
- d Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Min Jae Kim
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Sung Han Kim
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Sang-Oh Lee
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Sang-Ho Choi
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Jun Hee Woo
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Yang Soo Kim
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
| | - Yong Pil Chong
- c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea
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Abstract
Septic arthritis is an emergent condition caused by bacterial infection of a joint space. The most common etiology is hematogenous spread from bacteremia, but it can also occur from direct inoculation from bites, injection injuries, cellulitis, abscesses, or local trauma. Septic arthritis occurs most frequently in the lower extremities, with the hips and knees serving as the most common locations. The most sensitive findings include pain with motion of the joint, limited range of motion, tenderness of the joint, new joint swelling, and new effusion. Laboratory testing and imaging can support the diagnosis, but the criterion standard is diagnostic arthrocentesis. Treatment involves intravenous antibiotics and joint decompression.
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108
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Mohamed M, Patel S, Plavnik K, Liu E, Casey K, Hossain MA. Retrospective Analysis of Septic Arthritis Caused by Intra-Articular Viscosupplementation and Steroid Injections in a Single Outpatient Center. J Clin Med Res 2019; 11:480-483. [PMID: 31236165 PMCID: PMC6575118 DOI: 10.14740/jocmr3838] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 05/02/2019] [Indexed: 12/20/2022] Open
Abstract
Background Septic arthritis is defined by the presence of pathogen(s) in a joint by direct inoculation or hematogenous spread. Most common organisms include Staphylococcus aureus and Escherichia coli. Clinical presentation is fever, warmth and night pain, with most common joints involved being the knee and hip. Iatrogenic septic arthritis is an uncommon complication of intra-articular injection for osteoarthritis yet its complications can be devastating. We aim to highlight ten cases of iatrogenic septic arthritis in retrospective study reviewing symptoms, signs, laboratory data, causing organisms and reasons leading to those infections. Methods Retrospective analysis of charts of ten patients who were admitted to Jersey Shore University Medical Center with diagnosis of iatrogenic septic arthritis. Results Average age of patients is 69.9 years. Most common comorbidities seen in our patient were hypertension and diabetes mellitus. The most common intra-articular agents that were injected were cortisone and Synvisc. The mean incubation period was 11.9 days. Most common presenting symptoms were joint pain and swelling. The most common organism isolated in cultures was Streptococcus mitis. A total of 100% of patients underwent surgical intervention for septic arthritis. One case was complicated by sepsis. Conclusions Iatrogenic septic arthritis is not common; however its complications can be catastrophic to patients. Improper sterile techniques and untrained physicians are the main risks factors for this complication. Physicians should take proper sterile measures to avoid complications of intra-articular injections.
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Affiliation(s)
- Mujtaba Mohamed
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Swapnil Patel
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Kathy Plavnik
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Edward Liu
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Kathleen Casey
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
| | - Mohammad A Hossain
- Department of Medicine, Jersey Shore University Medical Center, Hackensack Meridian Health, Neptune, NJ 07753, USA
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McBride S, Mowbray J, Caughey W, Wong E, Luey C, Siddiqui A, Alexander Z, Playle V, Askelund T, Hopkins C, Quek N, Ross K, Orec R, Mistry D, Coomarasamy C, Holland D. Epidemiology, Management, and Outcomes of Large and Small Native Joint Septic Arthritis in Adults. Clin Infect Dis 2019; 70:271-279. [DOI: 10.1093/cid/ciz265] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/28/2019] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
Native joint septic arthritis (NJSA) is poorly studied. We describe the epidemiology, treatment, and outcomes of large joint NJSA (LNJSA) and small joint NJSA (SNJSA) in adults at Middlemore Hospital, Auckland, New Zealand.
Methods
This was a coding-based retrospective study of patients ≥16 years old admitted between 2009 and 2014. Prosthetic joint infections were excluded.
Results
Five hundred forty-three NJSA episodes were included (302 LNJSA, 250 SNJSA). Only 40% had positive synovial fluid culture. Compared to SNJSA, LNJSA has higher incidence (13 vs 8/100 000 person-years [PY]), occurs in older, more comorbid patients, and is associated with greater rates of treatment failure (23% vs 12%) and mortality, despite longer antibiotic treatment. Total incidence is higher than previously reported (21/100 000 PY), with marked interethnic variation. Incidence rises with age (LNJSA only) and socioeconomic deprivation (LNJSA and SNJSA). Tobacco smokers and males are overrepresented. The most commonly involved joints were knee (21%) and hand interphalangeal (20%). Staphylococcus aureus was the most common pathogen (53%). Mean antibiotic duration was 25 days for SNJSA and 40 days for LNJSA, and the mean number of surgical procedures was 1.5 and 1.6, respectively. Treatment failure was independently associated with LNJSA, age, intra-articular nonarthroplasty prosthesis, and number of surgical procedures.
Conclusions
This is the largest contemporary series of adult NJSA. SNJSA has better outcomes than LNJSA and may be able to be safely treated with shorter antimicrobial courses. Incidence is high, with significant ethnic and socioeconomic variation. Microbiological NJSA case ascertainment underestimates case numbers as it frequently excludes SNJSA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Katie Ross
- Middlemore Hospital, Auckland, New Zealand
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110
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Coiffier G, David C, Gauthier P, Le Bars H, Guggenbuhl P, Jolivet-Gougeon A, Albert JD. Broad-range 16 s rDNA PCR in synovial fluid does not improve the diagnostic performance of septic arthritis in native joints in adults: cross-sectional single-center study in 95 patients. Clin Rheumatol 2019; 38:1985-1992. [PMID: 30850963 DOI: 10.1007/s10067-019-04492-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 02/12/2019] [Accepted: 02/24/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To evaluate the diagnostic performance of bacterial identification by broad-range polymerase chain reaction (PCR) of ribosomal DNA (rDNA) 16 s (16S rDNA PCR) for the diagnosis of septic arthritis on native joints. METHODS Patients with acute mono or oligoarthritis who underwent synovial fluid puncture and prospective follow-up allowing definitive diagnosis (septic arthritis, crystal related disease, chronic inflammatory arthritis, undifferentiated arthritis) were recruited in this single-center study. Systematic analysis of synovial fluid included leukocytes count, search for urate and pyrophosphate crystals with polarized light microscopy, direct bacteriological examination (gram staining), bacteriological culture, and 16S rDNA PCR. RESULTS Ninety-five patients were included, 34 of which (35.8%) had septic arthritis. Nineteen (20.0%) patients had received probabilistic antibiotic therapy prior to joint puncture. Gram + cocci infection accounted for 79.4% of septic arthritis, of which nearly half (47.1%) was caused by Staphylococcus aureus. Eight (23.5%) septic arthritis patients had a 16S rDNA PCR positive in the synovial fluid with an AUC of 0.618 (95% CI, 0.493-0.742), a sensitivity of 0.24 (95% CI, 0.12-0.40), and a specificity of 1.00 (95% CI 0.94-1.00). The diagnostic performance of 16S rDNA PCR was lower than that of direct examination (AUC at 0.691, CI 95%, 0.570-0.812), blood cultures (AUC at 0.727, CI 95%, 0.610-0.844), and culture (0.925, CI 95%, 0.856-0.994) for the diagnosis of septic arthritis. There was no difference in the positivity of 16S rDNA PCR according to previous exposure to antibiotics. CONCLUSIONS 16 s rDNA PCR in the synovial fluid does not improve the diagnostic performance of septic arthritis on native adult joints, particularly for Gram-positive cocci infections.
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Affiliation(s)
- G Coiffier
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France.,Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France
| | - C David
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France
| | - P Gauthier
- EA 1254 Microbiologie Université de Rennes 1, Laboratoire Bactériologie CHU Pontchaillou, 35000, Rennes, France
| | - H Le Bars
- EA 1254 Microbiologie Université de Rennes 1, Laboratoire Bactériologie CHU Pontchaillou, 35000, Rennes, France
| | - P Guggenbuhl
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France.,Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France
| | - A Jolivet-Gougeon
- Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France.,EA 1254 Microbiologie Université de Rennes 1, Laboratoire Bactériologie CHU Pontchaillou, 35000, Rennes, France
| | - J D Albert
- Service de Rhumatologie, CHU Hôpital Sud, 16 boulevard de Bulgarie, 35203, Rennes, France. .,Institut NUMECAN, INSERM U 1241, INRA U 1341, 35000, Rennes, France.
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111
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Sigmund IK, Holinka J, Sevelda F, Staats K, Heisinger S, Kubista B, McNally MA, Windhager R. Performance of automated multiplex polymerase chain reaction (mPCR) using synovial fluid in the diagnosis of native joint septic arthritis in adults. Bone Joint J 2019; 101-B:288-296. [PMID: 30813795 DOI: 10.1302/0301-620x.101b3.bjj-2018-0868.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid diagnosis of native joint septic arthritis. PATIENTS AND METHODS Consecutive patients with suspected septic arthritis undergoing aseptic diagnostic joint aspiration were included. The aspirate was used for analysis by mPCR and conventional microbiological analysis. A joint was classed as septic according to modified Newman criteria. Based on receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) values of the mPCR and the synovial fluid culture were compared using the z-test. A total of 72 out of 76 consecutive patients (33 women, 39 men; mean age 64 years (22 to 92)) with suspected septic arthritis were included in this study. RESULTS Of 72 patients, 42 (58%) were deemed to have septic joints. The sensitivity of mPCR and synovial fluid culture was 38% and 29%, respectively. No significant differences were found between the AUCs of both techniques (p = 0.138). A strong concordance of 89% (Cohen's kappa: 0.65) was shown. The mPCR failed to detect Staphylococcus aureus (n = 1) and Streptococcus pneumoniae (n = 1; no primer included in the mPCR), whereas the synovial fluid culture missed six microorganisms (positive mPCR: S. aureus (n = 2), Cutibacterium acnes (n = 3), coagulase-negative staphylococci (n = 2)). CONCLUSION The automated mPCR showed at least a similar performance to the synovial fluid culture (the current benchmark) in diagnosing septic arthritis, having the great advantage of a shorter turnaround time (within five hours). Cite this article: Bone Joint J 2019;101-B:288-296.
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Affiliation(s)
- I K Sigmund
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - J Holinka
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - F Sevelda
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - K Staats
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - S Heisinger
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - B Kubista
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - M A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Foundation NHS Trust, Oxford, UK
| | - R Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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112
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Imagama T, Tokushige A, Seki K, Seki T, Nakashima D, Ogasa H, Sakai T, Taguchi T. Early diagnosis of septic arthritis using synovial fluid presepsin: A preliminary study. J Infect Chemother 2019; 25:170-174. [DOI: 10.1016/j.jiac.2018.10.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 10/06/2018] [Accepted: 10/29/2018] [Indexed: 11/24/2022]
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113
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Wang VTJ, Tan JH, Pay LH, Wu T, Shen L, O'Neill GK, Kumar VP. A comparison of Streptococcus agalactiae septic arthritis and non-Streptococcus agalactiae septic arthritis. Singapore Med J 2019; 59:528-533. [PMID: 30386859 DOI: 10.11622/smedj.2018127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Streptococcus agalactiae (Group B Streptococcus, GBS) is an uncommon cause of septic arthritis in the adult population. In recent years, there has been an increase in the incidence of GBS septic arthritis. This study aims to compare the clinical presentation, investigations, microbiology and outcome of management in patients with GBS and non-GBS septic arthritis. METHODS Retrospective review of hospital surgical records was done to identify all patients treated surgically at our institution from January 2011 to January 2016 for primary septic arthritis. Patients were categorised into two groups: those with culture-proven GBS septic arthritis and those with causative pathogens that were not GBS. Patients who were medically unfit for surgical intervention as well as those who declined interventional procedures were excluded from the study. RESULTS A total of 83 patients were included in the study: 62 (74.7%) had non-GBS septic arthritis and 21 (25.3%) had GBS septic arthritis. Patients with GBS septic arthritis were more likely to have polyarticular involvement (p < 0.001) and involvement of less common sites such as the elbow joint. They were also more likely to have elevated inflammatory markers (C-reactive protein > 150 mg/L; p = 0.017) and positive blood cultures (p = 0.02), and were typically healthy adults with no medical comorbidities (p = 0.012). CONCLUSION Patients with GBS septic arthritis were more likely to present with polyarticular involvement, positive blood cultures and higher levels of C-reactive protein on admission, and tended to be healthier individuals with no medical comorbidities.
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Affiliation(s)
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Leon Han Pay
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Tianyi Wu
- Department of Orthopaedic Surgery, National University Hospital, Singapore
| | - Liang Shen
- Biostatistics Unit, National University of Singapore, Singapore
| | - Gavin Kane O'Neill
- Department of Orthopaedic Surgery, National University Hospital, Singapore
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von Glinski A, Yilmaz E, Rausch V, Koenigshausen M, Schildhauer TA, Seybold D, Geßmann J. Surgical management of sternoclavicular joint septic arthritis. J Clin Orthop Trauma 2019; 10:406-413. [PMID: 30828216 PMCID: PMC6383133 DOI: 10.1016/j.jcot.2018.05.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Revised: 04/10/2018] [Accepted: 05/07/2018] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Infections of the sternoclavicular joint (SCJ) account for less than 1% of all joint infections. There are no standardized diagnostic and therapeutic algorithms defined in literature. This study intended to report the risk factors, the bacterial spectrum, the extent and localization and the clinical outcome of SCJ infections. PATIENTS AND METHODS We retrospectively reviewed the medical charts of 13 patients (8 men, five women, mean age 37.6 years) with SCJ infections between Januray 1st 2008 and October 30th 2015 for clinical parameters and radiological studies. All patients were interviewed during their follow-up along with clinical examination and assessing the Disabilities of the Arm, Shoulder and Hand questionnaire (DASH). RESULTS Nine patients presented with local chest pain and swelling; in 4 patients, the prevalent symptom was pain without local signs of inflammation. Full blood count revealed a mean leukocytosis of 15 × 109 L and a mean CRP of 21.0 mg/dl. Approximately 61.5% reported known diabetes mellitus. 10 patients presented an involvement of surrounding structures. All patients received a preoperativ CT scan. Each patient was treated via SCJ resection without intraoperative complications. Primary wound closure was possible in all cases. The mean follow-up was 95 days. Wound culture revealed Staphylococcus aureus in all patients. Pathological examination affirmed acute osteomyelitis in 7 patients. Four patients required the intensive care of which 2 patients died from septic shock. Recurrent infection was encountered in 3 patients who underwent revision surgery. Mean DASH Score was 18.7. CONCLUSION CT should be routinely obtained to recognize the possible extends to the surrounding structures. SCJ resection can result in satisfactory clinical results and should be considered in cases of extended infections including the surrounding structures. Empiric antibiotic coverage should contain cephalosporin or extended-spectrum penicillin. Inappropriate or less-invasive surgical procedures may cause recurrencent infections, especially in cases of osteomyelitis.
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Affiliation(s)
- Alexander von Glinski
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Corresponding author at: Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany.
| | - Emre Yilmaz
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States
| | - Valentin Rausch
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Matthias Koenigshausen
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Thomas Armin Schildhauer
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Dominik Seybold
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany
| | - Jan Geßmann
- Department of General and Trauma Surgery, BG University Hospital, Bochum, Germany,Bürkle-de-la-Camp Platz 1, 44789, Bochum, Germany,Swedish Neuroscience Institute, Swedish Medical Center, Seattle, WA, United States
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115
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Long B, Koyfman A, Gottlieb M. Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department. West J Emerg Med 2018; 20:331-341. [PMID: 30881554 PMCID: PMC6404712 DOI: 10.5811/westjem.2018.10.40974] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/21/2018] [Accepted: 10/28/2018] [Indexed: 02/06/2023] Open
Abstract
Septic arthritis is a dangerous medical condition associated with significant morbidity and mortality. However, the differential diagnosis can be broad with conditions that mimic this disease and require different evaluation and treatment. This narrative review presents the emergency medicine evaluation and management, as well as important medical conditions that may mimic this disease. Septic arthritis commonly presents with monoarticular joint pain with erythema, warmth, swelling, and pain on palpation and movement. Fever is present in many patients, though most are low grade. Blood testing and imaging may assist with the diagnosis, but the gold standard is joint aspiration. Management includes intravenous antibiotics and orthopedic surgery consult for operative management vs. serial aspirations. Clinicians should consider mimics, such as abscess, avascular necrosis, cellulitis, crystal-induced arthropathies, Lyme disease, malignancy, osteomyelitis, reactive arthritis, rheumatoid arthritis, and transient synovitis. While monoarticular arthritis can be due to septic arthritis, other medical and surgical conditions present similarly and require different management. It is essential for the emergency clinician to be aware how to diagnose and treat these mimics.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Houston, Texas
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, Dallas, Texas
| | - Michael Gottlieb
- Rush University Medical Center, Department of Emergency Medicine, Chicago, Illinois
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Assunção JH, Noffs GG, Malavolta EA, Gracitelli MEC, Lima ALM, Ferreira Neto AA. Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital. Rev Bras Ortop 2018; 53:707-713. [PMID: 30377604 PMCID: PMC6204575 DOI: 10.1016/j.rboe.2017.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment. Methods A retrospective case series was studied with patients treated between 2004 and 2014. The patients’ clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated. Results Twenty-seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors. Conclusions Septic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. S. aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.
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Affiliation(s)
- Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme Guelfi Noffs
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Lucia Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Artrite séptica do ombro e do cotovelo: análise epidemiológica de uma década em um hospital terciário. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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118
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Gilbertie JM, Schnabel LV, Stefanovski D, Kelly DJ, Jacob ME, Schaer TP. Gram-negative multi-drug resistant bacteria influence survival to discharge for horses with septic synovial structures: 206 Cases (2010-2015). Vet Microbiol 2018; 226:64-73. [PMID: 30389045 DOI: 10.1016/j.vetmic.2018.10.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 09/26/2018] [Accepted: 10/10/2018] [Indexed: 11/29/2022]
Abstract
Bacterial colonization of synovial structures can cause infections that are difficult to treat. Systemic and local antimicrobials and repeated joint lavages are the mainstays of therapy. However, despite aggressive treatments, infection may persist, leading to significant tissue damage or death of the patient. In order to investigate the impact of bacterial culture and antimicrobial resistance on survival to discharge, we reviewed medical records of horses admitted to the University of Pennsylvania's large animal teaching hospital from 2010-2015. Two-hundred and six cases with a definitive diagnosis of septic synovitis and a synovial fluid sample submitted for microbiological culture were included in the study. Of these horses, 48% were culture negative and 52% were positive for any bacterial growth, of which 66% were gram-positive and 28% were gram-negative aerobic organisms with 4% anaerobic and 2% fungal organisms. Overall survival to discharge from hospital was 86%. Horses that had negative growth on culture were more likely to survive until discharge (p < 0.02). Multivariable analyses revealed that the likelihood of euthanasia was significantly associated with identification of coagulase positive Staphylococcus spp. (OR 7.66, 5.46-10.74, p < 0.0001), β-hemolytic Streptococcus spp. (OR 5.18, 3.56-7.55, p < 0.0001), Enterococcus spp. (OR 18.38, 11.45-29.52, p = 0.002), Enterobacteriaceae (OR 31.37, 22.28-44.17, p < 0.0001), Pseudomonas aeruginosa (OR 9.31, 5.30-16.34, p = 0.0004) or other gram-negative species (OR 3.51, 2.07-5.94, p = 0.001). Multi-drug resistance and gram-negative bacteria species were associated with significantly decreased survival rates (OR 119.24, 70.57-201.46, p < 0.0001). In conclusion, prognosis for survival to discharge was poor for horses that were infected with gram-negative organisms, particularly those with MDR phenotypes.
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Affiliation(s)
- Jessica M Gilbertie
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, 382 West Street Rd., Kennett Square, PA 19348, United States; North Carolina State University, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, 27607 Raleigh, NC, United States
| | - Lauren V Schnabel
- North Carolina State University, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, 27607 Raleigh, NC, United States
| | - Darko Stefanovski
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, 382 West Street Rd., Kennett Square, PA 19348, United States
| | - Donna J Kelly
- Department of Pathobiology, New Bolton Center, School of Veterinary Medicine, 382 West Street Rd., Kennett Square, PA 19348, United States
| | - Megan E Jacob
- North Carolina State University, College of Veterinary Medicine, North Carolina State University, 1060 William Moore Drive, 27607 Raleigh, NC, United States
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, 382 West Street Rd., Kennett Square, PA 19348, United States.
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Abstract
The manifestation of glenohumeral arthritis in the young adult is a devastating occurrence that can be difficult to manage. This review details the many underlying etiologies including genetic causes, congenital abnormalities, glenohumeral instability, posttraumatic lesions, postcapsulorraphy arthropathy, osteonecrosis, intraarticular pain pump postoperative use, radiofrequency/thermal capsulorraphy treatments, septic arthritis/infection, and inflammatory arthropathies. Although each of these potential causes have been well-studied, their contributions to the development of glenohumeral arthritis in the young person has not been described extensively.
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Affiliation(s)
- Michael S Laidlaw
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, USA
| | - Harrison S Mahon
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, USA
| | - Brian C Werner
- Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 300, Charlottesville, VA 22903, USA.
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Bechert RE, Guebert GM. Osteomyelitis of the Thumb in a 21-Year-Old Chiropractic Patient: A Case Report. J Chiropr Med 2018; 17:201-205. [PMID: 30228812 PMCID: PMC6141363 DOI: 10.1016/j.jcm.2017.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 09/22/2017] [Accepted: 10/17/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to describe the presentation of a patient with osteomyelitis of the thumb. CLINICAL FEATURES A 21-year-old man presented with painful, red, and edematous thumb pain over the anterior and posterior surface for a duration of 4 days. The patient reported no trauma or recent operation. The patient was treated conservatively for capsulitis. The patient's symptoms worsened within 2 days, and he was referred for additional imaging consisting of a bone scan. The bone scan showed increased uptake, resulting in a change of diagnosis to suspected osteomyelitis. The patient was referred to a medical doctor for care that consisted of antibiotics and physiotherapy. INTERVENTION AND OUTCOME Despite treatment, the patient had some mild permanent damage to the range of motion of the joint and soft tissue volume loss. CONCLUSION This case demonstrates the importance of considering osteomyelitis as a differential diagnosis. Amputation was avoided for this patient because of the early recognition and referral.
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Affiliation(s)
| | - Gary M. Guebert
- Department of Radiology, Logan University, Chesterfield, Missouri
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121
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Abstract
Septic arthritis refers to an infection in a joint due to a bacterial, mycobacterial, or fungal cause. Joint infections are a serious cause of morbidity and mortality and constitute a true musculoskeletal emergency. The estimated incidence of septic arthritis in the general population is between 2 and 6 cases per 100,000 people per year. The most common presentation is an acute monoarthritis. Identification of organisms in the synovial fluid is the criterion standard for diagnosis. Synovial fluid aspiration should be performed prior to initiating antibiotics. While no diagnostic cutoff exists for synovial fluid white blood cell count, increasing leukocytosis is associated with a higher likelihood of an infectious cause of arthritis, and patients commonly present with values greater than 50,000/μL. The cornerstones of treating septic bacterial arthritis are adequate drainage and antimicrobials. Joint drainage is always recommended in septic arthritis; however, no clear guidelines or strong evidence exist to guide the preferred method of drainage. Options for joint drainage include daily needle aspiration, arthroscopy, or open surgical drainage via arthrotomy.
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122
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Coiffier G, Ferreyra M, Albert JD, Stock N, Jolivet-Gougeon A, Perdriger A, Guggenbuhl P. Ultrasound-guided synovial biopsy improves diagnosis of septic arthritis in acute arthritis without enough analyzable synovial fluid: a retrospective analysis of 176 arthritis from a French rheumatology department. Clin Rheumatol 2018; 37:2241-2249. [DOI: 10.1007/s10067-018-4160-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 05/20/2018] [Accepted: 05/24/2018] [Indexed: 12/25/2022]
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Lauper N, Davat M, Gjika E, Müller C, Belaieff W, Pittet D, Lipsky BA, Hannouche D, Uçkay I. Native septic arthritis is not an immediate surgical emergency. J Infect 2018; 77:47-53. [PMID: 29742468 DOI: 10.1016/j.jinf.2018.02.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/21/2018] [Accepted: 02/07/2018] [Indexed: 12/23/2022]
Abstract
Acute native joint septic arthritis is generally considered a surgical emergency, requiring drainage within hours, including during night, weekend or holiday shifts. However, there are few data supporting the need for the disruption caused by this degree of urgency. METHODS We performed a retrospective review of all adult patients seen in our medical center from 1997-2015 with culture-proven septic arthritis and noted the epidemiology of sequelae, and their possible association with a delay in surgical drainage. RESULTS Of 204 septic arthritis episodes, 46 (23%) involved interdigital hand and foot joints. Large joints involved included the knee (n = 67), shoulder (48), hip (22), ankle (8), acromio-clavicular (5), elbow (4), wrist (3), and sterno-clavicular (1) regions. All patients underwent surgical drainage of the joint and received targeted systemic antibiotic therapy. Sequelae of varying severity occurred in 83 patients (41%): recurrences (n = 15); secondary arthrosis (30); persistent pain (9); Girdlestone procedure (9); arthrodesis (9); amputation (8); stiffness (8); and Chronic Regional Pain Syndrome (2). By multivariate Cox regression analysis factors did not predict sequelae included: age; treatment with systemic corticosteroids; pre-existing clinical or radiological arthropathy; total duration of antibiotic therapy; type of joint; and, number of surgical interventions. Similarly, there was no association of sequelae with the number of days of pre-hospitalization joint symptoms (hazard ratio 1.0, 95% confidence interval 0.99-1.01) or hours spent in the emergency department (HR 1.0, 0.9-1.2). Notably, patients who had joint lavage within 6 h of presentation had similar functional outcomes as those with lavage done at 6-12 h, 12-24 h, or > 24 h after presentation. CONCLUSIONS Our data suggest that for native septic arthritis, in the absence of clinical sepsis immediate joint drainage does not appear to reduce the risk of sequelae compared with delayed drainage.
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Affiliation(s)
- Nicolas Lauper
- Orthopaedic Surgery Service, Geneva University Hospitals
| | - Marie Davat
- Orthopaedic Surgery Service, Geneva University Hospitals
| | - Ergys Gjika
- Orthopaedic Surgery Service, Geneva University Hospitals; Hand Surgery Unit, Geneva University Hospitals
| | - Camillo Müller
- Orthopaedic Surgery Service, Geneva University Hospitals; Hand Surgery Unit, Geneva University Hospitals
| | | | - Didier Pittet
- Service of Infectious Diseases, Geneva University Hospitals; Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Benjamin A Lipsky
- Service of Infectious Diseases, Geneva University Hospitals; Division of Medical Sciences, University of Oxford, UK
| | | | - Ilker Uçkay
- Orthopaedic Surgery Service, Geneva University Hospitals; Service of Infectious Diseases, Geneva University Hospitals; Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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124
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Kang G, Leow MQH, Tay SC. Wrist inflammation: a retrospective comparison between septic and non-septic arthritis. J Hand Surg Eur Vol 2018; 43:431-437. [PMID: 29199508 DOI: 10.1177/1753193417738166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED This study aims to identify differences in demographics, clinical and laboratory data between wrist septic arthritis and non-septic arthritis in patients admitted for wrist inflammation. A retrospective review of inpatients from May 2012 to April 2015 was conducted. Seventy-seven patients were included. Non-septic arthritis patients were more likely to have chronic kidney disease, pre-existing gout, or both. All septic arthritis patients had normal serum uric acid levels, and two or more raised inflammatory markers (white cell count, C-reactive protein, erythrocyte sedimentation rate). In patients with isolated wrist inflammation, the mean C-reactive protein in the septic arthritis group was significantly higher compared with the non-septic arthritis group (mean difference 132 mg/L, 95% CI 30.9-234). In this study, polyarticular involvement did not exclude a septic cause; nor did it imply a non-septic aetiology. Diabetic or immunosuppressed patients were not more likely to develop septic arthritis. The presence of chondrocalcinosis on wrist radiographs was virtually diagnostic of non-septic arthritis. LEVEL OF EVIDENCE IV.
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125
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Reis PVM, Boff D, Verly RM, Melo-Braga MN, Cortés ME, Santos DM, Pimenta AMDC, Amaral FA, Resende JM, de Lima ME. LyeTxI-b, a Synthetic Peptide Derived From Lycosa erythrognatha Spider Venom, Shows Potent Antibiotic Activity in Vitro and in Vivo. Front Microbiol 2018; 9:667. [PMID: 29681894 PMCID: PMC5897548 DOI: 10.3389/fmicb.2018.00667] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 03/21/2018] [Indexed: 01/07/2023] Open
Abstract
The antimicrobial peptide LyeTxI isolated from the venom of the spider Lycosa erythrognatha is a potential model to develop new antibiotics against bacteria and fungi. In this work, we studied a peptide derived from LyeTxI, named LyeTxI-b, and characterized its structural profile and its in vitro and in vivo antimicrobial activities. Compared to LyeTxI, LyeTxI-b has an acetylated N-terminal and a deletion of a His residue, as structural modifications. The secondary structure of LyeTxI-b is a well-defined helical segment, from the second amino acid to the amidated C-terminal, with no clear partition between hydrophobic and hydrophilic faces. Moreover, LyeTxI-b shows a potent antimicrobial activity against Gram-positive and Gram-negative planktonic bacteria, being 10-fold more active than the native peptide against Escherichia coli. LyeTxI-b was also active in an in vivo model of septic arthritis, reducing the number of bacteria load, the migration of immune cells, the level of IL-1β cytokine and CXCL1 chemokine, as well as preventing cartilage damage. Our results show that LyeTxI-b is a potential therapeutic model for the development of new antibiotics against Gram-positive and Gram-negative bacteria.
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Affiliation(s)
- Pablo V M Reis
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daiane Boff
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Rodrigo M Verly
- Departamento de Química, Faculdade de Ciências Exatas, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil
| | - Marcella N Melo-Braga
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - María E Cortés
- Departamento de Odontologia Restauradora, Faculdade de Odontologia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Daniel M Santos
- Serviço de Proteômica e Aracnídeos - Diretoria de Pesquisa e Desenvolvimento, Fundação Ezequiel Dias, Belo Horizonte, Brazil
| | - Adriano M de C Pimenta
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Flávio A Amaral
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jarbas M Resende
- Departamento de Química, Instituto de Ciências Exatas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria E de Lima
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Abstract
BACKGROUND Septic arthritis is a common orthopedic emergency. Immediate establishment of the diagnosis and administration of an adequate therapy is paramount in minimizing morbidity and mortality in this severe condition. OBJECTIVE The aim of the present review was to evaluate the existing evidence in order to give an overview on current best practice in diagnostics and treatment of septic arthritis in adults and children. RESULTS Joint infections result from either hematogenous spread or direct inoculation of bacteria into the joint, mostly iatrogenically. Predisposing risk factors include recent orthopedic joint surgery, i. v. drug abuse, pre-existing inflammatory and degenerative joint diseases and old age. Although pathogens differ in different populations and age groups Staphylococcus aureus is the single most frequently isolated causative organism, followed by streptococci. Although diagnosis is based on an integration of medical patient history, clinical and laboratory findings and imaging studies, joint fluid analysis remains the mainstay in establishing a valid diagnosis. The range of differential diagnostics is broad and includes non-infectious inflammatory joint diseases, such as gout or reactive arthritis. Once a diagnosis has been established treatment should be started immediately. Treatment is based on adequate antibiotic therapy and joint drainage until dryness. There is a paucity of studies on the optimal antibiotic regimen, route of application and duration of therapy. Moreover, no high-quality studies exist on the optimal mode of joint drainage. While superiority has yet to be shown, operative treatment in terms of arthroscopic lavage must be considered the standard of care in Germany. Finally, despite promising results in children, the role of corticosteroids as an adjunct to antibiotic treatment in adults has yet to be clarified.
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Affiliation(s)
- O Hauschild
- Department Chirurgie Klinik für Orthopädie und Unfallchirurgie, Klinikum der Albert-Ludwigs-Universität Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland.
| | - N P Südkamp
- Department Chirurgie Klinik für Orthopädie und Unfallchirurgie, Klinikum der Albert-Ludwigs-Universität Freiburg, Hugstetterstr. 55, 79106, Freiburg, Deutschland
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Boff D, Crijns H, Teixeira MM, Amaral FA, Proost P. Neutrophils: Beneficial and Harmful Cells in Septic Arthritis. Int J Mol Sci 2018; 19:E468. [PMID: 29401737 PMCID: PMC5855690 DOI: 10.3390/ijms19020468] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/17/2022] Open
Abstract
Septic arthritis is an inflammatory joint disease that is induced by pathogens such as Staphylococcus aureus. Infection of the joint triggers an acute inflammatory response directed by inflammatory mediators including microbial danger signals and cytokines and is accompanied by an influx of leukocytes. The recruitment of these inflammatory cells depends on gradients of chemoattractants including formylated peptides from the infectious agent or dying cells, host-derived leukotrienes, complement proteins and chemokines. Neutrophils are of major importance and play a dual role in the pathogenesis of septic arthritis. On the one hand, these leukocytes are indispensable in the first-line defense to kill invading pathogens in the early stage of disease. However, on the other hand, neutrophils act as mediators of tissue destruction. Since the elimination of inflammatory neutrophils from the site of inflammation is a prerequisite for resolution of the acute inflammatory response, the prolonged stay of these leukocytes at the inflammatory site can lead to irreversible damage to the infected joint, which is known as an important complication in septic arthritis patients. Thus, timely reduction of the recruitment of inflammatory neutrophils to infected joints may be an efficient therapy to reduce tissue damage in septic arthritis.
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Affiliation(s)
- Daiane Boff
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| | - Helena Crijns
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
| | - Mauro M Teixeira
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Flavio A Amaral
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte 31270-901, Brazil.
| | - Paul Proost
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, B-3000 Leuven, Belgium.
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Boff D, Oliveira VLS, Queiroz Junior CM, Silva TA, Allegretti M, Verri WA, Proost P, Teixeira MM, Amaral FA. CXCR2 is critical for bacterial control and development of joint damage and pain in Staphylococcus aureus-induced septic arthritis in mouse. Eur J Immunol 2018; 48:454-463. [PMID: 29168180 DOI: 10.1002/eji.201747198] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 10/23/2017] [Accepted: 11/15/2017] [Indexed: 02/06/2023]
Abstract
Staphylococcus aureus is the main pathogen associated with septic arthritis. Upon infection, neutrophils are quickly recruited to the joint by different chemoattractants, especially CXCR1/2 binding chemokines. Although their excessive accumulation is associated with intense pain and permanent articular damage, neutrophils have an important function in controlling bacterial burden. This work aimed to study the role of CXCR2 in the control of infection, hypernociception and tissue damage in S. aureus-induced septic arthritis in mice. The kinetics of neutrophil recruitment correlated with the bacterial load recovered from inflamed joint after intra-articular injection of S. aureus. Treatment of mice from the start of infection with the non-competitive antagonist of CXCR1/2, DF2156A, reduced neutrophil accumulation, cytokine production in the tissue, joint hypernociception and articular damage. However, early DF2156A treatment increased the bacterial load locally. CXCR2 was important for neutrophil activation and clearance of bacteria in vitro and in vivo. Start of treatment with DF2156A 3 days after infection prevented increase in bacterial load and reduced the hypernociception in the following days, but did not improve tissue damage. In conclusion, treatment with DF2156A seems be effective in controlling tissue inflammation and dysfunction but its effects are highly dependent on the timing of the treatment start.
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Affiliation(s)
- Daiane Boff
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Brazil.,Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Vivian L S Oliveira
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Brazil
| | - Celso M Queiroz Junior
- Department of Morphology, Institute of Biological Sciences, Universidade Federal de Minas Gerais, Brazil
| | - Tarcília A Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | - Waldiceu A Verri
- Department of Pathological Sciences, Centro de Ciências Biológicas, Universidade Estadual de Londrina, Brazil
| | - Paul Proost
- Laboratory of Molecular Immunology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Mauro M Teixeira
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Brazil
| | - Flavio A Amaral
- Imunofarmacologia, Department of Biochemistry and Immunology, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais Brazil
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Surgical treatment of shoulder infections: a comparison between arthroscopy and arthrotomy. J Shoulder Elbow Surg 2017; 26:1915-1921. [PMID: 28601485 DOI: 10.1016/j.jse.2017.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/31/2017] [Accepted: 04/16/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of bacterial shoulder infections includes antibiotic therapy and surgical joint decompression. Arthroscopy and open arthrotomy are recommended treatment options. Whether 1 of the 2 surgical options is superior remains unclear. The present study aimed (1) to compare the reinfection rates after arthroscopy and open arthrotomy and (2) to identify risk factors of reinfection after surgical intervention. MATERIALS AND METHODS The data of 59 consecutive patients were available for final analysis. All patients received arthroscopy or open arthrotomy at our institution between 2001 and 2015. The reinfection rates between the 2 distinct interventions were compared. We also evaluated the influence of potential confounders, such as age, sex, comorbidities, microbiological findings, duration of symptoms, osteoarthritis, Gächter score, and preoperative inflammatory parameters, on the recurrence of infections and compared the functional outcome between the 2 surgery groups. RESULTS From 59 included patients, 38 (64.4%) underwent open arthrotomy, and 21 (35.6%) were treated arthroscopically. Reinfection was documented in 18 patients (30.5%). The reinfection rate was significantly higher in arthroscopically treated patients (11 [52.4%]) than in patients who underwent open arthrotomy (7 [18.4%]; P = .007). An infection with Staphylococcus aureus negatively influenced the treatment success (P = .034). CONCLUSION According to our data, open arthrotomy is the more effective treatment method in septic arthritis of the shoulder, with lower reinfection rates and a comparable functional outcome. Furthermore, we could identify Staphylococcus aureus as an independent risk factor for the recurrence of infections.
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130
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Paez-Perez Y, McGovern T, Flannery A, Naim F. Sternoclavicular Septic Arthritis Caused by Streptococcus pyogenes in a Child. Clin Pract Cases Emerg Med 2017; 1:312-314. [PMID: 29849351 PMCID: PMC5965202 DOI: 10.5811/cpcem.2017.5.33811] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/14/2017] [Accepted: 05/11/2017] [Indexed: 11/11/2022] Open
Abstract
Septic arthritis can be a devastating condition that leads to further morbidity and potential mortality if not identified early in its course. Emergency providers must keep septic arthritis high on their differential of any joint-related pain in the pediatric population. We present a case of an eight-year-old female who initially presented with the chief complaint of chest pain and was subsequently diagnosed with septic arthritis of the left sternoclavicular joint in the emergency department.
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Affiliation(s)
- Yenisleidy Paez-Perez
- Department of Emergency Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey
| | - Terrance McGovern
- Department of Emergency Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey
| | - Ashley Flannery
- Department of Emergency Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey
| | - Farid Naim
- Department of Emergency Medicine, St. Joseph's Regional Medical Center, Paterson, New Jersey
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131
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Ultrasound abnormalities in septic arthritis are associated with functional outcomes. Joint Bone Spine 2017; 84:599-604. [DOI: 10.1016/j.jbspin.2017.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 11/23/2022]
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132
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Wu CJ, Huang CC, Weng SF, Chen PJ, Hsu CC, Wang JJ, Guo HR, Lin HJ. Septic arthritis significantly increased the long-term mortality in geriatric patients. BMC Geriatr 2017; 17:178. [PMID: 28793879 PMCID: PMC5550948 DOI: 10.1186/s12877-017-0561-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 07/23/2017] [Indexed: 11/21/2022] Open
Abstract
Background The elderly are predisposed to septic arthritis (SA) because of the aging nature and increasing comorbidities. SA may in turn increase the long-term mortality in the geriatric patients; however, it remains unclear. We conducted this prospective nationwide population-based cohort study to clarify this issue. Methods Using Taiwan National Health Insurance Research Database (NHIRD), we identified 1667 geriatric participants (≥ 65 years) with SA and 16,670 geriatric participants without SA matched at a ratio of 1:10 by age, sex, and index date between 1999 and 2010. A comparison of the long-term mortality between the two cohorts through follow-up until 2011 was performed. Results Geriatric participants with SA had a significantly increased mortality than those without SA [Adjusted hazard ratio (AHR): 1.49, 95% confidence interval (CI): 1.34–1.66], particularly the old elderly (≥ 85 years, AHR: 2.12, 95% CI: 1.58–2.84) and males (AHR: 1.54, 95% CI: 1.33–1.79). These results were stated after adjustment for osteoarthritis, diabetes, gout, renal disease, liver disease, cancer, rheumatoid arthritis, systemic lupus erythematosus, alcoholism, and human immunodeficiency virus infection. The increased mortality risk was highest in the first month (AHR: 3.93, 95% CI: 2.94–5.25) and remained increased even after following up for 2–4 years (AHR: 1.30, 95% CI: 1.03–1.65). After Cox proportional hazard regression analysis, SA (AHR: 1.37, 95% CI: 1.20–1.56), older age (≥ 85 years, AHR: 1.79, 95% CI: 1.59–2.02, 75–84 years, AHR: 1.65, 95% CI: 1.53–1.78), male sex, diabetes, renal disease, liver disease, cancer, and gout were independent mortality predictors. There was no significant difference in the mortality for SA between upper limb affected and lower limb affected. Conclusions This study delineated that SA significantly increased the long-term mortality in geriatric participants. For the increasing aging population worldwide, strategies for the prevention and treatment of SA and concomitant control of comorbidities are very important.
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Affiliation(s)
- Chia-Jung Wu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Cheng Huang
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational Medicine, Chi-Mei Medical Center, Tainan, Taiwan
| | - Shih-Feng Weng
- Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ping-Jen Chen
- Department of Geriatrics and Gerontology, Chi-Mei Medical Center, Tainan, Taiwan.,Bachelor Program of Senior Service, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Palliative Care Center, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chien-Chin Hsu
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - How-Ran Guo
- Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Hung-Jung Lin
- Department of Emergency Medicine, Chi-Mei Medical Center, 901 Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan. .,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan. .,Department of Emergency Medicine, Taipei Medical University, Taipei, Taiwan.
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133
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Septic arthritis associated with systemic sepsis. INTERNATIONAL ORTHOPAEDICS 2017; 42:1-7. [DOI: 10.1007/s00264-017-3565-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 06/30/2017] [Indexed: 10/19/2022]
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134
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A retrospective study of joint infections in patients with systemic lupus erythematosus. Clin Rheumatol 2017; 36:2011-2017. [PMID: 28688058 DOI: 10.1007/s10067-017-3738-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 05/30/2017] [Accepted: 06/16/2017] [Indexed: 10/19/2022]
Abstract
The aim of this study was to analyze the clinical characteristics of systemic lupus erythematosus (SLE) patients with joint infections. We retrospectively reviewed the medical records of 11,734 SLE patients admitted to Peking Union Medical College Hospital (PUMCH) from January 1990 to December 2016. Twenty patients who developed joint infections were identified. Subjects without joint infections (designated as control patients) were selected from the pool of SLE patients using a 1:4 systematic sampling method. The median disease duration from SLE onset to joint infection was 23 months (range 4 to 156 months). The symptoms of patients with joint infections manifested as joint pain (all cases), swelling (14 cases), and fever (15 cases). All patients had oligo-arthritis, and the knee was the joint most commonly affected joint. There were 7 patients in the Salmonella group and 5 in the Staphylococcus aureus group. One patient was infected with Streptococcus, and 7 patients were infected with Mycobacterium. SLE patients with and without joint infections demonstrated significant differences (P < 0.05) regarding the following symptoms: pre-existing arthritis (65.0 vs 33.8%), gastrointestinal involvement (5.0 vs 26.3%), cardiac damage (5.0 vs 31.3%), elevated C-reactive protein (CRP) (80.0 vs 22.5%), and elevated SLE Disease Activity Index (SLEDAI) score (≥5) (30.0 vs 77.5%). When an SLE patient presents with pre-existing arthritis and suddenly develops asymmetric oligo- or large-joint swelling and pain with elevated CRP levels and low disease activity, joint infections should be considered. Early treatment could protect the joint and improve functional outcomes.
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135
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Hospach T, Hedrich C, Fernandez F, Girschick H, Borte M, Günther A, Martin L, Hahn G, von Kalle T, Horneff G, Kallinich T, Huppertz HI. Bakterielle Arthritis bei Kindern und Jugendlichen, Schwerpunkt Therapie. Monatsschr Kinderheilkd 2017. [DOI: 10.1007/s00112-017-0327-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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136
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Abstract
Septic arthritis and spondylodiscitis are relatively rare but severe diseases with increasing incidence. Septic arthritis is an emergency situation with high morbidity (40 %) and fatality rates (11 %). The infection occurs via a hematogenous route by direct inoculation or per continuitatem. Patients with pre-existing destructive joint diseases or under immunosuppressive treatment are particularly at risk. It is mandatory to sample synovial fluid for isolation of the relevant pathogen and quantification of leucocytes before starting antibiotic therapy. In order to preserve the joint, early evacuation of the infected synovial space is necessary. Spondylodiscitis is characterized by infection of the vertebra and neighboring discs mainly via a hematogenous route. Immunosuppressed and older patients are primarily at risk of infection. Back pain represents the main symptom but due to its unspecific character and the frequent absence of fever, diagnosis is often delayed. In Europe Staphylococcus aureus is the most prevalent pathogen, whereas tuberculosis is the most frequent causal agent worldwide. Magnetic resonance imaging (MRI) respresents the method of choice for the radiological diagnostics. In stable patients isolation of the pathogen should be achieved before starting antimicrobial therapy (e.g. blood cultures or tissue samples by computed tomography guided puncture or biopsy). The recommended duration of pathogen-specific antibiotic therapy for native spondylodiscitis is normally 6 weeks.
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Affiliation(s)
- N Jung
- Klinik 1 für Innere Medizin, Universitätsklinikum Köln, Kerpener Str. 62, 50935, Köln, Deutschland.
| | - S Vossen
- Plastische, Ästhetische und Handchirurgie, Franziskushospital Aachen, 52074, Aachen, Deutschland
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137
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Sbiti M, Bouhamidi B, Louzi L. [Proteus mirabilis septic arthritis]. Pan Afr Med J 2017; 26:197. [PMID: 28674590 PMCID: PMC5483350 DOI: 10.11604/pamj.2017.26.197.12271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 03/24/2017] [Indexed: 12/03/2022] Open
Abstract
L'arthrite septique aigue est une pathologie peu fréquente mais grevée d'un pronostic lourd en termes de mortalité et morbidité. Nous rapportons un cas d'arthrite septique à Proteus mirabilis survenue de façon spontanée chez un patient de 61 ansprésentant un diabète compliqué,associée à des hémoculturespositives et des cultures positives du liquide articulaire. L'évolution était favorable grâce au diagnostic précoce et à l'institution d'une antibiothérapie adéquate. L'arthrite septique à Proteus Mirabilis est rare, ce qui nous a incité à revoir dans la littérature des séries d'arthrites à pyogènes incluant Proteus mirabilis portant sur les facteurs de risque, la pathogénie, le traitement et l'évolution de ces pathologies. Le diagnostic est avant tout microbiologique, la ponction articulaire précoce est réalisée avant toute antibiothérapie, l'examen direct, la culture et l'antibiogramme qui va guider le choix d'une antibiothérapie. L'arthrite septique est une urgence diagnostique et thérapeutique, la prise en charge précoce de cette pathologie permet une guérison sans séquelles.
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Affiliation(s)
- Mohammed Sbiti
- Service de Microbiologie, Hôpital Militaire Moulay Ismail Meknès, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohammed Ben Abdellah, Fès, Maroc
| | - Bahia Bouhamidi
- Service de Médecine, Hôpital Régional Mohamed VMeknès, Maroc
| | - Lhoussaine Louzi
- Service de Microbiologie, Hôpital Militaire Moulay Ismail Meknès, Maroc.,Faculté de Médecine et de Pharmacie, Université Mohammed V, Souissi-Rabat, Maroc
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138
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Abstract
Septic arthritis is a rheumatologic emergency that may lead to disability or death. Prompt evacuation of the joint, either by arthrocentesis at the bedside, open or arthroscopic drainage in the operating room, or imaging-guided drainage in the radiology suite, is mandatory. Methicillin-resistant Staphylococcus aureus (MRSA) has become a major cause of septic arthritis in the United States. MRSA joint infection seems to be associated with worse outcomes. Antibiotic courses of 3 to 4 weeks in duration are usually adequate for uncomplicated bacterial arthritis. Treatment duration should be extended to 6 weeks if there is imaging evidence of accompanying osteomyelitis.
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Affiliation(s)
- John J Ross
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, PBB-B420, Boston, MA 02115, USA.
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139
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Runner RP, Mener A, Bradbury TL. Renal failure after placement of an articulating, antibiotic impregnated polymethylmethacrlyate hip spacer. Arthroplast Today 2017; 4:51-57. [PMID: 29560396 PMCID: PMC5859207 DOI: 10.1016/j.artd.2017.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 11/25/2022] Open
Abstract
A 58-year-old male presented with native joint septic arthritis of the hip and osteomyelitis. After treatment with an articulating antibiotic spacer, he developed acute renal failure requiring dialysis. He continued to have elevated serum tobramycin levels exclusively from the antibiotic spacer elution as no intravenous tobramycin was used. Subsequent explantation was required to correct his renal failure. Although renal failure after antibiotic impregnated cement placement is rare, the risk of this potential complication should be considered preoperatively and in the postoperative management of these patients.
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Affiliation(s)
- Robert P. Runner
- Corresponding author. 59 Executive Park South, Atlanta, GA 30329, USA. Tel.: +1 404 778 1567.59 Executive Park SouthAtlantaGA30329USA
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140
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Ferreyra M, Coiffier G, Albert JD, David C, Perdriger A, Guggenbuhl P. Combining cytology and microcrystal detection in nonpurulent joint fluid benefits the diagnosis of septic arthritis. Joint Bone Spine 2017; 84:65-70. [DOI: 10.1016/j.jbspin.2016.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2016] [Indexed: 12/23/2022]
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141
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Long B, Koyfman A, Modisett KL, Woods CJ. Practical Considerations in Sepsis Resuscitation. J Emerg Med 2016; 52:472-483. [PMID: 27823892 DOI: 10.1016/j.jemermed.2016.10.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND Sepsis is a common condition managed in the emergency department, and the majority of patients respond to resuscitation measures, including antibiotics and i.v. fluids. However, a proportion of patients will fail to respond to standard treatment. OBJECTIVE This review elucidates practical considerations for management of sepsis in patients who fail to respond to standard treatment. DISCUSSION Early goal-directed therapy revolutionized sepsis management. However, there is a paucity of literature that provides a well-defined treatment algorithm for patients who fail to improve with therapy. Refractory shock can be defined as continued patient hemodynamic instability (mean arterial pressure, ≤ 65 mm Hg, lactate ≥ 4 mmol/L, altered mental status) after adequate fluid loading (at least 30 mL/kg i.v.), the use of two vasopressors (with one as norepinephrine), and provision of antibiotics. When a lack of improvement is evident in the early stages of resuscitation, systematically considering source control, appropriate volume resuscitation, adequate antimicrobial coverage, vasopressor selection, presence of metabolic pathology, and complications of resuscitation, such as abdominal compartment syndrome and respiratory failure, allow emergency physicians to address the entire clinical scenario. CONCLUSIONS The care of sepsis has experienced many changes in recent years. Care of the patient with sepsis who is not responding appropriately to initial resuscitation is troublesome for emergency physicians. This review provides practical considerations for resuscitation of the patient with septic shock. When a septic patient is refractory to standard therapy, systematically evaluating the patient and clinical course may lead to improved outcomes.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
| | - Katharine L Modisett
- Department of Pulmonary and Critical Care Medicine, MedStar Georgetown University/MedStar Washington Hospital Center, Washington, District of Columbia
| | - Christian J Woods
- Sections of Infectious Diseases and Pulmonary Critical Care, MedStar Washington Hospital Center, Washington, District of Columbia
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142
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Böhler C, Dragana M, Puchner S, Windhager R, Holinka J. Treatment of septic arthritis of the knee: a comparison between arthroscopy and arthrotomy. Knee Surg Sports Traumatol Arthrosc 2016; 24:3147-3154. [PMID: 26017744 DOI: 10.1007/s00167-015-3659-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of this study was to compare the efficacy of arthroscopy and arthrotomy in patients with septic monarthritis of the knee. METHODS Seventy consecutive patients who underwent surgery because of a bacterial monarthritis were evaluated. Patients were either treated with arthroscopy or with arthrotomy. Our primary outcome was the early recurrence of infection (>3 months after surgery), which made a second surgical procedure necessary. Furthermore, the influence of potential confounders on treatment outcome was analysed. RESULTS Of the 70 patients, 41 were treated arthroscopically and 29 with arthrotomy. Eight patients (11.4 %) had to undergo a second surgical procedure because of early re-infection. The rate was significantly higher in patients treated with arthrotomy (n = 6; 20.7 %) compared with those treated by arthroscopy (n = 2) (p = 0.041). Range of motion was significantly better in patients who underwent arthroscopy (p < 0.001). Male sex had negative influence on the treatment success (p = 0.03). CONCLUSIONS Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower re-infection rate and a better functional outcome than those treated with arthrotomy. As arthroscopy is the less invasive method, it should be considered the routine treatment, according to our data. LEVEL OF EVIDENCE Therapeutic study, Level III.
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Affiliation(s)
- Christoph Böhler
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Mirnic Dragana
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stephan Puchner
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Johannes Holinka
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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143
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Dave OH, Patel KA, Andersen CR, Carmichael KD. Surgical Procedures Needed to Eradicate Infection in Knee Septic Arthritis. Orthopedics 2016; 39:50-4. [PMID: 26726974 DOI: 10.3928/01477447-20151222-05] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 06/08/2015] [Indexed: 02/03/2023]
Abstract
Septic arthritis of the knee is encountered on a regular basis by orthopedists and nonorthopedists. No established therapeutic algorithm exists for septic arthritis of the knee, and there is much variability in management. This study assessed the number of surgical procedures, arthroscopic or open, required to eradicate infection. The study was a retrospective analysis of 79 patients who were treated for septic knee arthritis from 1995 to 2011. Patients who were included in the study had native septic knee arthritis that had resolved with treatment consisting of irrigation and debridement, either open or arthroscopic. Logistic regression analysis was used to explore the relation between the interval between onset of symptoms and index surgery and the use of arthroscopy and the need for multiple procedures. Fifty-two patients met the inclusion criteria, and 53% were male, with average follow-up of 7.2 years (range, 1-16.2 years). Arthroscopic irrigation and debridement was performed in 70% of cases. On average, successful treatment required 1.3 procedures (SD, 0.6; range, 1-4 procedures). A significant relation (P=.012) was found between time from presentation to surgery and the need for multiple procedures. With arthroscopic irrigation and debridement, most patients with septic knee arthritis require only 1 surgical procedure to eradicate infection. The need for multiple procedures increases with time from onset of symptoms to surgery.
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144
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Rutherford AI, Subesinghe S, Bharucha T, Ibrahim F, Kleymann A, Galloway JB. A population study of the reported incidence of native joint septic arthritis in the United Kingdom between 1998 and 2013. Rheumatology (Oxford) 2016; 55:2176-2180. [DOI: 10.1093/rheumatology/kew323] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 06/28/2016] [Indexed: 11/13/2022] Open
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145
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Williams M. Diagnostic challenges in acromioclavicular septic arthritis. BMJ Case Rep 2016; 2016:bcr-2016-216034. [PMID: 27257000 DOI: 10.1136/bcr-2016-216034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
A 69-year-old man with Klinefelter's syndrome presented with a painful shoulder and staphylococcal sepsis. He received intravenous antibiotics while investigations were performed to locate the source of infection. MRI demonstrated infection in the acromioclavicular joint (ACJ). The patient clinically improved and a further 5 weeks of oral antibiotics were given. He remained asymptomatic at 2-year follow-up. Although ACJ septic arthritis is rare, independent of immune-competent status, a high index of suspicion is essential for prompt diagnosis. The condition presents additional diagnostic challenges due to unfamiliarity, the challenges of interpreting imaging, desire for radiological guided arthrocentesis and low volume aspirates. Overcoming these pitfalls is essential to avoid significant morbidity and mortality.
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146
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Chiang C, Huang YC, Chang JM, Chen KH. Septic sternoclavicular arthritis, osteomyelitis and mediastinitis. J Acute Med 2016. [DOI: 10.1016/j.jacme.2016.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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147
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Ferrand J, El Samad Y, Brunschweiler B, Grados F, Dehamchia-Rehailia N, Séjourne A, Schmit JL, Gabrion A, Fardellone P, Paccou J. Morbimortality in adult patients with septic arthritis: a three-year hospital-based study. BMC Infect Dis 2016; 16:239. [PMID: 27246346 PMCID: PMC4888402 DOI: 10.1186/s12879-016-1540-0] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 05/05/2016] [Indexed: 01/06/2023] Open
Abstract
Background The objective of this ambispective study was to determine outcomes and associated factors for adult patients with confirmed septic arthritis (SA). Methods All adult patients admitted to Amiens University Hospital between November 2010 and December 2013 with confirmed SA were included in the study. Patients with prosthetic joint infections were excluded. A statistical analysis was performed in order to identify risk factors associated with a poor outcome (including mortality directly attributable to SA). Results A total of 109 patients (mean ± SD age: 60.1 ± 20.1; 74 male/35 females) were diagnosed with SA during the study period. The most commonly involved sites were the small joints (n = 34, 31.2 %) and the knee (n = 25, 22.9 %). The most frequent concomitant conditions were cardiovascular disease (n = 45, 41.3 %) and rheumatic disease (n = 39, 35.8 %). One hundred patients (91.7 %) had a positive microbiological culture test, with Staphylococcus aureus as the most commonly detected pathogen (n = 59, 54.1 %). Mortality directly attributable to SA was relatively infrequent (n = 6, 5.6 %) and occurred soon after the onset of SA (median [range]: 24 days [1–42]). Major risk factors associated with death directly attributable to SA were older age (p = 0.023), high C-reactive protein levels (p = 0.002), diabetes mellitus (p = 0.028), rheumatoid arthritis and other inflammatory rheumatic diseases (p = 0.021), confusion on admission (p = 0.012), bacteraemia (p = 0.015), a low creatinine clearance rate (p = 0.009) and the presence of leg ulcers/eschars (p = 0.003). The median duration of follow-up (in patients who survived for more than 6 months) was 17 months [6–43]. The proportion of poor functional outcomes was high (31.8 %). Major risk factors associated with a poor functional outcome were older age (0.049), hip joint involvement (p = 0.003), the presence of leg ulcers/eschars (p = 0.012), longer time to presentation (0.034) and a low creatinine clearance rate (p = 0.013). Conclusions In a university hospital setting, SA is still associated with high morbidity and mortality rates.
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Affiliation(s)
- Julien Ferrand
- Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France
| | - Youssef El Samad
- Department of Infectious Diseases, Amiens University Hospital, F-80054, Amiens, France
| | | | - Franck Grados
- Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France
| | | | - Alice Séjourne
- Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France
| | - Jean-Luc Schmit
- Department of Infectious Diseases, Amiens University Hospital, F-80054, Amiens, France
| | - Antoine Gabrion
- Department of Orthopaedics, Amiens University Hospital, F-80054, Amiens, France
| | - Patrice Fardellone
- Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France
| | - Julien Paccou
- Department of Rheumatology, Amiens University Hospital, F-80054, Amiens, France.
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148
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Omar M, Reichling M, Liodakis E, Ettinger M, Guenther D, Decker S, Krettek C, Suero EM, Mommsen P. Rapid exclusion of bacterial arthritis using a glucometer. Clin Rheumatol 2016; 36:591-598. [PMID: 27071629 DOI: 10.1007/s10067-016-3255-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Revised: 03/30/2016] [Accepted: 04/01/2016] [Indexed: 11/26/2022]
Abstract
Bacterial arthritis is a medical emergency. However, prompt diagnosis and differentiation from non-infectious diseases are challenging. As bacterial metabolism leads to glucose reduction, measurement of synovial fluid glucose seems to be a promising diagnostic approach. The purpose of this study was to determine whether synovial fluid glucose levels could be accurately measured by using a glucometer and to evaluate its diagnostic accuracy in diagnosing bacterial arthritis compared to currently available markers. In a prospective diagnostic study, 102 consecutive patients with atraumatic joint effusion were included. Synovial fluid glucose concentrations were determined using both glucometer and automated analyzer respectively. Synovial fluid culture, crystal analysis, and synovial cell analysis were performed. Blood samples were taken for blood cultures, analyses of serum infection markers, and serum glucose. There was a high correlation between synovial fluid glucose measured by the glucometer and the automated analyzer (r 2 = 0.92). According to the receiver operating characteristic curve, a threshold of 1.4 mmol/l had a sensitivity of 100 % (95 % CI 78.2-100 %), a specificity of 92.0 % (95 % CI 84.1-96.7 %), a positive predictive value of 68.2 % (95 % CI 45.1-86.1 %), and a negative predictive value of 100 % (95 % CI 95.5-100 %). These results suggest that synovial fluid glucose concentrations could be reliably measured using a glucometer. Due to its simplicity, this test has the potential to be an adjunct in the diagnostic cascade of bacterial arthritis.
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Affiliation(s)
- Mohamed Omar
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Moritz Reichling
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Max Ettinger
- Orthopedic Surgery Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany
| | - Daniel Guenther
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sebastian Decker
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Christian Krettek
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Eduardo M Suero
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Philipp Mommsen
- Trauma Department, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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149
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Scharf VF, Lewis DD, Wellehan JF, Wamsley HL, Richardson R. Comparison of synovial fluid culture and 16S rRNA PCR in dogs with suspected septic arthritis. Aust Vet J 2016; 93:204-7. [PMID: 26010926 DOI: 10.1111/avj.12329] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 09/15/2014] [Accepted: 09/28/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To prospectively compare the sensitivity and specificity of 16S rRNA PCR with culture for identifying the causative organism in synovial fluid obtained from dogs with suspected septic arthritis. METHODS Synovial fluid cytology, PCR analysis and aerobic, anaerobic and Mycoplasma culture of samples from the affected joints of 18 dogs presenting with suspected septic arthritis were performed. Synovial fluid samples from the corresponding contralateral joints of 7 dogs were also analysed as negative controls. RESULTS There was no significant difference between the sensitivity of bacterial detection via culture (63.2%) versus PCR (73.7%) of synovial fluid (P=0.728) or between culture and combined PCR and culture (89.5%) of synovial fluid (P=0.124). The specificity of PCR (42.9%) was significantly lower than culture specificity (100%) (P=0.07). CONCLUSION Although 16S PCR may hold potential as an ancillary diagnostic test for identifying the causative organism in dogs with septic arthritis, our study failed to demonstrate improved accuracy compared with traditional synovial fluid culture.
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Affiliation(s)
- V F Scharf
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - D D Lewis
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - J F Wellehan
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - H L Wamsley
- Department of Physiologic Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - R Richardson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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150
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MALDI-TOF MS performance compared to direct examination, culture, and 16S rDNA PCR for the rapid diagnosis of bone and joint infections. Eur J Clin Microbiol Infect Dis 2016; 35:857-66. [PMID: 26942744 DOI: 10.1007/s10096-016-2608-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/15/2016] [Indexed: 01/10/2023]
Abstract
The rapid identification of bacterial species involved in bone and joint infections (BJI) is an important element to optimize the diagnosis and care of patients. The aim of this study was to evaluate the usefulness of matrix-assisted laser desorption ionization mass spectrometry (MALDI-TOF MS) for the rapid diagnosis of bone infections, directly on synovial fluid (SF) or on crushed osteoarticular samples (CS). From January to October 2013, we prospectively analyzed 111 osteoarticular samples (bone and joint samples, BJS) from 78 patients in care at the University Hospital of Rennes, France. The diagnosis procedure leading to the sample collection was linked to a suspicion of infection, inflammatory disease, arthritis, or for any bone or joint abnormalities. Standard bacteriological diagnosis and molecular biology analysis [16S rRNA polymerase chain reaction (PCR) and sequencing] were conducted. In addition, analysis by MALDI-TOF MS was performed directly on the osteoarticular samples, as soon as the amount allowed. Culture, which remains the gold standard for the diagnosis of BJI, has the highest sensitivity (85.9 %) and remains necessary to test antimicrobial susceptibility. The 16S rDNA PCR results were positive in the group with positive BJI (28.6 %) and negative in the group without infection. Direct examination remains insensitive (31.7 %) but more effective than MALDI-TOF MS directly on the sample (6.3 %). The specificity was 100 % in all cases, except for culture (74.5 %). Bacterial culture remains the gold standard, especially enrichment in blood bottles. Direct analysis of bone samples with MALDI-TOF MS is not useful, possibly due to the low inoculum of BJS.
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