1
|
Ji JH, Parikh D, Hwang BJ, Jeong J, Oh S. Extra-Articular Abscess Expansion as a Specific Complication of Septic Arthritis of the Shoulder Joint: Report of Three Cases with Extension of the Infection through the Biceps Groove Producing a Large Abscess. Orthop Surg 2024. [PMID: 39223827 DOI: 10.1111/os.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 08/02/2024] [Accepted: 08/06/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Septic arthritis of shoulder is a rare clinical entity as the metaphysis is extracapsular and there is no communication between epiphyseal and metaphyseal vessels. Septic arthritis of the shoulder joint is a diagnostic and surgical emergency because joint destruction develops rapidly and can cause significant morbidity and mortality. Unusual complications of septic arthritis of the shoulder joint may include extra-articular abscess extension to the upper arm through the biceps groove and osteomyelitis of the greater tuberosity. CASE PRESENTATION Septic arthritis of the shoulder, if left untreated, can lead to complications such as extra-articular abscess extension and osteomyelitis. Three patients with septic arthritis of the shoulder joint with no clear history of trauma were reported in this study. The initial presentation was pseudoparalysis with upper arm swelling. MRI diagnosed septic arthritis of shoulder joint together with an upper arm abscess. Arthroscopic debridement with through irrigation and open drainage of the extra-articular abscess extension to the upper arm improved both the shoulder pain and abscess completely. However, if shoulder pain or abnormalities in laboratory findings continue after initial treatment, uncontrolled septic arthritis or secondary osteomyelitis are possibilities that should be concerned. MRI is a useful tool for detecting those atypical complications. CONCLUSIONS Rarely, septic arthritis of the shoulder joint can extend to the upper arm through the biceps tendon groove and cause an abscess. Also, acute osteomyelitis of the tuberosity should be considered in patients with long-standing refractory septic arthritis of the shoulder joint who have continued pain and uncontrolled laboratory findings after initial treatment.
Collapse
Affiliation(s)
- Jong-Hun Ji
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Darshil Parikh
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Byung-Jun Hwang
- Department of Orthopedic Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jinyoung Jeong
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seungbae Oh
- Department of Orthopedic Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
2
|
McKenna DP, Miller P, McAleese T, Cleary M. Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review. J Exp Orthop 2024; 11:e12041. [PMID: 38846377 PMCID: PMC11154831 DOI: 10.1002/jeo2.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/19/2024] [Accepted: 04/23/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose Septic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy. Methods A systematic review and meta-analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all-cause complications, length of inpatient stay and mortality secondary outcomes. Results A total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72-1.02], I 2 = 36%). Eligible studies found in favour of arthroscopy for all-cause complication rate (risk ratio 0.75 [95% CI: 0.6-0.93], I 2 = 84%) and length of stay in hospital (mean difference -1.98 days [95% CI: -3.43 to -0.53], I 2 = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52-2.63], I 2 = 57%). Conclusion Our analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All-cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates. Level of Evidence Level III.
Collapse
Affiliation(s)
- Daniel P. McKenna
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
| | - Peggy Miller
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
| | - Timothy McAleese
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
| | - May Cleary
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
| |
Collapse
|
3
|
Jetanalin P, Raksadawan Y, Inboriboon PC. Orthopedic Articular and Periarticular Joint Infections. Emerg Med Clin North Am 2024; 42:249-265. [PMID: 38641390 DOI: 10.1016/j.emc.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2024]
Abstract
Acute nontraumatic joint pain has an extensive differential. Emergency physicians must be adept at identifying limb and potentially life-threatening infection. Chief among these is septic arthritis. In addition to knowing how these joint infections typically present, clinicians need to be aware of host and pathogen factors that can lead to more insidious presentations and how these factors impact the interpretation of diagnostic tests.
Collapse
Affiliation(s)
- Pim Jetanalin
- Department Medicine, Division of Rheumatology, University of Illinois at College of Medicine, 818 South Wolcott Avenue, 6th Floor, MC 733, Chicago, IL 60612, USA.
| | - Yanint Raksadawan
- Department of Medicine, Weiss Memorial Hospital, Medical Education, 4646 N. Marine Drive, Chicago, IL 60640, USA
| | - Pholaphat Charles Inboriboon
- Department of Emergency Medicine, University of Illinois at College of Medicine, 808 South Wood Street MC 724, Chicago, IL, USA
| |
Collapse
|
4
|
Eze B, Green JT, Asante R, Okobi OE, Mercene KGF, Ogbodo CT, Anamazobi EG, Alozie AS. Trends in Arthritis Prevalence and Associated Chronic Health Indicators Among Adults: Insights From the Behavioral Risk Factor Surveillance System (BRFSS) Database. Cureus 2024; 16:e58925. [PMID: 38800280 PMCID: PMC11122663 DOI: 10.7759/cureus.58925] [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] [Accepted: 04/24/2024] [Indexed: 05/29/2024] Open
Abstract
Background Arthritis is a prevalent, chronic condition with significant implications for morbidity and healthcare utilization. Understanding trends in arthritis prevalence and associated chronic health indicators is vital for informing public health interventions and healthcare policies. Objective This retrospective study aimed to analyze trends in arthritis prevalence and associated chronic health indicators among adults using data from the Behavioral Risk Factor Surveillance System (BRFSS) database. Methods This retrospective study utilized data from the BRFSS database covering 2019 to 2022. Participants included United States adults aged 18 years and older who completed BRFSS surveys during the specified period. Primary variables included arthritis prevalence and its correlation with chronic health indicators and demographics. Data collection involved standardized telephone questionnaires administered annually, with rigorous attention to data quality and consistency. Prevalence estimates were calculated using weighted proportions, and statistical analysis utilized analysis of variance (ANOVA). Results The study revealed relatively stable arthritis prevalence over the study period, with notable demographic variations. Arthritis prevalence remained stable (2019: 43.3%, 2021: 42.5%). Females consistently had higher rates than males (2019: 45%, 2021: 44.9%). Activity limitation, joint pain, and work limitation were more prevalent in arthritis patients. White, non-Hispanic individuals had higher rates than other groups. Physical inactivity increased from 2019 (29.4%) to 2022 (72.4%), particularly in males. Counseling for physical activity was lower in males. Targeted interventions are needed to address these disparities and improve arthritis management. Conclusion This study provides insights into trends in arthritis prevalence and associated chronic health indicators among United States adults. The findings underscore the importance of considering demographic factors in arthritis prevention and management strategies. Targeted interventions promoting physical activity counseling, particularly among high-risk populations, are warranted to address the rising trend of physical inactivity among individuals with arthritis.
Collapse
Affiliation(s)
- Blessing Eze
- Internal Medicine, Creighton University School of Medicine, Phoenix, USA
| | | | | | - Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Charles T Ogbodo
- Internal Medicine, Médecins Sans Frontières (Doctors without Borders), Talata Mafara, NGA
| | | | | |
Collapse
|
5
|
Alamdaran SA, Taheri-Nezhad M, Nouri A, Khoroushi F, Aalami MH, Malek A, Mohtasham A, Alizadeh M. Role of ultrasound and inflammatory factors in the management of pediatric hip joint effusion. Pediatr Rheumatol Online J 2023; 21:146. [PMID: 38115094 PMCID: PMC10729365 DOI: 10.1186/s12969-023-00922-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 11/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Septic arthritis is an important differential diagnosis of hip joint pain. Joint aspiration analysis is a necessary diagnostic measure for septic arthritis. In order to reduce the need for joint aspiration, we compared the combination of ultrasound findings and laboratory findings to separate septic arthritis from reactive arthritis. METHODS Children aged < 14 years who were referred to Akbar pediatric hospital in 2020-2022 with hip pain or limping were included in this longitudinal study. Participants underwent ultrasound examinations of the hip and blood samples were obtained from them. After confirming an effusion, dependent on patient status and clinical diagnosis, one of the following approaches was recommended; the close follow-up, or the ultrasound-guided aspiration of the hip joint effusion, and or arthrotomy. The various ultrasound and laboratory were documented. Data were analyzed and P < 0.001 being considered statistically significant. RESULTS Overall, 115 patients with a mean age of 3.43 ± 5.76 years, 46 of whom were girls, were studied. The final diagnosis in 23 cases (20.0%) was septic arthritis and 92 (80.0%) had reactive arthritis. C-reactive protein (CRP) and The erythrocyte sedimentation rate (ESR) unlike aspirate volume, effusion volume measured on ultrasound, capsule thickness, total thickness, and recorded capsule-to-effusion ratio were significantly higher in patients with septic arthritis (P < 0.001). There was a significant agreement between the volume of measured fluid in the anterior recess and the volume of aspirated fluid (2.5 times, P < 0.001). Septic arthritis was not observed in any of the patients with effusion volume in anterior recess less than 0.5 cc and ESR less than 40 mm/hr or CRP less than 15 mg/L. CONCLUSION Since septic arthritis was not observed in any of the patients with effusion volume < 0.5 cc and normal inflammatory factors (ESR or CRP), conservative management and close follow-up can be recommended in these patients instead of joint fluid aspiration.
Collapse
Affiliation(s)
| | | | - Ahmad Nouri
- Faculty of Medicine, Semnan University of medical Sciences, Semnan, Iran
| | | | | | | | | | | |
Collapse
|
6
|
Jlidi M, Bouaicha W, Nouicer S, Mallek K, Chaabane I, Bachrouch S, Daas S. Sternoclavicular septic arthritis in a healthy adult: A case report and a review of the literature. SAGE Open Med Case Rep 2023; 11:2050313X231212831. [PMID: 38022866 PMCID: PMC10666677 DOI: 10.1177/2050313x231212831] [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] [Received: 09/18/2023] [Accepted: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
Sternoclavicular joint septic arthritis is rare and commonly associated with specific risk factors. We report the case of a 58-year-old female with no previous medical or surgical history who presented complaining of a warm, indurated mass overlying the right sternoclavicular joint. Computed tomography of the chest showed erosion of the sternal end of the clavicle and the manubrium sternum associated with thickening of the synovium and a sternoclavicular joint space narrowing, suggestive of an infective process. Intraoperative finds a purulent collection extending both over the clavicle and the sternum. Limited destruction of small parts of the sternoclavicular joint was noted. The abscess was drained. Simple debridement and limited curettage were preferred to en bloc resection given the limited size of necrotic tissues. Sternoclavicular joint septic arthritis is a condition with significant morbidity and potential mortality. All medical practitioners must maintain a high degree of suspicion, even in healthy patients, as it can lead to serious complications.
Collapse
Affiliation(s)
- Mohamed Jlidi
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Walid Bouaicha
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Saffet Nouicer
- Infectious Disease Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Karim Mallek
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Imene Chaabane
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Infectious Disease Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Sabrine Bachrouch
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Infectious Disease Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
| | - Selim Daas
- Orthopedics and Traumatology Department, Hospital of Mohamed Taher Maâmouri, Nabeul, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
7
|
Walinga AB, Stornebrink T, Emanuel KS, Kievit AJ, Janssen SJ, Kerkhoffs GMMJ. Failure rates in surgical treatment in adults with bacterial arthritis of a native joint: a systematic review of 8,586 native joints. Arch Orthop Trauma Surg 2023; 143:6547-6559. [PMID: 37395855 PMCID: PMC10541340 DOI: 10.1007/s00402-023-04958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Most adult cases of bacterial-septic-arthritis of a native joint are effectively managed with a single surgical debridement, but some cases may require more than one debridement to control the infection. Consequently, this study assessed the failure rate of a single surgical debridement in adults with bacterial arthritis of a native joint. Additionally, risk factors for failure were assessed. MATERIALS AND METHODS The review protocol was registered on PROSPERO (CRD42021243460) before data collection and conducted in line with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) guidelines. Multiple libraries were systematically searched to identify articles including patients reporting on the incidence of failure (i.e. persistence of infection requiring reoperation) of the treatment of bacterial arthritis. The quality of individual evidence were assessed using the Quality in Prognosis Studies (QUIPS) tool. Failure rates were extracted from included studies and pooled. Risk factors for failure were extracted and grouped. Moreover, we evaluated which risk factors were significantly associated with failure. RESULTS Thirty studies (8,586 native joints) were included in the final analysis. The overall pooled failure rate was 26% (95% CI 20 to 32%). The failure rate of arthroscopy and arthrotomy was 26% (95% CI 19 to 34%) and 24% (95% CI 17 to 33%), respectively. Seventy-nine potential risk factors were extracted and grouped. Moderate evidence was found for one risk factor (synovial white blood cell count), and limited evidence was found for five risk factors (i.e. sepsis, large joint infection, the volume of irrigation, blood urea nitrogen-test, and blood urea nitrogen/creatinine ratio). CONCLUSION A single surgical debridement fails to control bacterial arthritis of a native joint in approximately a quarter of all adult cases. Limited to moderate evidence exists that risk factors associated with failure are: synovial white blood cell count, sepsis, large joint infection, and the volume of irrigation. These factors should urge physicians to be especially receptive to signs of an adverse clinical course.
Collapse
Affiliation(s)
- Alex B. Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Arthur J. Kievit
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Stein J. Janssen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| |
Collapse
|
8
|
Ito H. Comment on Takahashi et al.: Factors affecting the outcome of septic arthritis of the shoulder joint with arthroscopic management. J Orthop Sci 2023; 28:1206. [PMID: 37316374 DOI: 10.1016/j.jos.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 10/13/2021] [Indexed: 06/16/2023]
Affiliation(s)
- Hiroshi Ito
- Division of Hospital Medicine, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki, 305-8576, Japan.
| |
Collapse
|
9
|
Patel A, Chadwick N, von Beck K, Goswami P, Soliman SB, Patel A, McGill KC. Ultrasound-guided joint interventions of the lower extremity. Skeletal Radiol 2023; 52:911-921. [PMID: 36042035 DOI: 10.1007/s00256-022-04168-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to better understand the role ultrasound plays in lower extremity joint interventions. Ultrasound is an important and reliable tool diagnostically and therapeutically. Real-time feedback, lack of ionizing radiation, and dynamic maneuverability make ultrasound an important tool in the proceduralist's armament. This article will touch upon the important anatomic considerations, clinical indications, and technical step-by-step details for lower extremity ultrasound interventions. Specifically, we will look at interventions involving the hip, knee, ankle, and foot. In addition, this article will discuss the roles corticosteroid and platelet-rich plasma may play in certain interventions.
Collapse
Affiliation(s)
- Ashish Patel
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Nicholson Chadwick
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly von Beck
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Pulak Goswami
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Steven B Soliman
- Division of Musculoskeletal Radiology, Department of Radiology, Henry Ford Hospital, Detroit, MI, USA
| | - Arjun Patel
- Division of Musculoskeletal Imaging, Department of Radiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kevin C McGill
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
10
|
Dubin JA, Chen Z, Bains SS, Hameed D, Mont MA, Delanois RE, Nace J. Less Than 1-Year Quiescent Period After Septic Arthritis of the Hip is Associated With High Risk of Periprosthetic Joint Infection Following Total Hip Arthroplasty. J Arthroplasty 2022; 38:930-934.e1. [PMID: 36436706 DOI: 10.1016/j.arth.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/14/2022] [Accepted: 11/18/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Approximately 20,000 patients are diagnosed with septic arthritis annually, with 15% specifically affecting the hip joint. These cases exacerbate arthritic changes, often warranting a total hip arthroplasty (THA). Given their prior history of infection, these patients are predisposed to subsequent periprosthetic joint infections (PJIs). Multiple studies suggest delaying THA after a native septic hip, but no study utilizing a large cohort examined the specific timing to mitigate post-THA PJI risk within a short (<1 year) quiescent period after septic arthritis. We sought to compare patients who were diagnosed with septic hip arthritis at time intervals (0-6, or 6-12 months) prior to an ipsilateral primary THA to a cohort of THA patients who never had a septic hip history. Specifically, we assessed: from 90 days to 2 years (1) revisions due to PJI and (2) associated risk factors for PJI at 2-years. METHODS A national, all-payer database was queried to identify all patients who underwent a primary THA between 2010 and 2021 and patients who had prior ipsilateral septic hip arthritis were characterized using International Classification of Disease and Current Practice Terminology codes (n = 1,052). A randomized sample of patients who never had a history of septic arthritis prior to undergoing THA was used as a nonseptic group comparison (n = 5,000). The incidences of PJI at 90 days through two years were then identified and compared using bivariate chi-square analyses. Risk factors for post-THA PJIs were then analyzed using multivariate regression models. RESULTS The septic arthritis cohorts were more likely to require revisions due to PJIs, as compared to the non-septic group at 90 days, 1 year, and 2 years (all P < .0001). Patients who were diagnosed with septic arthritis between 0 and 6 months prior to THA were at greater PJI risk at both one-year (odds ratio (OR) of 43.1 versus 29.6, P < .0001) and two years (OR of 38.3 versus 22.1, P < .0001) compared to patients who had diagnoses between 6 and 12 months. Diabetes mellitus, obesity, and tobacco use were associated risk factors for PJIs at 2 years in the septic hip cohort in comparison to the cohort without a septic hip history. CONCLUSION Less than a 1-year quiescent period after septic arthritis is associated with a 38 times increased risk and a 22 times risk for post-THA PJI, at 0 and 6 months and 6 and 12 months, respectively. Though patients who undergo THA greater than 6 months after their septic arthritis treatment have a decreased risk compared to those between 0 and 6 months the risks are still high. Orthopaedic surgeons should be aware of the increased risks of PJIs when considering performing a THA in patients with a history of septic arthritis.
Collapse
Affiliation(s)
- Jeremy A Dubin
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Zhongming Chen
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Sandeep S Bains
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Daniel Hameed
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Michael A Mont
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - Ronald E Delanois
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| | - James Nace
- Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, Maryland
| |
Collapse
|
11
|
FABIO ZANCHINI, CIPOLLONI VALERIO, NASTO LUIGIAURELIO, LUCCHESI SALVATORE, PISCOPO DAVIDE, FUSINI FEDERICO, VITIELLO RAFFAELE, CACCIAPUOTI STEFANO, POLA ENRICO. ACUTE DESTRUCTIVE HIP SEPTIC ARTHRITIS IN A YOUNG ADULT PATIENT: CASE REPORT (v2). Orthop Rev (Pavia) 2022; 14. [DOI: 10.52965/001c.37749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2024] Open
Abstract
The Authors describe a case of rapid right hip destructive septic arthritis in a 50-year-old male patient with no previous noteworthy medical history. Patient arrived to our attention following a one week history of right hip pain. Laboratory markers and imaging at presentation were negative. However, on a follow-up examination significant joint effusion was noted and joint tap was performed. Despite wide spectrum antibiotic therapy institution, significant joint damage was observed. This required surgical femoral head excision with antibiotic loaded spacer, followed by hip arthroplasty surgery 12 weeks afterwards. Complete healing of the infection and recovery of pain-free joint motion was noted at 1 year follow-up.
Collapse
Affiliation(s)
- ZANCHINI FABIO
- University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| | - VALERIO CIPOLLONI
- A. Gemelli IRCCS University Hospital, Catholic University of Rome, Largo Francesco Vito 1, 00168, Rome, Italy
| | | | | | - DAVIDE PISCOPO
- University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| | - FEDERICO FUSINI
- Regina Montis Regalis Hospital, ASL CN1, Strada S. Rocchetto 99, 12084, Mondovì (CN), Italy
| | | | | | - ENRICO POLA
- University of Campania "Luigi Vanvitelli", Naples, 80129 Italy
| |
Collapse
|
12
|
Kim KJ, Jeong HS, Ahn BH, Chung DM. Clinical Efficacy of the Antibiotic-Loaded Collagen Sponge During Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee. Orthop J Sports Med 2022; 10:23259671221087189. [PMID: 35400138 PMCID: PMC8984851 DOI: 10.1177/23259671221087189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background: To completely eliminate an infection, the antibiotic concentration must
exceed the minimum inhibitory concentration for the causative pathogens. The
antibiotic-loaded collagen sponge (ALCS) has been used to manage an
infection through a high local concentration of antibiotics. Purpose: To evaluate the clinical efficacy of ALCS in the arthroscopic treatment of
patients with acute septic arthritis of the native knee. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively reviewed the data for 132 consecutive patients
with acute septic arthritis of the knee who underwent arthroscopic
debridement between 2013 and 2019. Patients with a history of surgery in the
affected joint, concomitant osteomyelitis, or accompanying medical infection
were excluded. The study patients were divided into 2 groups based on the
use of ALCS during surgery. C-reactive protein (CRP) levels were temporally
measured to normalization and the duration of intravenous antibiotic
administration was recorded, and the mean length of hospital stay was
compared between the groups. Independent t test and
chi-square test were performed to assess differences between the groups, and
univariate analysis was used to analyze factors affecting recurrence of
septic arthritis. Results: Of the 132 patients, 88 were ultimately included in this study; 51 patients
were managed without ALCS and 37 were treated with ALCS. There were
statistically significant differences between groups in the mean period for
CRP-level normalization (15.2 ± 8.2 days [ALCS] vs 26.2 ± 14.7 days [without
ALCS]; P = .004), mean duration of intravenous antibiotic
use (18.4 ± 7.3 days [ALCS] vs 26.6 ± 16.1 days [without ALCS];
P = .046), and mean length of hospital stay (21.1 ±
11.6 days [ALCS] vs 30.3 ± 18.3 days [without ALCS]; P =
.045). The preoperative CRP level was the only significant risk factor for
recurrence or treatment failure after single arthroscopic debridement. Conclusion: The results of this study indicated that ALCS was able to reduce the duration
of CRP-level normalization, intravenous antibiotic use, and hospitalization
in patients who underwent arthroscopic irrigation and debridement for acute
septic arthritis of the native knee.
Collapse
Affiliation(s)
- Kook-Jong Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ho-Seung Jeong
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Byung-Hyun Ahn
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Dong-Min Chung
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| |
Collapse
|
13
|
Ho JSY, Zhou AK, Tran C, Jou E, Girish M, Thahir A, Chabra S, Hussain HA. Management of a Hot Swollen Joint in the Acute Setting. Curr Rheumatol Rev 2022; 18:173-177. [PMID: 35049435 DOI: 10.2174/1573397118666220113114104] [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: 02/15/2021] [Revised: 09/28/2021] [Accepted: 11/17/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The presentation of a hot swollen joint is common in the emergency department, general practice, rheumatology and orthopedic clinics. There is a wide set of differential diagnoses for a hot swollen joint, thus making it difficult to diagnose and manage, especially for junior doctors. Initially, it is pertinent to exclude/diagnose medical and surgical emergencies. OBJECTIVE This paper aims to summarize the key indications within the history, examination and investigations in order to quickly and effectively diagnose a hot swollen joint based on the original 2006 management guidelines and the papers discussing other possible indications and management strategies published since. RESULTS Currently, the management of crystal and non-infectious arthropathies are well recognized with little disparity. However, the treatment of infectious arthritis is not concrete and there are discrepancies in management between doctors. CONCLUSION We have summarized the key indications and provided a diagnostic flow chart to aid with the management.
Collapse
Affiliation(s)
| | - Andrew Kailin Zhou
- Department of Trauma And Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
| | | | - Eric Jou
- School Of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom
| | - Milind Girish
- Department of Trauma And Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
| | - Azeem Thahir
- Department of Trauma And Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
| | - Shirom Chabra
- School Of Clinical Medicine, University Of Cambridge, Cambridge, United Kingdom
| | | |
Collapse
|
14
|
Guillén-Astete CA, García-García V, Vazquez-Díaz M. Procalcitonin Serum Level Is a Specific Marker to Distinguish Septic Arthritis of the Knee in Patients With a Previous Diagnosis of Gout. J Clin Rheumatol 2021; 27:e575-e579. [PMID: 31804257 DOI: 10.1097/rhu.0000000000001215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
15
|
Tadych AS, Catano DE, Brill AL. Atypical Presentation of Haemophilus influenzae Septic Arthritis: A Case Report. Clin Pract Cases Emerg Med 2021; 5:459-462. [PMID: 34813444 PMCID: PMC8610458 DOI: 10.5811/cpcem.2021.9.54043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/20/2021] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Septic arthritis is a destructive form of acute arthritis that requires expeditious recognition. as delayed treatment yields significant morbidity and mortality. CASE REPORT A 40-year-old male presented to the emergency department with right elbow pain. Examination revealed tachycardia, swelling, redness, tenderness, and decreased range of motion of the right humeroulnar joint. Synovial fluid analysis was consistent with an inflammatory etiology, but blood and joint cultures ultimately revealed Haemophilus influenzae. DISCUSSION This case highlights the importance of trusting clinical findings over laboratory evidence in patients with suspected septic arthritis.
Collapse
Affiliation(s)
- Andrew Steven Tadych
- Department of Clinical Education, Midwestern University - Chicago College of Osteopathic Medicine, Downers Grove, Illinois
| | - David Enrique Catano
- Department of Emergency Medicine, Midwestern University, Franciscan Health Olympia Fields, Olympia Fields, Illinois
| | - April Lynn Brill
- Department of Emergency Medicine, Midwestern University, Franciscan Health Olympia Fields, Olympia Fields, Illinois
| |
Collapse
|
16
|
El Hasbani G, Jawad A, Uthman I. Septic arthritis of the knee caused by cupping (Hijama). J R Coll Physicians Edinb 2021; 50:58-59. [PMID: 32539042 DOI: 10.4997/jrcpe.2020.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Georges El Hasbani
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Jawad
- Consultant Rheumatologist, Department of Rheumatology, The Royal London Hospital, London, UK
| | - Imad Uthman
- Division of Rheumatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon,
| |
Collapse
|
17
|
Wang J, Wang L. Novel therapeutic interventions towards improved management of septic arthritis. BMC Musculoskelet Disord 2021; 22:530. [PMID: 34107951 PMCID: PMC8191206 DOI: 10.1186/s12891-021-04383-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/18/2021] [Indexed: 01/19/2023] Open
Abstract
Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA). In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring. The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.
Collapse
Affiliation(s)
- Jian Wang
- Department of Nursing, The Third Hospital of Jinan, Shandong Province, Jinan, 250132, China.
| | - Liucai Wang
- Hand and Foot Surgery, Shandong Provincial Hospital, Jinan, 250000, China
| |
Collapse
|
18
|
Roth CA, Da Lomba T, Dadwani R, Dahm J, Strelzow J. Analysis of factors that drives arthrocentesis for suspected septic joint. Ther Adv Musculoskelet Dis 2021; 13:1759720X211002582. [PMID: 33995601 PMCID: PMC8072930 DOI: 10.1177/1759720x211002582] [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: 01/06/2021] [Accepted: 02/15/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction: This study aims to develop a simple diagnostic criterion that could be used to justify arthrocentesis in adults with suspected septic arthritis. Our hypothesis is that no single factor will be predictive for a decision to aspirate a questionable septic joint. Methods: A prospective observational cohort study was performed at a Level 1 Trauma institution including all patients over the age of 18 years referred to Orthopaedics through the Emergency Department or inpatient orthopaedic consultations for a suspected septic joint. Patient information recorded was age, laboratory markers (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, physical exam findings (fever, pain with range-of-motion), and presence of smoking, diabetes, end-stage renal disease (ESRD) on dialysis, and body mass index > 30. Continuous data was analyzed using logistic regression, and nominal data was analyzed using a two-tailed Fisher’s exact test. Results: A total of 128 patients met inclusion criteria for this study; 71 patients underwent arthrocentesis for suspected septic joint. On analysis of risk factors, the demographics, laboratory markers, physical exam and comorbidities were not significant between the two groups. On subset analysis of the septic joints, we found the only risk factor to be significantly predictive of whether a joint was septic was the presence of ESRD on dialysis (p = 0.042). Conclusion: Past data have looked solely at predictive risk factors for septic arthritis; however, this study aims to predict what drives physicians towards aspirating a joint even before it is determined to be septic. We found no single factor was predictive of joint aspiration. Only ESRD on dialysis is predictive of whether a joint with concern for septic arthritis would ultimately be septic in our institution. The decision to aspirate continues to be best determined by clinician judgment in light of experience and available clinical information.
Collapse
Affiliation(s)
- Cameron A Roth
- Department of Orthopaedic Surgery, University of Chicago, 5841 S. Maryland Ave, MC 3079, Chicago, IL, 60637, USA
| | - Tony Da Lomba
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Rahul Dadwani
- Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - James Dahm
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL, USA
| | - Jason Strelzow
- Department of Orthopaedic Surgery, University of Chicago, Chicago, IL, USA
| |
Collapse
|
19
|
Elsissy JG, Liu JN, Wilton PJ, Nwachuku I, Gowd AK, Amin NH. Bacterial Septic Arthritis of the Adult Native Knee Joint: A Review. JBJS Rev 2021; 8:e0059. [PMID: 31899698 DOI: 10.2106/jbjs.rvw.19.00059] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
» Acute bacterial septic arthritis of the knee is an orthopaedic emergency and, if left untreated, can result in substantial joint degradation.
» Important risk factors for development of septic arthritis include age of >60 years, recent bacteremia, diabetes, cancer, cirrhosis, renal disease, drug or alcohol abuse, a history of corticosteroid injection, a recent injury or surgical procedure, a prosthetic joint, and a history of rheumatoid arthritis.
» The diagnosis is primarily based on history and clinical presentation of a red, warm, swollen, and painful joint with limited range of motion. Laboratory values and inflammatory markers from serum and joint fluid may serve as adjuncts when there is clinical suspicion of septic arthritis.
» The initial and general antibiotic regimen should cover methicillin-resistant Staphylococcus aureus and gram-negative and gram-positive organisms. The antibiotic regimen should be specified following the culture results of the infected joint.
» Operative management involves either arthrotomy or arthroscopy of the knee with thorough irrigation and debridement of all infected tissue. The Gächter classification is useful in establishing a prognosis or in determining the need for an extensive debridement.
Collapse
Affiliation(s)
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California
| | - Peter J Wilton
- Loma Linda University Medical Center, Loma Linda, California
| | - Ikenna Nwachuku
- Loma Linda University School of Medicine, Loma Linda, California
| | - Anirudh K Gowd
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Nirav H Amin
- Veterans Affairs Loma Linda, Loma Linda, California
| |
Collapse
|
20
|
Knapper T, Murphy RJ, Rocos B, Fagg J, Murray N, Whitehouse MR. Utility of bedside leucocyte esterase testing to rule out septic arthritis. Emerg Med J 2021; 38:707-710. [PMID: 33692113 DOI: 10.1136/emermed-2020-209842] [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: 05/01/2020] [Revised: 01/14/2021] [Accepted: 02/11/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Suspected septic arthritis is a common presentation to EDs. The underlying diagnosis is often non-infective pathology. Differentiating between aetiologies is difficult. A bedside test with high negative predictive value (NPV) may allow safe discharge of patients, reduce the time in the ED, hospital admission and associated costs. This study aims to evaluate the NPV of bedside leucocyte esterase (LE) in the assessment of these patients. METHODS A prospective multicentre observational study of ED adult patients referred to orthopaedics with suspected native joint septic arthritis between October 2015 and April 2016. At three hospital sites in the Bristol region, the results of the LE test exposed to aspirated synovial fluid were recorded along with Gram stain, culture, haematinics and length of stay. A positive LE test was considered 2+ or 3+ leucocytes based on the test strip colour. Data were analysed to establish sensitivity, specificity, NPV and positive predictive value (PPV) against the gold standard 48-hour culture. We determined the potential number of inpatient bed-days that might be avoided using this bedside test. RESULTS Eighty patients underwent joint aspiration. Five cases had positive 48-hour culture. All (5/5) infected cases showed ≥2+ LE, sensitivity of 100% (95% CI 47.8% to 100%) while the Gram stain was positive in only one case (sensitivity 20%, 95% CI 0.51% to 71.6%). Twenty-three LE were read negative or 1+, all with negative 48-hour culture results, resulting in an NPV of 100% (95% CI 82.1% to 1.00%) for a negative LE test. Specificity of a positive LE test was 30.7% (95% CI 20.5% to 42.45%) with PPV of 8.77% (95% CI 7.64% to 10.1%). It was calculated that 57 orthopaedic bed-days could have potentially been saved by immediately discharging those with a negative LE test. CONCLUSIONS LE point-of-care testing for suspected septic arthritis of native joints has a high NPV. Implementation of LE may facilitate more rapid discharge of patients with negative results. This test has the potential to reduce diagnostic uncertainty and costs to the healthcare system.
Collapse
Affiliation(s)
- Thomas Knapper
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Richard J Murphy
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Brett Rocos
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - James Fagg
- Department of Trauma and Orthopaedics, Royal United Hospitals Bath NHS Foundation Trust, Bath, Bath and North East Somerset, UK
| | - Nick Murray
- Trauma and Orthopaedics, Great Western Hospital, Swindon, UK
| | - Michael Richard Whitehouse
- Department of Trauma and Orthopaedics, North Bristol NHS Trust, Westbury on Trym, Bristol, UK.,Musculoskeletal Research Unit, University of Bristol School of Clinical Science, Bristol, UK
| |
Collapse
|
21
|
Abstract
Patients with septic arthritis are observed regularly in daily hospital practice, and most patients have a clearly confirmed diagnosis. Here, we present a patient with poorly controlled diabetes mellitus in silent septic shock. Following careful clinical examination and identification of the infection source, the culprit lesion was drained. This case report highlights a history of falls as a sign of silent septic arthritis. Diagnostic knee taps should be performed when silent sepsis is suspected as clinical symptoms may be masked and not always be discernable in patients with poorly controlled diabetes.
Collapse
Affiliation(s)
- Amr Mohamed
- Internal Medicine, Rochester Regional Health, Rochester, USA
| |
Collapse
|
22
|
The Utility of Leukocyte Esterase Strip Test in the Diagnosis of Pediatric Septic Arthritis. J Pediatr Orthop 2021; 41:e99-e100. [PMID: 32852365 DOI: 10.1097/bpo.0000000000001655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
23
|
Yanagihara T, Hirota M, Egashira A, Harada Y, Ogo N, Asoh T, Kuramoto T, Matsui G, Maeyama T. Successful treatment with mepolizumab for allergic bronchopulmonary mycosis complicated with bilateral septic arthritis of the knee joints caused by Methicillin-resistant Staphylococcus aureus. Respir Med Case Rep 2020; 31:101316. [PMID: 33318922 PMCID: PMC7723802 DOI: 10.1016/j.rmcr.2020.101316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/27/2020] [Accepted: 12/02/2020] [Indexed: 12/17/2022] Open
Abstract
We report the case of a 50-year-old man with allergic bronchopulmonary mycosis (ABPM) complicated with bilateral septic arthritis of the knees caused by Methicillin-resistant Staphylococcus aureus (MRSA). He had a background of bronchial asthma and end-stage renal failure on maintenance dialysis. He was treated with 30 mg/day of prednisolone for 14 days for ABPM. He developed bilateral septic arthritis of the knees, caused by MRSA during prednisolone treatment. He underwent bilateral arthroscopic washout with a 2-week course of intra-articular arbekacin, concomitantly treated with a 6-week course of intravenous teicoplanin and oral rifampicin, subsequently followed by oral linezolid treatment. However, he suffered exacerbation of ABPM during treatment of septic arthritis. Because of these serious infectious complications, he was treated with mepolizumab instead of corticosteroids for the ABPM, which resolved all symptoms and clinical features. This case highlights mepolizumab treatment as an alternative to corticosteroid therapy for treatment of ABPM in patients with comorbidities such as infection.
Collapse
Affiliation(s)
- Toyoshi Yanagihara
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
- Corresponding author.
| | - Mao Hirota
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Ayaka Egashira
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Yukiko Harada
- Department of Clinical Infectious Diseases, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Naruhiko Ogo
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Tatsuma Asoh
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Takahumi Kuramoto
- Department of Orthopedics, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Gen Matsui
- Department of Orthopedics, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| | - Takashige Maeyama
- Department of Respiratory Medicine, Hamanomachi Hospital, Fukuoka, 810-8539, Japan
| |
Collapse
|
24
|
Ahmed AF, Hammad M, Salameh M, Ahmed GO. Destructive Osteonecrosis of the Femoral Head After a Single Intra-Articular Corticosteroid Injection: A Report of Two Cases. Int J Surg Case Rep 2020; 77:711-715. [PMID: 33395881 PMCID: PMC7718135 DOI: 10.1016/j.ijscr.2020.11.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/18/2020] [Accepted: 11/18/2020] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Accelerated femoral head avascular necrosis after a single dose intra-articular steroid injection is a rare pathology. Few cases were reported in the literature. Most cases were managed with total hip arthroplasty. CASE PRESENTATION In this study, we report two rare cases of destructive osteonecrosis of the femoral head. Both patients presented with hip osteoarthritis that failed nonoperative measures. A single intra-articular corticosteroid injection was administered for each patient. Both patients had femoral head destruction and significant resorption at 14 and 11 weeks, respectively. Septic arthritis was ruled out by blood tests and joint aspiration. Total hip arthroplasty (THA) was undertaken and histology reports confirmed the osteonecrosis. The postoperative follow-up was uneventful with satisfactory hip function. DISCUSSION AND CONCLUSION Destructive osteonecrosis of the femoral head is a rare catastrophic potential complication of intra-articular corticosteroid injection. Hence, physicians must consider this complication when counseling patients before an intra-articular corticosteroid hip injection.
Collapse
Affiliation(s)
- Abdulaziz F Ahmed
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Mohammed Hammad
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Motasem Salameh
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, Doha, Qatar
| | - Ghalib O Ahmed
- Section of Orthopedics, Department of Surgery, Hamad General Hospital, Doha, Qatar.
| |
Collapse
|
25
|
Chung SL, Papanikitas J, Johnstone D, McKean D. Septic arthritis caused by Candida albicans: post intra-articular steroid injection in a native joint. BMJ Case Rep 2020; 13:13/8/e233841. [PMID: 32843447 DOI: 10.1136/bcr-2019-233841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Intra-articular steroid injections are widely prescribed for management of osteoarthritis when oral medication or physiotherapy treatment fails to relieve patient's pain. Septic arthritis is an uncommon side effect of steroid injection. Common causal micro-organisms are bacterial with Staphylococcus aureus being the most frequent. Fungal septic arthritis is rare and does not usually present beyond the neonatal period. We present a rare case of septic arthritis secondary to fungal infection.
Collapse
Affiliation(s)
- Siok Li Chung
- Radiology Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - Joseph Papanikitas
- Radiology Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - David Johnstone
- Orthopaedic, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| | - David McKean
- Radiology Department, Stoke Mandeville Hospital, Aylesbury, Buckinghamshire, UK
| |
Collapse
|
26
|
Vassallo C, Borg AA, Farrugia D, Mercieca C. The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study. Mediterr J Rheumatol 2020; 31:195-205. [PMID: 32676557 PMCID: PMC7362118 DOI: 10.31138/mjr.31.2.195] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 04/20/2020] [Accepted: 05/01/2020] [Indexed: 12/19/2022] Open
Abstract
Objective/Aim: Septic arthritis is an uncommon but important disease with significant morbidity and mortality, especially if inadequately managed. The aim of this epidemiological study was to identify the characteristics and outcomes of patients treated for septic arthritis at Mater Dei Hospital, Malta, over a 10-year period. Methods: This was a retrospective observational study. Patients diagnosed with septic arthritis between 2008 and 2018 were recruited. Cases were identified by reviewing all inhospital episodes of patients diagnosed with septic arthritis according to Newman criteria. Results: There were 124 cases of native joint septic arthritis and 138 of prosthetic joint infection. Cases were present amongst all age groups, with the highest incidence amongst those aged 61–70 years for both native and prosthetic infections. Fever was present in around 40% of cases. Raised white cell count was prevalent in 66.9% of native joint infections and 52.9% of prosthetic joints. Elevated C-reactive protein was overwhelmingly seen in most cases, present in 93.5% (median=159.5 mg/L; IQR=85.8–291) of native joints and 92.0% of prosthetic joint infections (median=68.7 mg/L; IQR=20.5–186). Over 55% of patients had one or more risk factors for joint sepsis, diabetes mellitus being the most prevalent clinical comorbidity (22.6% and 24.6% for native and prosthetic joint infections respectively). Synovial cultures were positive in 66% and 82% of native and prosthetic joint aspirates respectively. Staphylococcus aureus was the most commonly isolated organism from both native and prosthetic joint infection, followed by streptococcal infections in native joints and coagulase negative staphylococci and gram-negative infections in prosthetic joints. Fifteen deaths were directly attributed to joint sepsis. Conclusion: Absence of fever and elevated white cell count does not exclude the diagnosis. The mortality rate due to septic arthritis in this cohort of patients was found to be 5.7%. All deaths occurred in elderly patients with clinical comorbidities suggesting that this group is at highest risk.
Collapse
|
27
|
Paz Z, Fowler ML, Zhu C, Lieber SB, Moore A, Shmerling RH. Patients with surgically treated culture-negative native joint septic arthritis have less severe disease and better outcomes. Infect Dis (Lond) 2020; 52:713-720. [PMID: 32580675 DOI: 10.1080/23744235.2020.1784455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Patients with culture-negative septic arthritis patients are often treated surgically but might be successfully managed medically. We compared clinical characteristics and outcomes in patients with culture negative and culture positive native joint monoarticular septic arthritis.Methods: This retrospective study included all patients age ≥18 years admitted to a single, tertiary-care hospital between 1998 and 2015 with native joint monoarticular SA and treated with antibiotics and surgery.Results: Of 306 patients, 85 had negative and 221 had positive cultures. Mean C-reactive protein (p < .01) and mean percentage of peripheral polymorphonuclear cells (p = .01) were higher in culture-positive patients who had higher intensive care unit admission rates (16.7% vs. 4.7%, respectively, [p < .01]), longer length of hospital stay (11.4 vs. 7.1 days, respectively, [p < .01]) and higher mortality rates within 30 days (0% vs. 5.5%, respectively,[p = .02]). Of culture-negative patients, 28.6% received an alternative diagnosis within one year. Logistic regression models showed that culture positive patients had an adjusted odds ratio for length of stay of 4.5 (2.69, 7.51), intensive care unit admission of 5.76 (1.31, 25.22), discharge to rehabilitation of 4.7 (2.28, 9.71) and an alternative diagnosis within one year of 0.05 (0.02, 0.15) compared to culture negative patients.Conclusion: Patients with culture-negative native joint septic arthritis had less severe disease, better outcomes and higher rates of alternative diagnosis within one year than patients with positive cultures.
Collapse
Affiliation(s)
- Ziv Paz
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Clara Zhu
- Boston University School of Medicine, Boston, MA, USA
| | | | - Andrew Moore
- Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA
| | | |
Collapse
|
28
|
Rasmussen L, Bell J, Kumar A, Heckman MG, Lesser E, Whalen J, Shi GG, Ledford C, Wilke B. A Retrospective Review of Native Septic Arthritis in Patients: Can We Diagnose Based on Laboratory Values? Cureus 2020; 12:e8577. [PMID: 32670713 PMCID: PMC7358919 DOI: 10.7759/cureus.8577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Introduction The accurate diagnosis of acute septic arthritis is essential to initiating appropriate treatment and minimizing potential cartilage damage. A synovial fluid cell count of 50,000 cells/mm3 has been used as a diagnostic cutoff for acute septic arthritis, although data supporting this is lacking. The purpose of this study was to assess the efficacy of synovial cell counts to predict septic arthritis in patients with symptomatic native joints. Methods A retrospective review was performed of patients who were evaluated for septic arthritis at a single institution with the use of synovial fluid analysis and adjunctive lab tests. Exclusion criteria included history of a total joint arthroplasty of the affected joint or immunocompromised state. A true infection was considered on the basis of positive or negative synovial aspirate cultures. We evaluated the synovial cell count, synovial polymorphonuclear cell percentile (% neutrophils), serum white blood cell (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) in order to determine their association and predictive power in a true infection. Results Of the 65 patients included in the study, 40 (61.5%) had a positive culture for septic arthritis and 25 (38.5%) had negative cultures. Patients with positive cultures had a larger median % neutrophils than patients with negative cultures (median: 93 vs. median: 86, P=0.041). They also tended to have higher serum CRP levels compared to negative culture patients (median: 142.30 vs. 34.20, P=0.051). No outcomes were independently highly effective in discriminating between patient groups (area under the curve (AUC) ≤ 0.67). There was no significant difference between the synovial cell counts in patients with culture positive septic arthritis and patients with negative cultures (median: 32435 vs 35385, P = 0.94). Conclusion Patients with culture proven septic arthritis had larger % neutrophils. However, there were no other statistically significant differences between patient groups regarding ESR, CRP, WBC, or cell count aspiration at the time of diagnosis. No synovial cell count level was highly effective in discriminating patients with a positive culture for septic arthritis from patients with negative cultures.
Collapse
Affiliation(s)
| | - Jared Bell
- Orthopedics, Mayo Clinic, Jacksonville, USA
| | - Arun Kumar
- Orthopedics, Mayo Clinic, Jacksonville, USA
| | | | | | | | | | | | | |
Collapse
|
29
|
Mabille C, El Samad Y, Joseph C, Brunschweiler B, Goeb V, Grados F, Lanoix JP. Medical versus surgical treatment in native hip and knee septic arthritis. Infect Dis Now 2020; 51:164-169. [PMID: 32387296 DOI: 10.1016/j.medmal.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 01/07/2020] [Accepted: 04/28/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Antibiotic treatment and arthroscopic or open drainage is the gold standard for septic arthritis. Full recovery takes time after surgery and hospital stay is longer than for arthrocentesis at the bedside. We aimed to evaluate the effectiveness of arthrocentesis (medical approach) versus a surgical approach. METHOD We retrospectively included 97 cases of native joint arthritis (hip and knee) between 2010 and 2017. The primary outcome was treatment failure of medical and surgical approaches (defined as surgical intervention within 7 days following diagnosis). Risk factors of failure were identified by univariable and multivariable logistic regression. RESULTS We included 72 cases of knee arthritis, of which 43 and 29 were treated medically and surgically, respectively; 25 cases of hip arthritis, of which 8 and 17 were treated medically and surgically, respectively. Failure was observed in 39.2% of cases in the medical group and in 30.4% in the surgical group (P=0.2) (37.5% vs. 52.9% and 39.5% vs. 17.2% for hip and knee, respectively). The univariate analysis identified age and male sex as risk factors for failure (P=0.048 and P=0.02, respectively), but only age was independently associated with failure (P=0.04). Hospital length of stay was 12 days shorter in the medical group (21 vs. 33 days, P=0.02), sequelae were less frequent and less important in the medical group (31.7% vs. 60%). CONCLUSION The medical treatment seems to be as effective as the surgical treatment for native joint septic arthritis with a shorter hospital stay and better functional outcome. Further prospective studies are warranted.
Collapse
Affiliation(s)
- C Mabille
- Department of Infectious Diseases, University Hospital of Amiens-Picardie, Amiens, France.
| | - Y El Samad
- Department of Infectious Diseases, University Hospital of Amiens-Picardie, Amiens, France
| | - C Joseph
- Department of Infectious Diseases, University Hospital of Amiens-Picardie, Amiens, France
| | - B Brunschweiler
- Department of Orthopedic surgery, University Hospital of Amiens-Picardie, Amiens, France
| | - V Goeb
- Department of Rheumatology, University Hospital of Amiens-Picardie, Amiens, France
| | - F Grados
- Department of Rheumatology, University Hospital of Amiens-Picardie, Amiens, France
| | - J P Lanoix
- Department of Infectious Diseases, University Hospital of Amiens-Picardie, Amiens, France
| |
Collapse
|
30
|
Roerdink RL, Huijbregts HJTAM, van Lieshout AWT, Dietvorst M, van der Zwaard BC. The difference between native septic arthritis and prosthetic joint infections: A review of literature. J Orthop Surg (Hong Kong) 2020; 27:2309499019860468. [PMID: 31284831 DOI: 10.1177/2309499019860468] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Current literature occasionally considers septic arthritis in native joints and prosthetic joint infections as equal pathologies. However, significant differences can be identified. The aim of this review of literature is to describe these differences in definitions, pathology, diagnostic workups, treatment strategies, and prognosis.
Collapse
Affiliation(s)
- Ramon Lucas Roerdink
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
| | | | | | - Martijn Dietvorst
- 4 Department of Orthopedic Surgery at Máxima Medical Center, The Netherlands
| | - Babette Corine van der Zwaard
- 1 Department of Orthopedic Surgery, Jeroen Bosch General Hospital, Henri Dunantstraat, 's-Hertogenbosch, The Netherlands
| |
Collapse
|
31
|
Septic Arthritis in Immunosuppressed Patients: Do Laboratory Values Help? JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2020; 4:JAAOSGlobal-D-20-00007. [PMID: 32440635 PMCID: PMC7209792 DOI: 10.5435/jaaosglobal-d-20-00007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/16/2020] [Indexed: 11/18/2022]
Abstract
Previous studies have recommended synovial fluid cell count thresholds of 50,000 cells/mm-3 to diagnose septic arthritis; however, data to support this are limited. It is also unknown if this value is valid in immunosuppressed patients. Methods We retrospectively reviewed 33 immunosuppressed patients treated at our institution from 2008 to 2018. We compared culture-positive patients with culture-negative patients. Results We found no statistically significant differences in synovial fluid cell count, percent synovial fluid neutrophils, erythrocyte sedimentation rate, or C-reactive protein between the groups (all P = 0.081). The median synovial fluid cell count in the culture-positive cohort was 29,000 cells/mm-3, with only 31.2% having >50,000 cells/mm-3. Conclusion Traditional synovial fluid cell thresholds are not a reliable method of diagnosing septic arthritis in immunosuppressed patients.
Collapse
|
32
|
Clinical characteristics and outcomes of patients with septic arthritis treated without surgery. Eur J Clin Microbiol Infect Dis 2020; 39:897-901. [PMID: 31898794 DOI: 10.1007/s10096-019-03805-7] [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: 11/10/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
Septic arthritis (SA) is typically managed with antibiotic therapy with or without surgery. Little is known about how patients without surgery differ from their operatively managed counterparts. We compared SA patients who received antibiotic treatment with and without surgery. We conducted a retrospective study of patients with monoarticular septic arthritis admitted to a single tertiary care centre between 1998 and 2015. All 441 monoarticular septic arthritis patients received antibiotics; 382 were also managed operatively and 59 nonoperatively. Nonoperative patients were older (64.4 vs 58.3 years old; p = 0.02) and less likely to have prior joint pathology (44.1% vs 67.5%; p < 0.001). Nonoperative patients presented more often with sepsis (37.3% vs 31.9; p = 0.02) and were more frequently admitted to the intensive care unit (23.7% vs 16.5%; p = 0.04). Nonoperative patients were less often discharged to a rehabilitation facility (37.9% vs 55.8%; p = 0.002) and less frequently readmitted to hospital within 60 days of initial discharge (15.3% vs 18.6%; p = 0.05). However, nonoperative patients were more likely to expire within 30 days after hospital discharge (11.9% vs 3.9%; p = 0.009). Nonoperative patients were sicker at presentation; despite deferral of surgery, they had a relatively high survival rate (88%). Among survivors whose data was available, there were no significant sequelae in post-discharge imaging. These findings support the nonsurgical approach as effective for patients with septic arthritis who are not critically ill at time of presentation.
Collapse
|
33
|
Anis HK, Miller EM, George J, Shrestha NK, Klika AK, Kamath AF, Babic M, Higuera CA. Incidence and Characteristics of Osteoarticular Infections in Patients With Infective Endocarditis. Orthopedics 2020; 43:24-29. [PMID: 31693740 DOI: 10.3928/01477447-20191031-02] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/12/2019] [Indexed: 02/03/2023]
Abstract
Osteoarticular infections (OAIs) in the setting of infective endocarditis (IE) are uncommon. Although morbidity and mortality have been widely studied, details of the characteristics of patients with concurrent IE and OAI are limited. Therefore, the purpose of this study was to determine the (1) incidence, (2) mortality, (3) clinical features, and (4) microbiological profiles of OAIs in the setting of IE. A retrospective review was conducted of 1280 IE cases at a large academic institution between 2009 and 2015. Patients were categorized according to the following OAI types: spondylodiskitis, large joint septic arthritis, other site infections, or multiple affected joints. Inpatient mortality rates, clinical findings, and microbiological characteristics were compared between OAI types. Overall, the incidence of OAI among IE patients was 6.8% (n=87). The in-hospital mortality rate was 9.2% (n=8) and was not significantly associated with OAI type (P=.801). Eighteen patients had multiple affected joints resulting in a total of 114 infected sites. Of these, 39% (n=44) were spondylodiskitis, 29% (n=33) were large joint septic arthritis, and 32% (n=37) were infections of smaller joints. Back pain was most common among patients with spondylodiskitis (P<.001), whereas fever and general fatigue were most common with septic arthritis (P<.001). Of the available bone/ joint cultures, 69% were positive. Overall, Staphylococcus aureus was the most common IE pathogen in patients with both IE and OAI (63%). Clinicians should maintain a high suspicion for OAI in patients with IE caused by Staphylococcus aureus, particularly spondylodiskitis among those presenting with back pain. [Orthopedics 2020; 43(1):24-29.].
Collapse
|
34
|
Factors Related to Surgical Treatment and Outcomes of Thai Patients With Septic Arthritis. J Clin Rheumatol 2019; 25:176-180. [PMID: 29912769 DOI: 10.1097/rhu.0000000000000826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to identify factors associated with the surgical treatment of Thai patients with septic arthritis. METHODS This cohort study used a university hospital database in Thailand to identify 450 adult patients with confirmed septic arthritis. Data related to baseline characteristics, clinical and laboratory findings, treatment, and outcomes were collected. A multivariate analysis identified the factors related to surgical treatment. RESULTS The patients had a mean age (±SD) of 53.6 (±17.8) years, and 51% were male. Surgical drainage was performed on 332 patients (74%). The factors identifed as relating to the need for surgical drainage included preexisting joint disease (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.3-4.9), hip involvement (OR, 36.3; 95% CI, 4.1-320.5), abscess formation (OR, 5.6; 95% CI, 1.1-27.1), osteomyelitis (OR, 4; 95% CI, 1.1-14.9), and positive synovial fluid culture (OR, 3.8; 95% CI, 2-7.2). In contrast, patients who were treated with steroids (OR, 0.2; 95% CI, 0.1-0.4) or had septic shock (OR, 0.31; 95% CI, 0.13-0.83) were less likely to undergo surgery. This model correctly predicted 35% of cases. Patients treated with surgical drainage had a significant longer length of stay (median [interquartile range], 21 [11-34] days vs 14 [7-24] days; p < 0.0001) and were less likely to achieve complete recovery (26% vs 53%, p < 0.0001). However, the mortality rate was lower (2.4% vs 10.2%). CONCLUSIONS Patients with septic arthritis who had underlying joint disease, hip involvement, abscess formation, osteomyelitis, and organisms in their synovial fluid were more likely to undergo surgical intervention with a significantly prolonged length of stay but had a lower mortality rate.
Collapse
|
35
|
Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis: A Single Spanish Center's 8-Year Experience. J Clin Rheumatol 2019; 25:4-8. [PMID: 29215382 PMCID: PMC7654724 DOI: 10.1097/rhu.0000000000000615] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis. Methods In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016. Results A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group). Conclusions The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.
Collapse
|
36
|
Synovial fluid culture: agar plates vs. blood culture bottles for microbiological identification. Clin Rheumatol 2019; 39:275-279. [PMID: 31489513 DOI: 10.1007/s10067-019-04740-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/31/2019] [Accepted: 08/04/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Bacteriological diagnosis of septic arthritis (SA) is complicated. Agar plates are the main culture method and yields 40-60% of positive bacterial detection. Addition of bottled culture broth (Bactec®) as a method for detecting synovial microorganisms is common. The advantages of this method and the combination of both have not been thoroughly investigated. This study evaluates an added value of the Bactec culture broth as a single method or as combined with the agar-plate culture. METHODS All culture aspirates of SA-suspected patients were analyzed. All cases with a positive result by either method were reviewed for background data and clinical diagnosis. RESULTS Out of 5000 synovial fluid samples, a clinical diagnosis of SA was suspected in 1024 cases. Samples processed by both culture methods were extracted during the same event. Bactec® vials were positive for significant bacterial detection in 113/148 cases (76.4%) while agar-plate cultures were positive in only 96/154 (62.3%) representing higher sensitivity of 0.5 vs. 0.42 and a positive predictive value (PPV) of 0.76 vs. 0.62. Bacterial detection by both methods combined was positive in 137/221 (62%) and did not achieve a significant increment. CONCLUSIONS The Bactec® method has many advantages in bacteriological identification of synovial infection, including a broader identification spectrum, faster response time, and superior qualities of identification although being more expensive. This method has a better yield in detecting septic arthritis and might be considered a single method for synovial fluid culture in cases suspected for SA.Key Points• The Bactec method had improved detection rates.• Culturing by agar plates and Bactec revealed higher sensitivity and lower specificity.• The use of the blood culture bottles (Bactec system) alone will raise the detection rate of septic arthritis with lower false positive rates and at lower costs.
Collapse
|
37
|
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.
Collapse
|
38
|
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.
Collapse
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
| |
Collapse
|
39
|
Abstract
Septic arthritis usually presents as subacute monoarticular inflammation. Majority of the cases in healthy adults are caused by methicillin-resistant Staphylococcus aureus, streptococci and certain gram-negative organisms, mostly in the setting of extremes of ages, trauma or immunosuppression. This is a case of a healthy adult with a sudden onset of inflammation of the knee joint, being diagnosed with septic arthritis of the left knee with Veillonella sp. growing from the joint aspirate on two successive cultures. The patient was treated with 6 weeks of oral metronidazole and 4 weeks of intravenous ceftriaxone in addition to arthroscopic drainage and irrigation. Rare causes of septic arthritis should be considered even in healthy adults with native joints. Closer follow-up might be needed to ensure successful treatment.
Collapse
Affiliation(s)
- Syed Shah
- Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA
| | - Daniel Havlichek
- Department of Internal Medicine, Michigan State University, Lansing, Michigan, USA
| |
Collapse
|
40
|
Shamrock AG, Bertsch ML, Kowalski HR, Weinstein SL. Ruptured Appendicitis and Retrocecal Abscess Masquerading as Knee Pain in a Pediatric Patient: A Case Report. J Emerg Med 2019; 57:e21-e25. [PMID: 31060848 DOI: 10.1016/j.jemermed.2019.03.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2019] [Revised: 02/23/2019] [Accepted: 03/30/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Knee pain has a variety of etiologies in the pediatric population, including septic arthritis, osteomyelitis, fracture, ligamentous injury, and neoplasms. Extrinsic sources of knee pain may also be intra-abdominal, although abdominal pathology is much more likely to manifest as hip or proximal thigh musculature pain. CASE REPORT A 5-year-old healthy male presented with atraumatic right knee pain, discomfort with weightbearing, fever, and elevated inflammatory laboratory markers. Physical examination and magnetic resonance imaging findings of the knee were benign, leading to low clinical suspicion for knee septic arthritis. Blood cultures were positive for a gastrointestinal organism, Granulicatella adiacens, suggesting abdominal pathology leading to referred pain. Ultrasound evaluation and computed tomography (CT) of the abdomen revealed a large abscess secondary to perforated appendicitis, which was treated with CT-guided drainage and i.v. antibiotics. The patient's musculoskeletal pain subsided with treatment of the appendicitis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Acute appendicitis may present as knee pain, with other signs and symptoms mimicking septic arthritis, such as fever, inability to bear weight, and elevated inflammatory markers. Considering an array of differential diagnoses in pediatric patients with apparent knee septic arthritis is crucial to prevent delay in diagnosis of alternative infectious sources.
Collapse
Affiliation(s)
- Alan G Shamrock
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Morgan L Bertsch
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Heather R Kowalski
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Stuart L Weinstein
- Department of Orthopaedics and Rehabilitation, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
| |
Collapse
|
41
|
Verbner JM, Pereira-Duarte M, Zicaro JP, Yacuzzi C, Costa-Paz M. Infected Baker's Cyst: A New Classification, Diagnosis and Treatment Recommendations. J Orthop Case Rep 2019; 8:16-23. [PMID: 30915286 PMCID: PMC6424320 DOI: 10.13107/jocr.2250-0685.1238] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction: Baker’s cyst has a high prevalence in adult population. Despite being usually asymptomatic, cyst complications may develop, such as an infection, rupture and content dissemination into the calf. This clinical presentation has a low incidence with few reports in the literature. We have not found any publication describing a systematic approach for its treatment. The purpose of this study is to propose a new classification, diagnosis, and treatment recommendations based on a case report and a literature review to guide physicians on the best course of treatment. Case Report: A 53-year-old man presented with sudden left popliteal pain associated with progressive knee and calf swelling and limited knee flexion. After the initial evaluation, a Baker’s cyst rupture and dissemination into the calf, associated with a septic arthritis, were diagnosed. An arthroscopic surgical irrigation of the knee and open debridement of the calf collection were performed. Conclusion: Our classification may allow an accurate and structured description of the different stages of Baker’s cyst presentations, with simplification of the clinical description, diagnosis, and treatment approaches.
Collapse
Affiliation(s)
- Jonathan Maximiliano Verbner
- Department of Orthopaedics, Hospital Italiano de Buenos Aires, Servicio de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi", Ciudad Autónoma de Buenos Aires, Argentina
| | - Matias Pereira-Duarte
- Department of Orthopaedics, Hospital Italiano de Buenos Aires, Servicio de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi", Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Pablo Zicaro
- Department of Orthopaedics, Hospital Italiano de Buenos Aires, Servicio de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi", Ciudad Autónoma de Buenos Aires, Argentina
| | - Carlos Yacuzzi
- Department of Orthopaedics, Hospital Italiano de Buenos Aires, Servicio de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi", Ciudad Autónoma de Buenos Aires, Argentina
| | - Matías Costa-Paz
- Department of Orthopaedics, Hospital Italiano de Buenos Aires, Servicio de Ortopedia y Traumatología "Dr. Prof. Carlos E. Ottolenghi", Ciudad Autónoma de Buenos Aires, Argentina
| |
Collapse
|
42
|
Kawashiri SY, Edo Y, Kawakami A. Early Detection of Inflammation and Joint Destruction Revealed by Ultrasound in a Patient with Sternoclavicular Septic Arthritis. Intern Med 2019; 58:865-869. [PMID: 30449803 PMCID: PMC6465004 DOI: 10.2169/internalmedicine.1782-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old Japanese man experienced fever/neck pain, and neck magnetic resonance imaging revealed a spinal epidural abscess. The following day, he developed a palpable mass with evident inflammatory signs in the right sternoclavicular joint (SCJ) with severe pain. Ultrasound revealed synovitis with remarkable power Doppler signals in the right SCJ. Blood cultures yielded Streptococcus agalactiae growth. After 12 days, ultrasound showed right distal clavicle bone erosion. His symptoms improved with long-term parenteral antibiotic treatment, but the right SCJ joint destruction progressed for several months. We diagnosed him with sternoclavicular septic arthritis complicated with a spinal epidural abscess and bacteremia.
Collapse
Affiliation(s)
- Shin-Ya Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Japan
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Yushiro Edo
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Japan
| |
Collapse
|
43
|
Sweet MC, Sheena GJ, Liu S, Fisk FE, Lynch JR, Muh SJ. Clinical Characteristics and Long-term Outcomes After Septic Arthritis of the Native Glenohumeral Joint: A 20-Year Retrospective Review. Orthopedics 2019; 42:e118-e123. [PMID: 30602050 DOI: 10.3928/01477447-20181227-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/17/2018] [Indexed: 02/03/2023]
Abstract
Septic arthritis of the native glenohumeral joint is rare, and there is little information available regarding the natural progression and long-term joint outcomes of this pathology. The authors performed a retrospective analysis of 97 patients with culture-positive glenohumeral septic arthritis between 1995 and 2015 at their institution with a mean clinical follow-up of 83.1 months. Patient records were reviewed to document demographic and laboratory data, clinical presentation, postoperative complications, recurrences, and subsequent shoulder arthroplasty. Common comorbidities uncovered included 20 immunocompromised patients (20.6%), intravenous drug use among 27 patients (27.8%), diabetes mellitus among 40 patients (41.2%), and 18 patients (18.5%) receiving hemodialysis. Staphylococcus aureus was the most common pathogen identified (61 patients; 62.8%), followed by streptococcal species (17 patients; 17.2%). Hematogenous spread of infection was the most common etiology of shoulder sepsis (40.2%). Seven patients (7.2%) developed shoulder sepsis of undetermined etiology in the absence of established risk factors, and 16 patients (16.4%) developed recurrent glenohumeral septic arthritis at a mean of 40 months following initial eradication of infection. Three patients (3.0%) eventually underwent same-side shoulder arthroplasty at a mean of 18 months following septic arthritis, with none experiencing a periprosthetic joint infection. Glenohumeral septic arthritis is highly unlikely in the absence of medical risk factors. Long-term recurrence after clinically successful treatment is low (16.5%), and few patients undergo elective arthroplasty following shoulder septic arthritis. However, orthopedic surgeons can expect 30% to 40% of patients to require multiple trips to the operating room to successfully treat the initial joint infection, regardless of treatment method. [Orthopedics. 2019; 42(1):e118-e123.].
Collapse
|
44
|
Kaziz H, Triki M, Mouelhi T, Bouattour K, Naouar N, Ben Ayeche M. Septic elbow arthritis in children: Epidemiology and outcome. Arch Pediatr 2019; 26:38-43. [DOI: 10.1016/j.arcped.2018.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/16/2018] [Accepted: 11/10/2018] [Indexed: 02/01/2023]
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Delgado‐Noguera MF, Forero Delgadillo JM, Franco AA, Vazquez JC, Calvache JA. Corticosteroids for septic arthritis in children. Cochrane Database Syst Rev 2018; 11:CD012125. [PMID: 30480764 PMCID: PMC6517045 DOI: 10.1002/14651858.cd012125.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Septic arthritis is an acute infection of the joints characterised by erosive disruption of the articular space. It is the most common non-degenerative articular disease in developing countries. The most vulnerable population for septic arthritis includes infants and preschoolers, especially boys. Septic arthritis disproportionately affects populations of low socioeconomic status. Systemic corticosteroids and antibiotic therapy may be beneficial for treatment of septic arthritis. Even if the joint infection is eradicated by antibiotic treatment, the inflammatory process may produce residual joint damage and sequelae. OBJECTIVES To determine the benefits and harms of corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis. SEARCH METHODS We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, Latin American Caribbean Health Sciences Literature (LILACS), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/), ClinicalTrials.gov (www.ClinicalTrials.gov), and Google Scholar. We searched all databases from their inception to 17 April 2018, with no restrictions on language of publication. SELECTION CRITERIA We included randomised controlled trials (RCTs) with patients from two months to 18 years of age with a diagnosis of septic arthritis who were receiving corticosteroids in addition to antibiotic therapy or as an adjuvant to other therapies such as surgical drainage, intra-articular puncture, arthroscopic irrigation, or debridement. DATA COLLECTION AND ANALYSIS Two review authors independently assessed eligibility, data extraction, and evaluation of risk of bias. We considered as major outcomes the presence of pain, activities of daily living, normal physical joint function, days of antibiotic treatment, length of hospital stay, and numbers of total and serious adverse events. We used standard methodological procedures expected by Cochrane. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table. MAIN RESULTS We included two RCTs involving a total of 149 children between three months and 18 years of age who were receiving antibiotics for septic arthritis. The most commonly affected joints were hips and knees. These studies were performed in Costa Rica and Israel. In both studies, dexamethasone administered intravenously (ranging from 0.15 to 0.2 mg/kg/dose every six to eight hours) during four days was the corticosteroid, and the comparator was placebo. Trials excluded patients with any degree of immunodeficiency or immunosuppression. The longest follow-up was one year. Trials did not report activities of daily living nor length of hospital stay. Both studies used adequate processes for randomisation, allocation concealment, and blinding, and review authors judged them to have low risk of selection and performance bias. Losses to follow-up were substantive in both studies, and we judged them to have high risk of attrition bias and of selective outcome reporting. We graded all outcomes as low quality due to concerns about study limitations and imprecision.The risk ratio (RR) for absence of pain at 12 months of follow-up was 1.33, favouring corticosteroids (95% confidence interval (CI) 1.03 to 1.72; P = 0.03; number needed to treat for an additional beneficial outcome (NNTB) = 13, 95% CI 6 to 139; absolute risk difference 24%, 95% CI 5% to 43%).The RR for normal function of the affected joint at 12 months of follow-up was 1.32, favouring corticosteroids (95% CI 1.12 to 1.57; P = 0.001; NNTB = 13, 95% CI 7 to 33; absolute risk difference 24%, 95% CI 11% to 37%).We found a reduction in the number of days of intravenous antibiotic treatment favouring corticosteroids (mean difference (MD) -2.77, 95% CI -4.16 to -1.39) based on two trials with 149 participants.Researchers did not report length of hospital stay. One trial (49 participants) reported that treatment with dexamethasone was associated with a shorter duration of IV antibiotic treatment, leading to a shorter hospital stay, and although duration of hospitalisation was a primary outcome of the study, study authors did not provide data on the duration of hospitalisation. We downgraded the quality by one level for concerns about study limitations (high risk of attrition bias and selective reporting), and by another level for imprecision.In one trial of 49 participants, researchers followed 29 children for 12 months, and parents reported that no children demonstrated adverse effects of the intervention. AUTHORS' CONCLUSIONS Evidence for corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis is of low quality and is derived from the findings of two trials (N = 149). Corticosteroids may increase the proportion of patients without pain and the proportion of patients with normal function of the affected joint at 12 months, and may also reduce the number of days of antibiotic treatment. However, we cannot draw strong conclusions based upon these trial results. Additional randomised clinical trials in children with relevant outcomes are needed.
Collapse
Affiliation(s)
- Mario F Delgado‐Noguera
- Facultad Ciencias de la Salud, Universidad del CaucaDepartamento de PediatriaHospital Universitario San JoseDepartamento de PediatríaPopayánColombiaNA
| | - Jessica M Forero Delgadillo
- Facultad Ciencias de la Salud, Universidad del CaucaDepartamento de PediatriaHospital Universitario San JoseDepartamento de PediatríaPopayánColombiaNA
| | - Alexis A Franco
- Facultad Ciencias de la Salud, Universidad del CaucaDepartamento de PediatriaHospital Universitario San JoseDepartamento de PediatríaPopayánColombiaNA
| | - Juan C Vazquez
- Instituto Nacional de Endocrinologia (INEN)Departamento de Salud ReproductivaZapata y DVedadoHabanaCuba10 400
| | | |
Collapse
|
47
|
Woerner A, Pourmalek F, Panozzo C, Pileggi G, Hudson M, Caric A, Abraham S, Varricchio F, Velasco C, Oleske J, Bauwens J, Bonhoeffer J. Acute aseptic arthritis: Case definition & guidelines for data collection, analysis, and presentation of immunisation safety data. Vaccine 2018; 37:384-391. [PMID: 30342899 DOI: 10.1016/j.vaccine.2017.08.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 08/29/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Andreas Woerner
- University of Basel Children's Hospital, Basel, Switzerland.
| | | | - Catherine Panozzo
- Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, United States
| | - Gecilmara Pileggi
- School of Medicine of Ribeirão Preto, University of São Paulo, Brazil; School of Medicine, University Federal of São Carlos, Brazil
| | | | | | - Sonya Abraham
- Imperial National Institute of Health Research/Wellcome CRF, Imperial College, London, United Kingdom
| | | | - Cesar Velasco
- Barcelona Centre for International Health Research (CRESIB), Barcelona, Spain
| | | | | | - Jan Bonhoeffer
- University of Basel Children's Hospital, Basel, Switzerland; Brighton Collaboration Foundation, Basel, Switzerland
| | | |
Collapse
|
48
|
Fahmy MD, Gupta A, Abdelkader A, MacKinney T, Sewall S. Clinical pathologic conference: acute onset malocclusion and facial pain. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:301-306. [DOI: 10.1016/j.oooo.2017.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Revised: 04/07/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
|
49
|
Minegishi Y, Uchiyama K, Sakurai K, Ibe S, Kanda H, Nihonyanagi S, Nakamura M, Ikeda S, Takaso M. Clinical usefulness of multiplex PCR-lateral flow for the diagnosis of orthopedic-related infections. Mod Rheumatol 2018; 29:867-873. [PMID: 30126317 DOI: 10.1080/14397595.2018.1514690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: Polymerase chain reaction (PCR)-based assays are being increasingly used for the diagnosis of orthopedic-related infections. Unfortunately, classical PCR requires imaging devices that are expensive and complex. We previously developed the PCR-lateral flow (PCR-LF) method, which does not require any additional imaging device. In the present study, the objective was to determine whether PCR-LF tests could be used to effectively diagnose orthopedic-related infections. Methods: In this study, we used PCR-LF to diagnose common causes of orthopedic-related infections and compared the results to those from conventional bacterial cultures of the same samples. Results: Notably, for 228 synovial fluid or pus specimens, the sensitivity and specificity of bacterial cultures were 53.5% and 97.7%, respectively, compared to 61.6% and 89.9% for PCR-LF. Although the difference in sensitivity between bacterial cultures and PCR-LF was not significant, when our analysis was limited to cases with suspected periprosthetic joint infection, the sensitivity of PCR-LF (66.1%) was superior to that of bacterial cultures (42.9%). Conclusion: This study indicates that PCR-LF is a useful method for diagnosing orthopedic-related infections.
Collapse
Affiliation(s)
- Yojiro Minegishi
- Graduate School of Medical Sciences, Kitasato University , Sagamihara , Japan.,Department of Orthopaedic Surgery, School of Medicine, Kitasato University , Sagamihara , Japan
| | - Katsufumi Uchiyama
- Graduate School of Medical Sciences, Kitasato University , Sagamihara , Japan.,Department of Orthopaedic Surgery, School of Medicine, Kitasato University , Sagamihara , Japan.,Infection Control Team, Kitasato University Hospital , Sagamihara , Japan
| | - Keizo Sakurai
- Department of Clinical Laboratory, Kitasato University Hospital , Sagamihara , Japan
| | - Shiro Ibe
- Kitasato-Otsuka Biomedical Assay Laboratories Co., Ltd , Sagamihara , Japan
| | - Hiromi Kanda
- Kitasato-Otsuka Biomedical Assay Laboratories Co., Ltd , Sagamihara , Japan
| | - Shin Nihonyanagi
- Department of Clinical Laboratory, Kitasato University Hospital , Sagamihara , Japan.,Infection Control Team, Kitasato University Hospital , Sagamihara , Japan
| | - Masaki Nakamura
- Graduate School of Medical Sciences, Kitasato University , Sagamihara , Japan.,Department of Microbiology, Kitasato University School of Allied Health Science , Sagamihara , Japan.,Infection Control Team, Kitasato University Hospital , Sagamihara , Japan
| | - Shinsuke Ikeda
- Graduate School of Medical Sciences, Kitasato University , Sagamihara , Japan.,Department of Orthopaedic Surgery, School of Medicine, Kitasato University , Sagamihara , Japan
| | - Masashi Takaso
- Graduate School of Medical Sciences, Kitasato University , Sagamihara , Japan.,Department of Orthopaedic Surgery, School of Medicine, Kitasato University , Sagamihara , Japan
| |
Collapse
|
50
|
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.
Collapse
|