1
|
Wu KA, Kugelman DN, Seidelman JL, Seyler TM. Native Joint Septic Arthritis. Antibiotics (Basel) 2024; 13:596. [PMID: 39061278 PMCID: PMC11274354 DOI: 10.3390/antibiotics13070596] [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: 05/30/2024] [Revised: 06/20/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024] Open
Abstract
Native joint septic arthritis (NJSA) is a severe and rapidly progressing joint infection, predominantly bacterial but also potentially fungal or viral, characterized by synovial membrane inflammation and joint damage, necessitating urgent and multidisciplinary management to prevent permanent joint damage and systemic sepsis. Common in large joints like knees, hips, shoulders, and elbows, NJSA's incidence is elevated in individuals with conditions like rheumatoid arthritis, diabetes, immunosuppression, joint replacement history, or intravenous drug use. This review provides a comprehensive overview of NJSA, encompassing its diagnosis, treatment, antibiotic therapy duration, and surgical interventions, as well as the comparison between arthroscopic and open debridement approaches. Additionally, it explores the unique challenges of managing NJSA in patients who have undergone graft anterior cruciate ligament (ACL) reconstruction. The epidemiology, risk factors, pathogenesis, microbiology, clinical manifestations, diagnosis, differential diagnosis, antibiotic treatment, surgical intervention, prevention, and prophylaxis of NJSA are discussed, highlighting the need for prompt diagnosis, aggressive treatment, and ongoing research to enhance patient outcomes.
Collapse
Affiliation(s)
- Kevin A. Wu
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA; (K.A.W.)
| | - David N. Kugelman
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA; (K.A.W.)
| | - Jessica L. Seidelman
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA
| | - Thorsten M. Seyler
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA; (K.A.W.)
| |
Collapse
|
2
|
Ozbek L, Kyriakides J, Asokan A. A case of otogenic septic arthritis of the knee. J Surg Case Rep 2023; 2023:rjad682. [PMID: 38115949 PMCID: PMC10728415 DOI: 10.1093/jscr/rjad682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023] Open
Abstract
Septic arthritis is a serious condition resulting in rapid destruction of articular cartilage and potential sepsis. Bacterial invasion of a joint occurs most commonly as a result of haematogenous spread from a distant infection. However, an otogenic source of this transient bacteraemia and resultant septic arthritis has not yet been reported in the literature. We report a case of acute septic arthritis of the knee with Streptococcus pyogenes, secondary to acute otitis media of the ear.
Collapse
Affiliation(s)
- Leyla Ozbek
- Otolaryngology Department, University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Jonathon Kyriakides
- Trauma and Orthopaedics Department, Barnet Hospital, Wellhouse Lane, London EN5 3DJ, United Kingdom
| | - Ajay Asokan
- Trauma and Orthopaedics Department, Barnet Hospital, Wellhouse Lane, London EN5 3DJ, United Kingdom
| |
Collapse
|
3
|
Lu V, Zhou A, Hussain HA, Thahir A, Krkovic M. Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre. Clin Rheumatol 2022; 41:2513-2523. [PMID: 35366159 PMCID: PMC9287235 DOI: 10.1007/s10067-022-06151-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/19/2023]
Abstract
Background Septic arthritis (SA) is a dangerous condition that requires emergency treatment. Managed by culture-specific antibiotics, irrigation, and debridement (I&D), some patients require repeat surgical treatment. The objectives were to determine the risk factors for SA and risk factors for repeat arthroscopic I&D in SA patients. We hypothesized that variables which directly or indirectly contributed to a larger infection burden would be associated with the development of SA and the need for repeat arthroscopic I&D. Methods All patients ≥ 18 years old presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2018 and January 2020 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma and metalwork in the affected joint, periprosthetic joint infection, previous joint arthroplasty surgery, soft tissue infection, missing data, transferred to another centre, diagnosis not concerning the joint, and < 24-month follow-up were excluded. Two hundred eleven patients were included (SA: 28; pseudogout: 32; gout: 50; others: 101). Variables of interest in the 3-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariable analysis. A multivariable logistic regression model was formed using covariates with corresponding univariable tests of p < 0.200. Similar analyses were performed to compare SA patients with multiple washouts/procedures with those with one washout/procedure. Results Multivariable analysis showed multiple risk factors for SA, namely rheumatoid arthritis (RA) (OR: 3.4; 95% CI: 1.2–10.0; p = 0.023); skin infection (OR: 3.3; 95% CI: 1.2–9.0; p = 0.017), liver disease (OR: 9.9; 95% CI: 2.2–43.9; p = 0.003), knee joint involvement (OR: 3.5; 95% CI: 1.3–9.4; p = 0.014), and use of immunosuppressive medication (OR: 3.5; 95% CI: 1.2–10.6; p = 0.027). Risk factors for multiple washouts included synovial WBC levels > 10.5 × 109 cells/L (OR: 3.0; 95% CI: 2.3–38.8; p = 0.009) and RA (OR: 3.5; 95% CI: 1.9–66.3; p = 0.017). Conclusions These findings suggest that prophylactic actions against septic arthritis should be targeted at patients with liver disease, RA, or skin infection. Repeat arthroscopic I&D of septic joints may be needed, especially in patients with synovial WBC levels > 10.5 × 109 cells/L and RA. Key Points • The risk factors for septic arthritis determined in this study are rheumatoid arthritis, skin infection, liver disease, knee joint involvement, and immunosuppressant usage. • Some septic arthritis patients need multiple rounds of arthroscopic irrigation and debridement. The risk factors for this are a synovial WBC count > 10.5 × 109 cells/L and rheumatoid arthritis. |
Supplementary Information The online version contains supplementary material available at 10.1007/s10067-022-06151-w.
Collapse
Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK. .,Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK.
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | | | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| |
Collapse
|
4
|
Khubaib MU, Stark BE, Gross B, Gross ML, Vazquez O. A Rare Case of Septic Knee Arthritis Caused by Clostridium perfringens in a Patient With Colostomy. Cureus 2021; 13:e16823. [PMID: 34522480 PMCID: PMC8425027 DOI: 10.7759/cureus.16823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2021] [Indexed: 11/30/2022] Open
Abstract
Septic arthritis of the knee is commonly caused by aerobic organisms. Rarely, it can be caused by Clostridium perfringens, usually due to penetrating trauma. This is a rare case of C. perfringens septic arthritis in a patient with colostomy due to hematogenous spread. The patient was treated successfully with a synovectomy and a prolonged intravenous antibiotic course. The case report summarizes the existing literature on the topic and discusses the diagnosis, management, and prognosis of such cases as well.
Collapse
Affiliation(s)
| | - Brett E Stark
- Orthopaedic Surgery, Active Orthopedics & Sports Medicine, Hackensack, USA
| | - Benjamin Gross
- Sports Medicine, Active Orthopedics & Sports Medicine, Hackensack, USA
| | - Michael L Gross
- Sports Medicine, Active Orthopedics & Sports Medicine, Hackensack, USA
| | - Oscar Vazquez
- Sports Medicine, Active Orthopedics & Sports Medicine, Hackensack, USA
| |
Collapse
|
5
|
Mahlouly J, Lhopitallier L, Suttels V, Mueller L, Wernly D, Borens O, Steinmetz S. Septic arthritis of the shoulder due to Ureaplasma urealyticum after emergency caesarean section: a case report. BMC Infect Dis 2020; 20:767. [PMID: 33069221 PMCID: PMC7568409 DOI: 10.1186/s12879-020-05497-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Ureaplasma urealyticum is an intra-cellular bacterium frequently found colonizing the genital tract. Known complications include localized infections, which can result in premature deliveries. Septic arthritis due to U. urealyticum in healthy patients is exceptionally rare, although opportunistic septic arthritis in agammaglobulinemic patients have been reported. However, there are no reports of septic arthritis due to U. urealyticum following caesarean section or in the post-partum period. Case presentation A 38-year-old immunocompetent woman presented with severe right shoulder pain, 1 month following emergency caesarean section at 26 weeks of gestation for pre-eclampsia and spontaneous placental disruption with an uncomplicated post-operative recovery. Our suspicion of septic arthritis was confirmed with abundant pus following arthrotomy by a delto-pectoral approach. Awaiting culture results, empirical antibiotic treatment with intravenous amoxicilline and clavulanic acid was initiated. In spite of sterile cultures, clinical evolution was unfavorable with persistent pain, inflammation and purulent drainage, requiring two additional surgical débridement and lavage procedures. The 16S ribosomal RNA PCR of the purulent liquid was positive for U. urealyticum at 2.95 × 106 copies/ml, specific cultures inoculated a posteriori were positive for U. urealyticum. Levofloxacin and azithromycine antibiotherapy was initiated. Susceptibility testing showed an intermediate sensibility to ciprofloxacin and clarithromycin. The strain was susceptible to doxycycline. Following cessation of breastfeeding, we started antibiotic treatment with doxycycline for 4 weeks. The subsequent course was favorable with an excellent functional and biological outcome. Conclusions We report the first case of septic arthritis due to U. urealyticum after caesarean section. We hypothesize that the breach of the genital mucosal barrier during the caesarean section led to hematogenous spread resulting in purulent septic arthritis. The initial beta-lactam based antibiotic treatment, initiated for a purulent arthritis, did not provide coverage for cell wall deficient organisms. Detection of 16S rRNA allowed for a correct microbiological diagnosis in a patient with an unexpected clinical course.
Collapse
Affiliation(s)
- Jaad Mahlouly
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Loic Lhopitallier
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Véronique Suttels
- Department of Infectious Diseases, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Linda Mueller
- Institute of Microbiology, University of Lausanne, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Diane Wernly
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Olivier Borens
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Sylvain Steinmetz
- Department of Orthopaedics and Traumatology, Lausanne University Hospital (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| |
Collapse
|
6
|
Fornwalt BE, Goosmann M, Reynolds S, Bunevich JD. Sternoclavicular joint septic arthritis presenting as cervical abscess and subcutaneous emphysema: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20902874. [PMID: 32110404 PMCID: PMC7000855 DOI: 10.1177/2050313x20902874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 12/31/2019] [Indexed: 11/23/2022] Open
Abstract
Sternoclavicular joint septic arthritis results from hematogenous spread of a
bacterial infection, usually in the immunocompromised. It commonly presents as a
chest wall abscess. Cervical abscess resulting from sternoclavicular joint
septic arthritis is a rare complication with only one reported case in the
English literature. We describe a case of sternoclavicular joint septic
arthritis in an elderly diabetic adult with cervical abscess as initial
presentation.
Collapse
Affiliation(s)
- Brandon E Fornwalt
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | | | - Stephen Reynolds
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| | - Jared D Bunevich
- Department of Otolaryngology, Bon Secours Mercy Health-St. Elizabeth Boardman Hospital, Boardman, OH, USA
| |
Collapse
|
7
|
Bacterial septic arthritis infections associated with intra-articular injection practices for osteoarthritis knee pain-New Jersey, 2017. Infect Control Hosp Epidemiol 2019; 40:1013-1018. [PMID: 31311611 DOI: 10.1017/ice.2019.168] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND In March 2017, the New Jersey Department of Health received reports of 3 patients who developed septic arthritis after receiving intra-articular injections for osteoarthritis knee pain at the same private outpatient facility in New Jersey. The risk of septic arthritis resulting from intra-articular injection is low. However, outbreaks of septic arthritis associated with unsafe injection practices in outpatient settings have been reported. METHODS An infection prevention assessment of the implicated facility's practices was conducted because of the ongoing risk to public health. The assessment included an environmental inspection of the facility, staff interviews, infection prevention practice observations, and a medical record and office document review. A call for cases was disseminated to healthcare providers in New Jersey to identify patients treated at the facility who developed septic arthritis after receiving intra-articular injections. RESULTS We identified 41 patients with septic arthritis associated with intra-articular injections. Cultures of synovial fluid or tissue from 15 of these 41 case patients (37%) recovered bacteria consistent with oral flora. The infection prevention assessment of facility practices identified multiple breaches of recommended infection prevention practices, including inadequate hand hygiene, unsafe injection practices, and poor cleaning and disinfection practices. No additional cases were identified after infection prevention recommendations were implemented by the facility. DISCUSSION Aseptic technique is imperative when handling, preparing, and administering injectable medications to prevent microbial contamination. CONCLUSIONS This investigation highlights the importance of adhering to infection prevention recommendations. All healthcare personnel who prepare, handle, and administer injectable medications should be trained in infection prevention and safe injection practices.
Collapse
|
8
|
A case of acute septic arthritis of the hip joint caused by Panton-Valentine leukocidin-positive ST772 community-acquired methicillin-resistant Staphylococcus aureus. J Infect Chemother 2018; 25:212-214. [PMID: 30217733 DOI: 10.1016/j.jiac.2018.08.015] [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: 07/31/2018] [Revised: 08/07/2018] [Accepted: 08/21/2018] [Indexed: 11/24/2022]
Abstract
Acute septic arthritis (ASA) caused by Staphylococcus aureus can lead to fulminant arthritis and cause permanent joint destruction. In particular, infection caused by methicillin-resistant Staphylococcus aureus (MRSA) becomes intractable and severe owing to limitation of therapeutic drugs. Here, we report the case of a young patient with ASA without any record of overseas travel, who was infected by the Panton-Valentine leukocidin-positive Bengal-Bay clone, which is a predominant community-acquired MRSA in India.
Collapse
|
9
|
Malachovsky I, Janickova M, Stasko J, Kasaj M, Sadlonova V, Novakova E, Gengelova P, Smatanová M, Statelová D. Pseudomonas Infection of the Temporomandibular Joint (TMJ) Health and Public Health Issues. ACTA MEDICA MARTINIANA 2017. [DOI: 10.1515/acm-2017-0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The authors describe a case of a rare infectious disease of intra-articular tissues of the temporomandibular joint caused mainly by Pseudomonas aeruginosa. In scientific literature, under the heading invasive (malignant) external otitis, we can find cases of an infectious disease of the external acoustic meatus caused by a microbial agent of Pseudomonas aeruginosa which can subsequently penetrate into structures. However, a primary affliction of the abovementioned structures has not been described. Localisation and severity of the infection requires long-term and massive treatment with antibiotics.
Collapse
Affiliation(s)
- I. Malachovsky
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Janickova
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - J. Stasko
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Kasaj
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - V. Sadlonova
- Institute of Microbiology, Comeniu University, Jessenius Faculty of Medicine, Martin , Slovakia
| | - E. Novakova
- Institute of Microbiology, Comeniu University, Jessenius Faculty of Medicine, Martin , Slovakia
| | - P. Gengelova
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - M. Smatanová
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Martin , Slovakia
| | - D. Statelová
- Clinic of Stomatology and Maxillofacial Surgery, Comenius University, Jessenius Faculty of Medicine and University Hospital Martin, Kollarova Str.N. 2,036 59, Martin , Slovak Republic
| |
Collapse
|
10
|
Abstract
To evaluate the efficacy and safety of intraarticular propolis compared with systemic antibiotic treatment in an experimental septic arthritis model. Thirty-two rabbits were infected intraarticularly by Staphylococcus aureus. The rabbits were randomly divided into four groups, including a control group and three experimental groups. Drainage was the only procedure performed in group I (control group). The animals were treated with daily intramuscular cefazolin sodium (75 mg/kg) for 7 days in group II. In group III, intraarticular ethanolic extract of propolis (0.5 mg/ml) was injected to the infected knees under sterile conditions on days 7, 14, and 21 after drainage. In group IV, the rabbits received both intramuscular cefazolin sodium as in group II and intraarticular ethanolic extract of propolis as in group III. After 8 weeks, the animals were killed and joint histopathological and scanning electron microscopic parameters were assessed. The best clinical score was obtained in group IV. There were statistically significant differences among all the groups (P<0.05). The highest total score of the histological examination was found in group I and the best total score was obtained in group IV. There were statistically significant differences among the groups when we evaluated the scores of the parameters as loss of chondrocytes, loss of matrix, and pannus in-growth (P<0.05). But there was no significant difference among the groups for the scores of cloning of the chondrocytes (P>0.05). The highest scanning electron microscopy score was found in group I and the best score was obtained in group IV. Our results confirm the safety and efficacy of intraarticular propolis and synergistic effect of propolis when used with cefazolin in an experimental septic arthritis model.
Collapse
|
11
|
Weiss S, Geiss H, Kommerell M, Simank HG, Bernd L, Henle P. [Improving the diagnosis of septic arthritis by use of a pediatric blood culture system]. DER ORTHOPADE 2007; 35:456, 458-62. [PMID: 16344955 DOI: 10.1007/s00132-005-0900-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Prognosis and outcome of bacterial joint infections are dependent on the fast and reliable identification of pathogens in the synovial fluid. Previous studies have suggested the possible advantage of using a blood culture system in contrast to conventional culture methods. PATIENTS AND METHODS A total of 101 synovial specimens from patients presenting with symptoms suggesting septic arthritis were taken by aspiration with a sterile syringe. We compared the diagnostic results of automated analysis in a blood culture system against conventional culture on solid agar plates. RESULTS Some 67 specimens (66.3%) were found to be negative in both preparations, while samples from 21 patients (20.8%) yielded the same microorganisms. In 13 cases (12.9%), the isolation of a pathogen was possible only with the blood culture method, whereas the conventional method never yielded a positive result when the blood culture was negative. Thus, the diagnostic yield was significantly improved by use of the blood culture system (P <0.001). CONCLUSION The use of a commonly available blood culture system offers a fast, reliable and cost-effective approach for the diagnosis of septic arthritis and should therefore be considered as an useful alternative to conventional culture methods.
Collapse
Affiliation(s)
- S Weiss
- Abteilung Orthopädie I, Stiftung Orthopädische Universitätsklinik Heidelberg
| | | | | | | | | | | |
Collapse
|
12
|
Carson CC. Efficacy of antibiotic impregnation of inflatable penile prostheses in decreasing infection in original implants. J Urol 2004; 171:1611-4. [PMID: 15017233 DOI: 10.1097/01.ju.0000118245.66976.e1] [Citation(s) in RCA: 155] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We compared infection rates in original inflatable penile prostheses implants between prostheses impregnated with InhibiZone (American Medical Systems, Minnetonka, Minnesota), an antibiotic surface treatment, and prostheses without antibiotic treatment. MATERIALS AND METHODS We retrospectively reviewed patient information forms filed with the manufacturer following original implantation in the United States to implant AMS 700 series penile prostheses (American Medical Systems) between May 1, 2001 and April 30, 2003. We compared results in 4205 men, including 2261 with a mean age of 60.71 years who received prostheses with InhibiZone, a surface treatment combining rifampin and minocycline hydrochloride, and a control group of 1944 with a mean age of 61.04 years who received untreated prostheses. Followup in the treatment and control groups was 0 to 11.5 months (mean 5 and 8, respectively). In the treatment group only implants in which all components were treated were included. RESULTS The reported incidence of infection after 60 days was 0.28% in the treated group and 1.59% in the control group (p = 0.0034). After 180 days the infection rate in the treated and control groups was 0.68% and 1.61%, respectively (p = 0.0047). The treated group had an infection rate that was 82.4% lower than in the control group after 60 days and 57.8% lower after 180 days. Erectile dysfunction etiologies occurred at statistically similar rates in the 2 groups and did not impact infection rate results. CONCLUSIONS The use of InhibiZone to target postoperative infections results in a statistically significant decrease in penile prosthesis infection rates in original implants. Infection rates in the control group were consistent with those in the published literature.
Collapse
Affiliation(s)
- Culley C Carson
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
13
|
Abstract
Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection.
Collapse
Affiliation(s)
- Mark E Shirtliff
- Center for Biofilm Engineering Montana State University, Bozeman, Montana 59717-3980, USA.
| | | |
Collapse
|
14
|
Abstract
Prosthetic devices are a cornerstone of urologic surgical care. The most disastrous complication of these surgical procedures is infection. The prevention, identification, and management of infections are critical to maintaining functional urologic prosthetic devices. Although the incidence is low, rapid identification of infections once they occur and proper management with antibiotics, surgical intervention, irrigation, and salvage procedures can maintain the function of urologic prosthetic devices despite clinical infection.
Collapse
Affiliation(s)
- C C Carson
- Division of Urology, University of North Carolina School of Medicine, Chapel Hill 27599, USA
| |
Collapse
|
15
|
Morgan DS, Fisher D, Merianos A, Currie BJ. An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 1996; 117:423-8. [PMID: 8972665 PMCID: PMC2271655 DOI: 10.1017/s0950268800059070] [Citation(s) in RCA: 148] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A retrospective study of 191 cases of septic arthritis was undertaken at Royal Darwin Hospital in the tropical north of Australia. Incidence was 9.2 per 100,000 overall and 29.1 per 100,000 in Aboriginal Australians (RR 6.6; 95% CI 5.0-8.9). Males were affected more than females (RR 1.6; 95% CI 1.2-2.1). There was no previous joint disease or medical illness in 54%. The commonest joints involved were the knee (54%) and hip (13%). Significant age associations were infected hips in those under 15 years and infected knees in those over 45 years. Seventy two percent of infections were haematogenous. Causative organisms included Staphylococcus aureus (37%), Streptococcus pyogenes (16%) and Neisseria gonorrhoeae (12%). Unusual infections included three melioidosis cases. Polyarthritis occurred in 17%, with N. gonorrhoeae (11/23) more likely to present as polyarthritis than other organisms (22/168) (OR 6.0; 95% CI 2.1-16.7). Univariate and multivariate analysis showed the hip to be at greater risk for S. aureus than other joints. Open arthrotomy was a more successful treatment procedure than arthroscopic washout or needle aspiration.
Collapse
Affiliation(s)
- D S Morgan
- Division of Medicine, Royal Darwin Hospital, Northern Territory, Australia
| | | | | | | |
Collapse
|
16
|
Affiliation(s)
- E Cardinal
- Department of Radiology, Indiana University Hospital, Indianapolis, USA
| | | | | | | |
Collapse
|
17
|
Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA. Risk factors for septic arthritis in patients with joint disease. A prospective study. ARTHRITIS AND RHEUMATISM 1995; 38:1819-25. [PMID: 8849354 DOI: 10.1002/art.1780381215] [Citation(s) in RCA: 244] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To quantify potential risk factors for septic arthritis, in order to identify a basis for prevention. METHODS The occurrence of potential risk factors for septic arthritis in patients with joint diseases attending a rheumatic disease clinic was prospectively monitored at 3-month intervals over a period of 3 years. Potential risk factors investigated were type of joint disease, comorbidity, medication, joint prosthesis, infections, and invasive procedures. The frequencies of risk factors in patients with and those without septic arthritis were compared using multiple logistic regression analysis. RESULTS There were 37 patients with and 4,870 without septic arthritis. Risk factors for developing septic arthritis were age > or = 80 years (odds ratio [OR] = 3.5, 95% confidence interval [95% CI] 1.4-8.6), diabetes mellitus (OR = 3.3, 95% CI 1.1-10.1), rheumatoid arthritis (OR = 4.0, 95% CI 1.9-8.3), hip and/or knee prosthesis (OR = 15, 95% CI 4.1-54.3), joint surgery (OR = 5.1, 95% CI 2.2-11.9), and skin infection (OR = 27.2, 95% CI 7.6-97.1). CONCLUSION These findings indicate that preventive measures against septic arthritis in patients with joint diseases should mainly be directed at those with joint prostheses and/or skin infection.
Collapse
Affiliation(s)
- C J Kaandorp
- Jan van Breemen Institute for Rheumatology and Rehabilitation, Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
18
|
|