[Articular infections due to intra-articular corticosteroid therapy]

Septic and aseptic complications of corticosteroid injections: an assessment of 278 cases reviewed by expert commissions and mediation boards from 2005 to 2009

BACKGROUND

Local corticosteroid injections can have serious septic and aseptic complications.

METHODS

From 2005 to 2009, medical expert committees and mediation boards reviewed 1528 cases of alleged treatment errors relating to injections.

RESULTS

278 cases were identified in which complications arose after local glucocorticosteroid injections. The injections were intra-articular, paravertebral, intramuscular, and at other sites. In 39.6% of cases, treatment errors or patient information errors of the following types were found: aseptic technique was not maintained, injections were performed in the absence of an indication, time intervals between injections were too short, excessive doses were administered, infections were not diagnosed, erroneous injections were performed, patients were not informed of the risks, and there were errors of organization and documentation.

CONCLUSIONS

Injections of glucocorticosteroids must be performed in strict adherence to the manufacturer's instructions with respect to the composition of the solution to be injected, the quantity per injection, and the intervals between injections. Repeated injections with too little time between them raise the risk of infection. Physicians should pay more attention to this fact, particularly when deciding on the indication for paravertebral injections. Aseptic technique should be strictly maintained. The indication for the injection should be clearly documented. When glucocorticosteroids are injected into small joints and tendon spaces, the introduction of crystals into the subcutaneous tissue and adipose tissue should be avoided. The intramuscular administration of depot glucocorticosteroids should be avoided. Patients should be informed of the risk of infection and/or tissue atrophy, as well as of alternative forms of treatment.

[Indications, technic and dangers of intra-articular injection treatment of the knee]

The indication for knee injection depends on the drugs to be used and the illness to be treated. These are lot of degenerative and inflammatory joint pains which demand for monarticular treatment by corticosteroid crystal suspension, local anaesthetica, non-steroidal antiinflammatory substances or drugs for chemical synovectomy in PCP. The technique is quite easy as for the big volume and the broad entrance of the articular space when the knee is flexed. The demand of hygienic circumstances must content a handling which prevents infection by quite simple methods by local antiseptics for the skin and one-way instruments. With the seldom exception of haemarthros and osteochondral necrosis infection is the utmost danger of knee injection. The putride arthritis should be managed by early synovectomia and movement trauma in order to limit infection and prevent ankylosis. Nevertheless, in case of empyema half of the joints will not regain their pre-existent movement and nearly a quarter loses their natural function.