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Pothini T, Wilmot CD, Waters JK, Wait MA, Reznik SI, Jordan KG, Caire JT, Ashworth JM, Cady LC, Lysikowski JR, Yen CF, Weinschenk RC, Samade R, Jessen ME, Kusiak A, Kernstine KH. Clinical and radiological septic joint analysis of spontaneous sternoclavicular joint infections: achieving the best outcomes-a systems engineering approach. Eur J Cardiothorac Surg 2024; 65:ezae128. [PMID: 38547389 DOI: 10.1093/ejcts/ezae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/12/2024] [Accepted: 03/26/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVES Spontaneous sternoclavicular joint infection (SSCJI) is a rare and poorly understood disease process. This study aims to identify factors guiding effective management strategies for SSCJI by using data mining. METHODS An Institutional Review Board-approved retrospective review of patients from 2 large hospitals (2010-2022) was conducted. SSCJI is defined as a joint infection without direct trauma or radiation, direct instrumentation or contiguous spread. An interdisciplinary team consisting of thoracic surgeons, radiologists, infectious disease specialists, orthopaedic surgeons, hospital information experts and systems engineers selected relevant variables. Small set data mining algorithms, utilizing systems engineering, were employed to assess the impact of variables on patient outcomes. RESULTS A total of 73 variables were chosen and 54 analysed against 11 different outcomes. Forty-seven patients [mean age 51 (22-82); 77% male] met criteria. Among them, 34 underwent early joint surgical resection (<14 days), 5 patients received delayed surgical intervention (>14 days) and 8 had antibiotic-only management. The antibiotic-only group had comparable outcomes. Indicators of poor outcomes were soft tissue fluid >4.5 cm, previous SSCJI, moderate/significant bony fragments, HgbA1c >13.9% and moderate/significant bony sclerosis. CONCLUSIONS This study suggests that targeted antibiotic-only therapy should be considered initially for SSCJI cases while concurrently managing comorbidities. Patients displaying indicators of poor outcomes or no symptomatic improvement after antibiotic-only therapy should be considered for surgical joint resection.
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Affiliation(s)
- Tanushri Pothini
- School of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Charles D Wilmot
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - John K Waters
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael A Wait
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Scott I Reznik
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kirk G Jordan
- Division of Chest Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline T Caire
- Division of Chest Radiology, Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - John M Ashworth
- Department of Health Systems Planning and Analytics, Parkland Hospital, Dallas, TX, USA
| | - Leah C Cady
- Department of Health Systems Planning and Analytics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jerzy R Lysikowski
- Department of Health Systems Planning and Analytics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Christina F Yen
- Division of Infectious Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert C Weinschenk
- Department of Orthopedic Surgery, University of Texas Sokuthwestern Medical Center, Dallas, TX, USA
| | - Richard Samade
- Department of Orthopedic Surgery, University of Texas Sokuthwestern Medical Center, Dallas, TX, USA
| | - Michael E Jessen
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Andrew Kusiak
- Department of Industrial and Systems Engineering, University of Iowa, Iowa City, IA, USA
| | - Kemp H Kernstine
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Walker JK, Cronin JT, Richards BW, Skedros JG. Acute Sternoclavicular Joint Sepsis With Medial Clavicle Osteomyelitis (Staphylococcus aureus) and Cervical-Thoracic Epidural Phlegmon in an Adult Female With No Apparent Risk Factors. Cureus 2023; 15:e35870. [PMID: 37033534 PMCID: PMC10079283 DOI: 10.7759/cureus.35870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
This is a case of a 71-year-old female with a history of only one known medical problem (hypertension) who presented with a right sternoclavicular joint (SCJ) infection in addition to (1) a contiguous lower cervical and upper thoracic epidural phlegmon and (2) cellulitis and a phlegmon in her posterior neck, which was subcutaneous and near the lower cervical and upper thoracic spinous processes. These loci of infection developed several days after she had pricked her fingers when cutting rose bushes and were initially considered to be epidural abscesses. However, after the patient was transferred to our tertiary medical center, a neurosurgeon and radiologist determined that the cervicothoracic infections were phlegmons rather than fully developed abscesses. The phlegmons were treated with only IV antibiotics. The SCJ infection was surgically debrided, and the medial clavicle was excised. Bone and fluid cultures grew methicillin-sensitive Staphylococcus aureus (S. aureus). The patient recovered uneventfully (the final follow-up was four years later). This case is uncommon because of the concurrent SCJ infection with medial clavicle osteomyelitis, cervical-thoracic epidural, and paraspinous phlegmons.
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Schendrigin IN, Podsvirova IA. Synovial microflora of large joints in patients of a multidisciplinary hospital. RUDN JOURNAL OF MEDICINE 2022. [DOI: 10.22363/2313-0245-2022-26-2-138-149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Relevance. There is no doubt that microorganisms participate in occurrence and development of septic process in joints. However, the issue of etiological significance of each agent remains controversial, because, in spite of the general trends, indicating the participation of numerous microorganisms in the development of articular pathology, each result of microbiological analysis concerns only a specific case in the territorial and clinical aspects. The aim of the study - microbiological research of synovial fluid obtained from knee joint during synovitis after its aspiration in patients of various departments of the Stavropol Regional Clinical Hospital. Materials and Methods . There were studied 198 samples of synovial fluid. Primary inoculation of puncture was performed with subsequent isolation, identification of the cultures by mass spectrometry and assessment of their antibiotic sensitivity by discodiffusion method. Results and Discussion . 11 cultures of bacterial pathogens were isolated. Gram-positive cocci - 82 %, of which 77.8 % - microorganisms of Staphylococcus genus (44.4 % S.aureus , 33.4 % S.epidermidis ), 22.2 % - other gram-positive cocci: one strain of each, Enterococcus faecium and Streptococcus mitis . Gram-negative pathogens are represented by K.neumoniae and P.aeruginosa with a total content of 18 %. Highly virulent microorganisms S.aureus , K.neumoniae and P.aeruginosa are isolated from the synovial fluid of patients of the surgical departments (orthopedotraumatological No. 1, No. 2) and the rheumatological department. Microorganisms with low virulence E.faecium , S.mitis and S.epidermidis are isolated from synovial fluid of patients of various departments. No obvious resistance of isolated pathogens to antimicrobial drugs has been registered. Conclusion . The presence and species affiliation of the microorganisms identified in synovial fluid allows predicting their etiological significance in development of septic process in joints. Their role as causative agents of nosocomial infections typical for a medical institution is not excluded. The presence of articular pathology in each of the examined departments dictates the need for a clear understanding of the importance of timely and high-quality joint aspiration followed by microbiological examination in almost all patients with damage of large joints, including patients without clinical signs of septic arthritis. Such an approach that makes it possible to identify a greater number of causative agents of septic arthritis and quickly evaluate the dynamics of their antimicrobial resistance should become an obligatory part of a comprehensive research and treatment of a patient with arthritis in multi-fi eld hospitals.
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Alhariri S, Kalas MA, Hassan M, Carter JT, Ghafouri SR, Dihowm F. Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report. Cureus 2022; 14:e23969. [PMID: 35547421 PMCID: PMC9088884 DOI: 10.7759/cureus.23969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/05/2022] Open
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Ali B, Barlas V, Shetty A. Re: Medical and conservative surgical management of bacterial sternoclavicular joint septic arthritis: a case series. ANZ J Surg 2021; 91:215. [PMID: 33590627 DOI: 10.1111/ans.16372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Barkat Ali
- Division of Plastic and Reconstruction Surgery, Department of Surgery, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Venus Barlas
- School of Medicine, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Anil Shetty
- Division of Plastic and Reconstruction Surgery, Department of Surgery, The University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
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Wako Y, Sakamoto M, Rokkaku T, Motegi H, Watanabe H, Yamada T, Yamaguchi T, Inagaki K, Maruyama J, Ueta T. A case of hip joint septic arthritis due to haematogenous infection, which was misdiagnosed sternoclavicular joint septic arthritis as SAPHO syndrome. Mod Rheumatol Case Rep 2021; 5:409-413. [PMID: 33427583 DOI: 10.1080/24725625.2020.1869510] [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: 10/22/2022]
Abstract
Anterior chest pain associated with sternoclavicular arthritis has been considered a symptom specific to SAPHO syndrome. Differentiating aseptic arthritis of the SAPHO syndrome from infectious sternoclavicular joint (SCJ) arthritis is often difficult. We reported a 55-year-old woman with left hip joint and right SCJ pain. Diagnosis and treatment were delayed because she was misdiagnosed with SAPHO syndrome, and haematogenous infection spread to the hip joint septic arthritis. She was diagnosed promptly after presenting to our hospital and underwent early debridement, and her hip joint and SCJ was found to have almost no dysfunction. Differentiation between sternoclavicular arthritis of the SAPHO syndrome and sternoclavicular septic arthritis is clinically important and requires careful attention.
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Affiliation(s)
- Yasushi Wako
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Masaaki Sakamoto
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Tomoyuki Rokkaku
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hiroyuki Motegi
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Hitoshi Watanabe
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Toshiyuki Yamada
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Takeshi Yamaguchi
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Kenta Inagaki
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Juntaro Maruyama
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Toru Ueta
- Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan
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