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Rodrigues TC, Taneja AK, Skaf A, Godoy IRB. Upper extremity infection: imaging features with focus on magnetic resonance imaging. Skeletal Radiol 2024; 53:1991-2006. [PMID: 38097765 DOI: 10.1007/s00256-023-04545-8] [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: 08/19/2023] [Revised: 11/01/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. KEY FINDINGS: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.
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Affiliation(s)
- Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Abdalla Skaf
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil.
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil.
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil.
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2
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Okpala OE, Rondevaldova J, Osei-Owusu H, Kudera T, Kokoskova T, Kokoska L. Susceptibility of Staphylococcus aureus to Anti-Inflammatory Drugs with a Focus on the Combinatory Effect of Celecoxib with Oxacillin In Vitro. Molecules 2024; 29:3665. [PMID: 39125072 PMCID: PMC11314137 DOI: 10.3390/molecules29153665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 07/26/2024] [Accepted: 07/30/2024] [Indexed: 08/12/2024] Open
Abstract
Musculoskeletal infections (MIs) are among the most difficult-to-treat staphylococcal diseases due to antibiotic resistance. This has encouraged the development of innovative strategies, such as combination therapy, to combat MI. The aim of this study was to investigate the in vitro antistaphylococcal activity of anti-inflammatory drugs and the combined antimicrobial effect of celecoxib and oxacillin. The minimum inhibitory concentrations (MICs) of 17 anti-inflammatory drugs against standard strains and clinical isolates of S. aureus, including methicillin-resistant strains (MRSAs), were determined using the broth microdilution method. The fractional inhibitory concentration indices (FICIs) were evaluated using checkerboard assays. Celecoxib produced the most potent antistaphylococcal effect against all tested strains (MICs ranging from 32 to 64 mg/L), followed by that of diacerein against MRSA3 and MRSA ATCC 33592 (MIC 64 mg/L). Several synergistic effects were observed against the tested S. aureus strains, including MRSA (FICI ranging from 0.087 to 0.471). The strongest synergistic interaction (FICI 0.087) was against MRSA ATCC 33592 at a celecoxib concentration of 2 mg/L, with a 19-fold oxacillin MIC reduction (from 512 to 26.888 mg/L). This is the first report on the combined antistaphylococcal effect of celecoxib and oxacillin. These findings suggest celecoxib and its combination with oxacillin as perspective agents for research focused on the development of novel therapies for MI caused by S. aureus. This study further indicates that celecoxib could resensitize certain MRSA strains, in some cases, to be susceptible to β-lactams (e.g., oxacillin) that were not previously tested. It is essential to mention that the in vitro concentrations of anti-inflammatory drugs are higher than those typically obtained in patients. Therefore, an alternative option for its administration could be the use of a drug delivery system for the controlled slow release from an implant at the infection site.
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Affiliation(s)
- Onyedika Emmanuel Okpala
- Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, Suchdol, 165 00 Prague, Czech Republic; (O.E.O.); (J.R.); (H.O.-O.)
| | - Johana Rondevaldova
- Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, Suchdol, 165 00 Prague, Czech Republic; (O.E.O.); (J.R.); (H.O.-O.)
| | - Hayford Osei-Owusu
- Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, Suchdol, 165 00 Prague, Czech Republic; (O.E.O.); (J.R.); (H.O.-O.)
| | - Tomas Kudera
- Drift-Food Research Centre, Faculty of Agrobiology, Food and Natural Resources, Czech University of Life Sciences Prague, Kamycka 129, Suchdol, 165 00 Prague, Czech Republic;
| | - Tersia Kokoskova
- Department of Animal Science and Food Processing, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, Suchdol, 165 00 Prague, Czech Republic;
| | - Ladislav Kokoska
- Department of Crop Sciences and Agroforestry, Faculty of Tropical AgriSciences, Czech University of Life Sciences Prague, Kamycka 129, Suchdol, 165 00 Prague, Czech Republic; (O.E.O.); (J.R.); (H.O.-O.)
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Kaye AD, Greene D, Alvarez-Amado AV, Townsend HL, Forte M, Vasterling M, Hirsch JD, Howard J, Ahmadzadeh S, Willett O, Kaye AM, Shekoohi S, Varrassi G. Pathophysiology and Evolving Treatment Options of Septic Arthritis: A Narrative Review. Cureus 2024; 16:e65883. [PMID: 39219968 PMCID: PMC11364462 DOI: 10.7759/cureus.65883] [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: 07/15/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Pyogenic (septic) arthritis is a severe joint infection characterized by the invasion of microorganisms into the synovium, causing inflammation and joint destruction. This review article provides a comprehensive overview of pyogenic arthritis, focusing on etiology, pathogenesis, clinical manifestations, diagnosis, and management strategies. This review explores routes of microbial entry into joints, emphasizing the importance of prompt identification and treatment to prevent irreversible joint damage. Clinical manifestations, such as joint pain, swelling, and limited range of motion, are discussed, along with the challenges in differentiating pyogenic arthritis from other joint disorders. Diagnostic approaches, including joint aspiration and imaging modalities, are critically examined for accuracy in confirming diagnosis. This review also addresses the significance of early intervention through antimicrobial therapy and joint drainage, highlighting the role of multidisciplinary collaboration in optimizing patient outcomes. In summary, the present investigation underscores the complexities of pyogenic arthritis and the need for a comprehensive understanding of pathophysiology for timely and effective management to improve patient prognosis and quality of life.
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Affiliation(s)
- Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Driskell Greene
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Horace L Townsend
- School of Medicine, American University of the Caribbean, Cupecoy, SXM
| | - Michael Forte
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Megan Vasterling
- School of Medicine, Louisiana State University Health Sciences Center New Orleans, New Orleans, USA
| | - Jon D Hirsch
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Jeffrey Howard
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Olga Willett
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Adam M Kaye
- Department of Pharmacy Practice, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, USA
| | - Sahar Shekoohi
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Hodea FV, Grosu-Bularda A, Teodoreanu RN, Cretu A, Ratoiu VA, Lascar I, Hariga CS. Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections-A Five-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:895. [PMID: 38929511 PMCID: PMC11205443 DOI: 10.3390/medicina60060895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.
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Affiliation(s)
- Florin-Vlad Hodea
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Razvan Nicolae Teodoreanu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Andrei Cretu
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Vladut-Alin Ratoiu
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
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Kim S, Won SJ, Lee NK, Chang CB. Life Expectancy of Patients Undergoing Total Knee Arthroplasty: Comparison With General Population. J Korean Med Sci 2024; 39:e106. [PMID: 38529576 DOI: 10.3346/jkms.2024.39.e106] [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: 10/24/2023] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND This study aimed to analyze the life expectancy and cause of death in osteoarthritis (OA) patients who underwent total knee arthroplasty (TKA) and to identify risk factors that affect long-term mortality rate after TKA. METHODS Among 601 patients, who underwent primary TKA due to OA by a single surgeon from July 2005 to December 2011, we identified patients who died after the operation using data obtained from the National Statistical Office of Korea. We calculated 5-, 10-, and 15-year survival rates of the patients and age-specific standardized mortality ratios (SMRs) compared to general population of South Korea according to the causes of death. We also identified risk factors for death. RESULTS The 5-year, 10-year, and 15-year survival rates were 94%, 84%, and 75%, respectively. The overall age-specific SMR of the TKA cohort was lower than that of the general population (0.69; P < 0.001). Cause-specific SMRs for circulatory diseases, neoplasms, and digestive diseases after TKA were significantly lower than those of the general population (0.65, 0.58, and 0.16, respectively; all P < 0.05). Male gender, older age, lower body mass index (BMI), anemia, and higher Charlson comorbidity index (CCI) were significant factors associated with higher mortality after TKA. CONCLUSION TKA is a worthwhile surgery that can improve life expectancy, especially from diseases of the circulatory system, neoplasms, and digestive system, in patients with OA compared to the general population. However, careful follow-up is needed for patients with male gender, older age, lower BMI, anemia, and higher CCI, as these factors may increase long-term mortality risk after TKA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sanghyo Kim
- Department of Orthopaedic Surgery, Busan Mirae Hospital, Busan, Korea
| | - Samuel Jaeyoon Won
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Na-Kyoung Lee
- Department of Orthopaedic Surgery, National Medical Center, Seoul, Korea.
| | - Chong Bum Chang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
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Garg V, Singh V, Kalia RB, Regmi A, Yasam R, Sinha SK. Role of Magnetic Resonance Imaging in Concomitant Periarticular Infections in Septic Arthritis of Large Joints in Children: A Systematic Review. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:83-89. [PMID: 38486643 PMCID: PMC10936883 DOI: 10.4103/jwas.jwas_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 03/17/2024]
Abstract
Background Septic arthritis associated with adjacent infections, presents a diagnostic challenge as the clinical presentation is similar to that of isolated septic arthritis, additional diagnostic tools are needed to detect these infections. The purpose of this study was to examine the effectiveness of magnetic resonance imaging (MRI) for diagnosis of concomitant infection in children with septic arthritis of large joints and its effect on patient outcome and treatment. Materials and Methods Electronic literature research of PubMed, Cochrane and Scopus, was conducted in January 2022 using a combination of MeSH, search terms and keywords. The data extracted included the study details, demographic data, the proportion of patients having a concomitant periarticular infection, clinical presentation, blood parameters and culture findings and outcomes. Results This review included seven studies with 499 patients. The mean age was 7.08 ± 2.38 years in the study. There was a male predominance, with 174 being males (62.36%). The most common joint involved was the hip joint (44.47%). 42.48% had concomitant periarticular infections detected by MRI. Osteomyelitis was the most common infection seen in 209 patients (41.84%). The mean duration of antibiotics given and hospital stay was significantly more in periarticular infections (P > 0.05). 32.5% of the patients with septic arthritis underwent a second surgical procedure whereas 61.11% of patients with periarticular infections underwent second procedure in this review (P > 0.05). Conclusions The use of MRI to diagnose these complicated infections appears to be beneficial. Multi-centric randomised control trials are needed to investigate the efficacy of MRI and its impact on patient care and outcome.
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Affiliation(s)
- Varun Garg
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Roop Bhusan Kalia
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ramapriya Yasam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sourabh Kumar Sinha
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Ozbek L, Kyriakides J, Asokan A. A case of otogenic septic arthritis of the knee. J Surg Case Rep 2023; 2023:rjad682. [PMID: 38115949 PMCID: PMC10728415 DOI: 10.1093/jscr/rjad682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023] Open
Abstract
Septic arthritis is a serious condition resulting in rapid destruction of articular cartilage and potential sepsis. Bacterial invasion of a joint occurs most commonly as a result of haematogenous spread from a distant infection. However, an otogenic source of this transient bacteraemia and resultant septic arthritis has not yet been reported in the literature. We report a case of acute septic arthritis of the knee with Streptococcus pyogenes, secondary to acute otitis media of the ear.
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Affiliation(s)
- Leyla Ozbek
- Otolaryngology Department, University College Hospital, 235 Euston Road, London NW1 2BU, United Kingdom
| | - Jonathon Kyriakides
- Trauma and Orthopaedics Department, Barnet Hospital, Wellhouse Lane, London EN5 3DJ, United Kingdom
| | - Ajay Asokan
- Trauma and Orthopaedics Department, Barnet Hospital, Wellhouse Lane, London EN5 3DJ, United Kingdom
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Ota M, Urita A, Shibayama H, Iwasaki N. Glenohumeral joint preservation using continuous intramedullary perfusion of high-concentration antibiotics in a patient with septic shoulder arthritis and proximal humerus osteomyelitis: A case report. J Orthop Sci 2023; 28:1548-1551. [PMID: 34716064 DOI: 10.1016/j.jos.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mitsutoshi Ota
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Orthopaedic Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan.
| | - Hiroki Shibayama
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Joo EJ, Kim B, Sohn KM, Kym S, Kim J. Administering Antibiotics for Less Than Four Weeks Increases the Risk of Relapse in Culture-Positive Septic Arthritis of Native Joints. J Clin Med 2023; 12:6808. [PMID: 37959273 PMCID: PMC10649866 DOI: 10.3390/jcm12216808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Objectives: This study investigated the optimal duration of antibiotic therapy and determined the risk factors associated with relapse in patients with culture-proven septic arthritis of native joints. (2) Methods: A retrospective review was conducted on patients aged ≥18 years diagnosed with native joint septic arthritis, with bacteria isolated from joints and/or blood. The exclusion criteria were prosthetic joint infections and cases with no identified microorganisms. The outcomes were assessed in the remission and relapse groups. (3) Results: Among 479 patients with native joint septic arthritis, 137 met the inclusion criteria, with a median follow-up duration of 2.7 years. The relapse rate was 9.5%, which mainly occurred within 30 days after antibiotic treatment completion. Compared with the remission group, the relapse group showed a significantly higher proportion of cases that received antibiotic therapy for ≤ 4 weeks (4.8% vs. 46.2%, p < 0.001), synovial fluid white blood cell (WBC) counts ≥150 × 103/mm3 (25.3% vs. 60.0%, p = 0.030), acute kidney injury (19.2% vs. 50%, p = 0.024), and extended-spectrum beta-lactamases-producing Enterobacteriaceae (0.8 vs. 15.4%, p = 0.024). Independent risk factors for relapse were determined as antibiotic therapy duration of ≤ 4 weeks (odds ratio (OR), 25.47; 95% confidence interval (CI), 1.57-412.33; p = 0.023) and synovial fluid WBC counts ≥150 × 103/mm3 (OR, 17.46; 95% CI, 1.74-175.62; p = 0.015). (4) Conclusions: Patients with native joint septic arthritis require vigilant monitoring for relapse, particularly when treated with antibiotic regimens administered for less than four weeks or when synovial aspirates exhibit elevated WBC counts at diagnosis.
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Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (E.-J.J.); (B.K.)
| | - Bomi Kim
- Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (E.-J.J.); (B.K.)
| | - Kyung Mok Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (K.M.S.); (S.K.)
| | - Sungmin Kym
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (K.M.S.); (S.K.)
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong-si 30099, Republic of Korea
| | - Jungok Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (K.M.S.); (S.K.)
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong-si 30099, Republic of Korea
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Abujubara H, Hintzen JCJ, Rahimi S, Mijakovic I, Tietze D, Tietze AA. Substrate-derived Sortase A inhibitors: targeting an essential virulence factor of Gram-positive pathogenic bacteria. Chem Sci 2023; 14:6975-6985. [PMID: 37389257 PMCID: PMC10306101 DOI: 10.1039/d3sc01209c] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
The bacterial transpeptidase Sortase A (SrtA) is a surface enzyme of Gram-positive pathogenic bacteria. It has been shown to be an essential virulence factor for the establishment of various bacterial infections, including septic arthritis. However, the development of potent Sortase A inhibitors remains an unmet challenge. Sortase A relies on a five amino acid sorting signal (LPXTG), by which it recognizes its natural target. We report the synthesis of a series of peptidomimetic inhibitors of Sortase A based on the sorting signal, supported by computational binding analysis. By employing a FRET-compatible substrate, our inhibitors were assayed in vitro. Among our panel, we identified several promising inhibitors with IC50 values below 200 μM, with our strongest inhibitor - LPRDSar - having an IC50 of 18.9 μM. Furthermore, it was discovered that three of our compounds show an effect on growth and biofilm inhibition of pathogenic Staphylococcus aureus, with the inclusion of a phenyl ring seemingly key to this effect. The most promising compound in our panel, BzLPRDSar, could inhibit biofilm formation at concentrations as low as 32 μg mL-1, manifesting it as a potential future drug lead. This could lead to treatments for MRSA infections in clinics and diseases such as septic arthritis, which has been directly linked with SrtA.
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Affiliation(s)
- Helal Abujubara
- Department of Chemistry and Molecular Biology, Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Kemigården 4 412 96 Göteborg Sweden
| | - Jordi C J Hintzen
- Department of Chemistry and Molecular Biology, Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Kemigården 4 412 96 Göteborg Sweden
| | - Shadi Rahimi
- Division of Systems & Synthetic Biology, Department of Biology and Biological Engineering, Chalmers University of Technology Kemivägen 10 412 96 Göteborg Sweden
| | - Ivan Mijakovic
- Division of Systems & Synthetic Biology, Department of Biology and Biological Engineering, Chalmers University of Technology Kemivägen 10 412 96 Göteborg Sweden
- The Novo Nordisk Foundation, Center for Biosustainability, Technical University of Denmark DK-2800 Kongens Lyngby Denmark
| | - Daniel Tietze
- Department of Chemistry and Molecular Biology, Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Kemigården 4 412 96 Göteborg Sweden
| | - Alesia A Tietze
- Department of Chemistry and Molecular Biology, Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg Kemigården 4 412 96 Göteborg Sweden
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Stahl JP, Canouï E, Bleibtreu A, Dubée V, Ferry T, Gillet Y, Lemaignen A, Lesprit P, Lorrot M, Lourtet-Hascoët J, Manaquin R, Meyssonnier V, Pavese P, Pham TT, Varon E, Gauzit R. SPILF update on bacterial arthritis in adults and children. Infect Dis Now 2023; 53:104694. [PMID: 36948248 DOI: 10.1016/j.idnow.2023.104694] [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: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
In 2020 the French Society of Rhumatology (SFR) published an update of the 1990 recommendations for management of bacterial arthritis in adults. While we (French ID Society, SPILF) totally endorse this update, we wished to provide further information about specific antibiotic treatments. The present update focuses on antibiotics with good distribution in bone and joint. It is important to monitor their dosage, which should be maximized according to PK/PD parameters. Dosages proposed in this update are high, with the optimized mode of administration for intravenous betalactams (continuous or intermittent infusion). We give tools for the best dosage adaptation to conditions such as obesity or renal insufficiency. In case of enterobacter infection, with an antibiogram result "susceptible for high dosage", we recommend the requesting of specialized advice from an ID physician. More often than not, it is possible to prescribe antibiotics via the oral route as soon as blood cultures are sterile and clinical have symptoms shown improvement. Duration of antibiotic treatment is 6 weeks for Staphylococcus aureus, and 4 weeks for the other bacteria (except for Neisseria: 7 days).
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Affiliation(s)
- J P Stahl
- Université Grenoble Alpes, Maladies Infectieuses, 38700, France.
| | - E Canouï
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
| | - A Bleibtreu
- Maladies Infectieuseset Tropicales, Hôpital Pitié Salpêtrière, AP-HP Sorbonne Université, Paris France
| | - V Dubée
- Maladies Infectieuses et Tropicales, CHU d'Angers, Angers, France
| | - T Ferry
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - Y Gillet
- Urgences et Réanimation Pédiatrique, Hospices Civils de Lyon, Université Claude Bernard Lyon, France
| | - A Lemaignen
- Maladies Infectieuses, CHRU de Tours, Université de Tours, 37044, France
| | - P Lesprit
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - M Lorrot
- Pédiatrie Générale et Equipe Opérationnelle d'Infectiologie, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Pitié), Hôpital Armand Trousseau AP-HP Sorbonne Université, Paris France
| | | | - R Manaquin
- Maladies Infectieuses et Tropicales, GHSR , CHU de La Réunion, CRAtb La Réunion, Saint-Pierre, 97410, FRANCE
| | - V Meyssonnier
- Centre de Référence des Infections Ostéo-articulaires, GH Diaconesses Croix Saint-Simon, 75020, Paris, France; Service de Médecine Interne Générale, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - P Pavese
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - T-T Pham
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - E Varon
- Centre National de Référence des Pneumocoques, CRC-CRB, Centre Hospitalier Intercommunal de Créteil, 94000, Créteil, France
| | - R Gauzit
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
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Hong CC, Chan MC, Wu T, Toh M, Tay YJ, Tan JH. Does concomitant gout in septic arthritis affect surgical outcomes? Injury 2023; 54:409-415. [PMID: 36351859 DOI: 10.1016/j.injury.2022.10.028] [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: 01/15/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aim to review and describe the proportion of patients with co-existing gout amongst patients with surgical treated septic arthritis, characterize their clinical presentation, outcomes and complications compared to patients with native joint septic arthritis. METHODS Sixty-one patients with surgically treated primary joint septic arthritis were identified from the period of January 2011 to December 2016. There were 13 (21.3%) patients with co-existing septic arthritis and crystal proven gout. Pertinent details such as demographics, comorbidities, clinical features on presentation, infection markers, number of surgeries, length of stay (LOS) in general and individual LOS in supportive care units, limb amputations, readmissions and mortality were reviewed. Multiple linear and logistic regression models were used to control for confounders during analysis. RESULTS The average age of patients was 60.8 years (range: 23-87 years). The patients with gout are associated with comorbidities such as being hypertensive, hyperlipidemia and renal impaired. They tend to present with ankle joint involvement (46.2% vs 8.3%; p = 0.004) while septic arthritis patients without gout tend to present with knee joint involvement (75% vs 46.2%; p = 0.046). In terms of complications, up to two thirds of them require supportive care in the High Dependency Unit and/or Intensive Care Unit during treatment (61.5% vs 29.2%; p = 0.031) and having gout with septic arthritis independently predicted a significant increase in LOS by an additional 12.6 days on average (95% CI: 2.11 - 23.03; p = 0.019). They are also more likely to end up with limb amputation (23.1% vs 0%; p = 0.008) on univariate analysis. CONCLUSION Gout accompanying septic arthritis in the same joint is potentially associated with major systemic and joint related sequela, complications in terms of prolonged hospital stay, need for complex care and risk for limb amputation. Our findings further indicate the value and need for well-designed prospective controlled cohort studies to explore the relationship between gout and septic arthritis.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Ming Chun Chan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Tianyi Wu
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Mingzhou Toh
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Yuan Jie Tay
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
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Saeed K, Ahmad-Saeed N, Annett R, Barlow G, Barrett L, Boyd SE, Boran N, Davies P, Hughes H, Jones G, Leach L, Lynch M, Nayar D, Maloney RJ, Marsh M, Milburn O, Mitchell S, Moffat L, Moore LSP, Murphy ME, O'Shea SA, O'Sullivan F, Peach T, Petridou C, Reidy N, Selvaratnam M, Talbot B, Taylor V, Wearmouth D, Aldridge C. A multicentre evaluation and expert recommendations of use of the newly developed BioFire Joint Infection polymerase chain reaction panel. Eur J Clin Microbiol Infect Dis 2023; 42:169-176. [PMID: 36474096 PMCID: PMC9836977 DOI: 10.1007/s10096-022-04538-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
Septic arthritis is a serious condition with significant morbidity and mortality, routinely diagnosed using culture. The FDA has recently approved the rapid molecular BioFire® Joint Infection Panel (BJIP) for synovial fluid. We aimed to evaluate the BJIP compared to culture and its potential use in patient management. A multicentre retrospective evaluation of BJIP was conducted in the UK and Ireland. Positive percent agreement (PPA) and negative percent agreement (NPA) were calculated between the BJIP and routine culture. A multidisciplinary team (MDT) discussion addressing the optimal or potential case use of the assay practice was facilitated. Three hundred ninety-nine surplus synovial fluid samples (~ 70% from native joints) from eight centres were processed using BJIP in addition to routine culture. An increased yield of positive results was detected using BJIP compared to routine culture (98 vs 83), giving an overall PPA of 91.6% and overall NPA of 93% for the BJIP compared to culture results. The BJIP detected resistant markers and additional organisms that could influence antibiotic choices including Neisseria gonorrhoeae and Kingella kingae. The MDT agreed that the assay could be used, in addition to standard methods, in adult and children patients with specialist advice use based on local needs. Rapid results from BJIP were assessed as having potential clinical impact on patient management. Organisms not included in the panel may be clinically significant and may limit the value of this test for PJI.
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Affiliation(s)
- Kordo Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- Clinical and Experimental Sciences, University of Southampton, Southampton, UK.
| | - Nusreen Ahmad-Saeed
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Rachel Annett
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Gavin Barlow
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
- Experimental Medicine & Biomedicine, York Biomedical Research Institute, Hull York Medical School, University of York, Heslington, UK
| | | | - Sara E Boyd
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, UK
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, L69 3GE, UK
| | - Nicola Boran
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Peter Davies
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
| | - Harriet Hughes
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Gwennan Jones
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Laura Leach
- Oxford University Hospitals (OUH), Oxford, UK
| | - Maureen Lynch
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Deepa Nayar
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert J Maloney
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Martin Marsh
- Department of Orthopaedics, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Olivia Milburn
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Shanine Mitchell
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Lynn Moffat
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
| | - Luke S P Moore
- Chelsea and Westminster NHS Foundation Trust, London, UK
- Imperial College Healthcare NHS Trust, North West London Pathology, Fulham Palace Road, London, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections & Antimicrobial Resistance, Imperial College London, Du Cane Road, London, UK
| | - Michael E Murphy
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
- College of Medical, Veterinary & Life Sciences, Wolfson Medical School Building, University of Glasgow, Glasgow, UK
| | - Shaan Ashk O'Shea
- Department of Infection, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Fionnuala O'Sullivan
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Teresa Peach
- Health Protection and Infection Division, Capital Quarter, Public Health Wales, Cardiff, Wales, UK
| | - Christina Petridou
- Department of Infection, Hampshire Hospitals NHS Foundation Trust, Winchester, UK
| | - Niamh Reidy
- Department of Clinical Microbiology, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Ben Talbot
- Department of Microbiology, NHS Greater Glasgow and Clyde, Glasgow Royal Infirmary, New Lister Building, Alexandra Parade, Glasgow, UK
| | - Vanessa Taylor
- Public Health Wales Department of Microbiology, University Hospital of Wales, Cardiff, Wales, UK
| | - Deborah Wearmouth
- Department of Infection, Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Catherine Aldridge
- Department of Microbiology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
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Fernandes LS, Yagi AJ, Santos Netto AD, Salles MJ, Oliveira VMDE, Cury RDEPL. S. AUREUS IS ASSOCIATED WITH A GREATER NEED FOR REOPERATION IN SEPTIC ARTHRITIS OF THE KNEE. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e260592. [PMID: 37151729 PMCID: PMC10158961 DOI: 10.1590/1413-785220233102e260592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 05/30/2022] [Indexed: 05/09/2023]
Abstract
Objective To determine the frequency of reoperations in the treatment of adult patients diagnosed with septic arthritis of the knee, the average number of debridements needed to control the infection, the mortality rate, and to assess factors associated with a greater need for reoperation and mortality. Methods Retrospective cohort study evaluating 38 adult patients diagnosed with septic arthritis who underwent arthrotomy via a medial parapatellar approach for joint cleaning and debridement. Demographic, clinical, surgical, and microbiological variables of the cases were analyzed by review of medical records. Tests for equality of two proportions, chi-square, and multivariate logistic regression analysis were performed, defining a significance level at 0.05, with 95% confidence interval. Results A total of 50% of the cases underwent reoperation, with an average number of required debridement of 2.02 and a mortality rate of 10.5%. Patients with infection caused by Staphylococcus aureus were more likely to need a reoperation compared to patients with positive cultures for other agents (OR 6.0). Conclusion In 50% of cases, an average of 2.02 debridements were necessary and the mortality rate was 10.5%. Staphylococcus aureus infection is associated with a 6 times greater chance of additional surgeries. / Level of Evidence IV, Case Series.
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Affiliation(s)
- Lucas Saade Fernandes
- Santa Casa de Misericórdia de Sao Paulo, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Sao Paulo, SP, Brazil
| | - Alexandre Joji Yagi
- Santa Casa de Misericórdia de Sao Paulo, Faculdade de Ciências Médicas, Departamento de Ortopedia e Traumatologia, Sao Paulo, SP, Brazil
| | - Alfredo Dos Santos Netto
- Santa Casa de Misericórdia de Sao Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Joelho, Sao Paulo, SP, Brazil
- Santa Casa de Misericórdia de Sao Paulo, Faculdade de Ciências Médicas, Sao Paulo, SP, Brazil
| | - Mauro José Salles
- Santa Casa de Misericórdia de Sao Paulo, Faculdade de Ciências Médicas, Departamento de Medicina, Sao Paulo, SP, Brazil
- Universidade Federal de Sao Paulo, Escola Paulista de Medicina, Grupo de Infecção Musculoesquelética, Sao Paulo, SP, Brazil
| | - Victor Marques DE Oliveira
- Santa Casa de Misericórdia de Sao Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Joelho, Sao Paulo, SP, Brazil
- Santa Casa de Misericórdia de Sao Paulo, Faculdade de Ciências Médicas, Sao Paulo, SP, Brazil
| | - Ricardo DE Paula Leite Cury
- Santa Casa de Misericórdia de Sao Paulo, Departamento de Ortopedia e Traumatologia, Grupo de Joelho, Sao Paulo, SP, Brazil
- Santa Casa de Misericórdia de Sao Paulo, Faculdade de Ciências Médicas, Sao Paulo, SP, Brazil
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15
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Performance of a diagnostic score for gouty arthritis: results from a cohort of acute arthritis suspected of being septic. Rheumatol Int 2023; 43:119-124. [PMID: 36273364 DOI: 10.1007/s00296-022-05216-y] [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: 08/04/2022] [Accepted: 09/14/2022] [Indexed: 02/02/2023]
Abstract
Septic arthritis (SA) and gout are the main suspected etiologies of acute monoarthritis. Differentiating them is essential because SA is an emergency. The performance of a gout diagnostic score developed by Janssens et al. was investigated in a cohort of patients with acute arthritis suspected of being septic. This was an ancillary study of a single-center cohort of patients with suspected SA. Patients were classified into three groups according to the final diagnosis (gout, SA or other diagnosis). We assessed the performance of the score (sensitivity [Se], specificity [Sp], positive and negative predictive value [PPV, NPV], area under the receiver operating characteristic [ROC] curve) for the diagnosis of gouty arthritis. In total, 138 patients were included: 28 (20.3%) had gout, 42 (30.4%) SA, and 68 (49.3%) another diagnosis. The median diagnostic score was 7.0 [4.5; 8.8] for patients with gout, 3.5 [2.5; 6.0] for those with SA and 3.0 [2.0-5.0] for those with another diagnosis. With a score threshold of ≥ 8, the Se for a diagnosis of gout was 28.6%, Sp 96.4%, PPV 66.7%, and NPV 84.1%. With a threshold of ≤ 4, the Se was 82.1%, Sp 64.5%, PPV 37.1%, and NPV 93.4%. The area under the ROC for the diagnostic score was 0.79. The performance of the clinico-biological score of Janssens et al. for a diagnosis of gout applied to a cohort of patients with acute arthritis and suspected of being septic was poor. Joint aspiration remains necessary to differentiate SA from another etiology.
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16
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Epidemiology and Economic Outcomes Associated with Timely versus Delayed Receipt of Appropriate Antibiotic Therapy among US Patients Hospitalized for Native Septic Arthritis: A Retrospective Cohort Study. Antibiotics (Basel) 2022; 11:antibiotics11121732. [PMID: 36551387 PMCID: PMC9774525 DOI: 10.3390/antibiotics11121732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/02/2022] Open
Abstract
Timely administration of appropriate antibiotic therapy is associated with better patient outcomes and lower costs of care compared to delayed appropriate therapy, yet initial treatment is often empiric since causal pathogens are typically unknown upon presentation. The challenge for clinicians is balancing selection of adequate coverage treatment regimens, adherence to antimicrobial stewardship principles to deter resistance, and financial constraints. This retrospective cohort study aimed to assess the magnitude and impact of delayed appropriate antibiotic therapy among patients hospitalized with septic arthritis (SA) in the U.S. from 2017 to 2019 using healthcare encounter data. Timely appropriate therapy was defined as the receipt of antibiotic(s) with in vitro activity against identified pathogens within two days of admission; all other patients were assumed to have received delayed appropriate therapy. Of the 517 patients admitted to hospital for SA who met all selection criteria, 26 (5.0%) received delayed appropriate therapy. In inverse-probability-treatment-weighting-adjusted analyses, the receipt of delayed appropriate therapy was associated with an additional 1.1 days of antibiotic therapy, 1.4 days in length of stay, and $3531 in hospital costs (all vs. timely appropriate therapy; all p ≤ 0.02). Timely appropriate therapy was associated with a twofold increased likelihood of antibiotic de-escalation during the SA admission.
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17
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Ghosh R, Dey R, Sawoo R, Haque W, Bishayi B. Endogenous neutralization of TGF-β and IL-6 ameliorates septic arthritis by altering RANKL/OPG interaction in lymphocytes. Mol Immunol 2022; 152:183-206. [DOI: 10.1016/j.molimm.2022.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/18/2022] [Accepted: 10/27/2022] [Indexed: 11/12/2022]
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Brinksman P, Nugent L. What is the incidence of septic arthritis in patients with infective endocarditis? A systematic review. CLINICAL INFECTION IN PRACTICE 2022. [DOI: 10.1016/j.clinpr.2022.100208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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19
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Varady NH, Schwab PE, Kheir MM, Dilley JE, Bedair H, Chen AF. Synovial Fluid and Serum Neutrophil-to-Lymphocyte Ratio: Novel Biomarkers for the Diagnosis and Prognosis of Native Septic Arthritis in Adults. J Bone Joint Surg Am 2022; 104:1516-1522. [PMID: 35726876 DOI: 10.2106/jbjs.21.01279] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Septic arthritis (SA) is a musculoskeletal emergency for which prompt diagnosis and treatment are critical. However, traditional diagnostic criteria of a synovial fluid (SF) white blood-cell count (WBC) of >50,000 cells/mm 3 or >90% polymorphonuclear leukocytes (%PMN) are not particularly sensitive or specific for the diagnosis of SA. Furthermore, prognostic markers are lacking. The purposes of this study were to assess the discriminative ability of the SF neutrophil-to-lymphocyte ratio (NLR) in the diagnosis of SA and of the serum NLR in the prognosis of SA. METHODS A multi-institution, retrospective study of 598 patients with native shoulder, hip, or knee SA in 2000 to 2018 was conducted. SF-NLR was calculated from the arthrocentesis cell count with differential. Receiver operating characteristic curves were analyzed, and the optimal threshold of SF-NLR for SA diagnosis was determined using the Youden index. Results were compared with traditional SF diagnostic criteria. Similar analyses assessed the association of serum NLR with 90-day treatment failure and mortality for the subset of patients with confirmed hip or knee SA and with serum complete blood-cell counts with differentials (n = 235). Results were compared with traditional serum prognostic markers (WBC, C-reactive protein [CRP], and erythrocyte sedimentation rate [ESR]). RESULTS The SF-NLR (area under the receiver operating characteristic curve [AUC], 0.85 [95% confidence interval (CI), 0.82 to 0.88]) was significantly more accurate for an SA diagnosis than SF-WBC (AUC, 0.80 [95% CI, 0.76 to 0.83]; p = 0.002) and SF-%PMN (AUC, 0.81 [95% CI, 0.77 to 0.84]; p = 0.01). The optimal threshold of SF-NLR was 25 (78% sensitivity and 81% specificity), compared with >50,000 cells/mm 3 for SF-WBC (56% sensitivity and 80% specificity) and >90% for SF-%PMN (65% sensitivity and 78% specificity). Elevated serum NLR was independently associated with 90-day treatment failure (odds ratio [OR], 7.04 [95% CI, 3.78 to 13.14]; p < 0.001) and mortality (OR, 7.33 [95% CI, 2.00 to 26.92]; p = 0.003); elevated serum WBC and CRP were also associated with treatment failure, and WBC, CRP, and ESR were not associated with mortality. CONCLUSIONS This study provides compelling data on the superior diagnostic and prognostic ability of serum NLR and SF-NLR for SA compared with current clinical standards. Given that this biomarker requires no additional cost or time to return than current laboratory tests already being performed, pending validation, it can readily be used to aid clinicians in the diagnosis and prognostication of SA. LEVEL OF EVIDENCE Diagnostic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Pierre-Emmanuel Schwab
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Michael M Kheir
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY.,Department of Orthopaedic Surgery, University of Indiana, Indianapolis, Indiana
| | - Julian E Dilley
- Department of Orthopaedic Surgery, University of Indiana, Indianapolis, Indiana
| | - Hany Bedair
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Yun SY, Choo HJ, Jeong HW, Lee SJ. Comparison of MR Findings between Patients with Septic Arthritis and Acute Gouty Arthritis of the Knee. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:1071-1080. [PMID: 36276224 PMCID: PMC9574278 DOI: 10.3348/jksr.2021.0147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 11/15/2022]
Abstract
Purpose To compare the MR findings of septic and acute gouty arthritis of the knee joint. Materials and Methods This retrospective study included patients who underwent knee MRI for septic or gouty arthritis at our hospital between October 2012 and October 2018. The MR findings were analyzed for the presence of bone marrow edema, soft tissue edema, abscess, pattern of synovial thickening (frondlike, lamellated, diffuse linear), maximum thickness of the synovium, and joint effusion volume. The gouty (n = 5) and septic arthritis (n = 10) groups were compared using the Wilcoxon rank-sum test and Fisher's exact test. Results No statistically significant differences were observed for each item. One patient in the gouty arthritis group and seven in the septic arthritis group had bone marrow edema. Soft tissue abscess formation was only observed in the septic group. The incidence of each synovial thickening pattern was as follows: 100% (diffuse linear) in the gouty arthritis group and 20% (frondlike), 50% (lamellated), and 30% (diffuse linear) in the septic arthritis group. Conclusion Differentiation of gouty arthritis and septic arthritis based on imaging findings is difficult. However, lamellated synovial thickening patterns, bone marrow edema, and soft tissue abscess formation are more commonly observed in patients with septic arthritis than in those with gouty arthritis.
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21
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Choi HJ, Yoon HK, Oh HC, Hong JH, Choi T, Park SH. Mortality of septic knee arthritis in Korea: risk factors analysis of a large national database. Sci Rep 2022; 12:14008. [PMID: 35978108 PMCID: PMC9385853 DOI: 10.1038/s41598-022-18420-4] [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: 12/28/2021] [Accepted: 08/10/2022] [Indexed: 11/12/2022] Open
Abstract
This study aimed to analyze the risk factors for mortality of septic knee arthritis in Korea through a large nationwide data research. The National Health Insurance Service-Health Screening database was used to analyze 89,120 hospitalizations for septic knee arthritis between 2005 and 2018. In-hospital, thirty-day, and ninety-day mortality, and their association with patient’s demographic factors, various comorbidities (i.e., cerebrovascular disease, congestive heart failure, and myocardial infarction) and Charlson Comorbidity Index (CCI) were assessed. Secondary outcomes of complications (osteomyelitis, knee arthroplasty, recurrence) were analyzed. The number of hospitalization with septic knee arthritis increased from 1847 cases in 2005 to 8749 cases in 2018. There was no significant difference in mortality after diagnosis of septic knee arthritis between years. The risk of mortality in patients who hospitalized with septic knee arthritis increased in comorbidities like Congestive heart failure, dementia, myocardial infarction, chronic kidney disease. Hazard ratio (HR) decreased in patients who have comorbidities such as rheumatoid arthritis, liver disease, rheumatologic disease. HR for mortality in septic knee arthritis increased in patients with CCI more than 1. The risk factors for mortality in all periods were male sex, old age, high CCI, comorbidities such as congestive heart failure, dementia, myocardial infarction, chronic kidney disease. Efforts to reduce mortality should be concentrate more on patients with these risk factors.
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Affiliation(s)
- Ho-Jun Choi
- Department of Orthopedic Surgery, Gwangmyeong-Sungae Hospital, Gwangmyeong-si, Republic of Korea
| | - Han-Kook Yoon
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444, Republic of Korea
| | - Hyun-Cheol Oh
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444, Republic of Korea
| | - Jung-Hwa Hong
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Taeyun Choi
- Department of Orthopedic Surgery, Gwangmyeong-Sungae Hospital, Gwangmyeong-si, Republic of Korea
| | - Sang-Hoon Park
- Department of Orthopaedic Surgery, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang, 10444, Republic of Korea.
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Richebé P, Coiffier G, Guggenbuhl P, Mulleman D, Couderc M, Dernis E, Deprez V, Salliot C, Urien S, Brault R, Ruyssen-Witrand A, Hoppe E, Chatelus E, Roux CH, Ottaviani S, Baufrere M, Michaut A, Pauvele L, Darrieutort-Laffite C, Wendling D, Coquerelle P, Bart G, Gervais E, Goeb V, Ardizzone M, Pertuiset E, Derolez S, Ziza JM, Flipo RM, Godot S, Seror R. Management and outcome of native joint septic arthritis: a nationwide survey in French rheumatology departments, 2016-2017. Ann Rheum Dis 2022; 81:annrheumdis-2022-222143. [PMID: 35820674 DOI: 10.1136/ard-2022-222143] [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: 02/14/2022] [Accepted: 06/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments. METHODS For this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded. RESULTS Overall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0-14)). Knee was the most frequent site (n=160 (38.9%)), and Staphylococcus sp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; p<0.001), Charlson's index (OR 1.30, 95% CI 1.06 to 1.58; p=0.012), presence of bacteraemia (OR 4.02, 95% CI 1.35 to 11.99; p=0.008), antibiotic use in the previous 3 months (OR 3.32, 95% CI 1.11 to 9.87; p=0.029) and Staphylococcus aureus NJSA compared with Streptococcus sp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%). CONCLUSION Prognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.
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Affiliation(s)
- Pauline Richebé
- Service de rhumatologie, Hôpitaux universitaires Paris-Sud, Le Kremlin-Bicetre, France
| | - Guillaume Coiffier
- Service de Rhumatologie, GHT Rance-Emeraude, CH Dinan et Saint-Malo, France, Dinan, France
| | - Pascal Guggenbuhl
- Service de Rhumatologie, CHU Rennes Univ Rennes, INSERM UMR 1241, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France, Rennes, France
| | - Denis Mulleman
- Service de rhumatologie, Centre de Référence en Infections Ostéo-Articulaires Complexes du grand Ouest, CHRU de Tours, Tours, France
| | - Marion Couderc
- Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France
| | | | - Valentine Deprez
- Rheumatology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
| | - Carine Salliot
- Rheumatology, Nouvel Hôpital d'Orléans CHRO La Source, Orleans, France
| | - Saik Urien
- INSERN et Unité de recherche clinique, Site Tarnier (hôpital Cochin), Paris, France
| | - Rachel Brault
- Service rhumatologie, CHU Poitiers, Poitiers, France
| | | | | | - Emmanuel Chatelus
- Rheumatology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | | | | | - Marie Baufrere
- Rheumatology, Hôpital Ambroise-Pare, Boulogne-Billancourt, France
| | - Alexia Michaut
- Centre Hospitalier Départemental Vendée Hôpital de Montaigu, Montaigu, France
| | - Loic Pauvele
- Rheumatology, Centre Hospitalier Universitaire de Reims Hôpital d'enfants, Reims, France
| | | | | | | | | | | | | | - Marc Ardizzone
- Rheumatology, Centre Hospitalier de Mulhouse, Mulhouse, France
| | | | - Sophie Derolez
- Rheumatology, Hôpital Bicêtre, Le Kremlin-Bicetre, France
| | - Jean Marc Ziza
- Rheumatology, Hôpital de la Croix Saint-Simon, Paris, France
| | - René-Marc Flipo
- Service de Rhumatologie, CHU Roger Salengro, Université de Lille, Lille, France
| | - Sophie Godot
- Rheumatology, Hôpital de la Croix Saint-Simon, Paris, France
| | - Raphaele Seror
- Rheumatology, Hôpitaux universitaires Paris-Sud, Le Kremlin Bicêtre, France
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Yeh HT, Liau SK, Niu KY, Hsiao CH, Yeh CC, Lu JX, Ng CJ, Yen CC. Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58030401. [PMID: 35334577 PMCID: PMC8953317 DOI: 10.3390/medicina58030401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/04/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022]
Abstract
Background and Objectives: Septic arthritis is a medical emergency associated with high morbidity and mortality. The incidence rate of septic arthritis among dialysis patients is higher than the general population, and dialysis patients with bacteremia frequently experience adverse outcomes. The aim of this study was to identify the clinical features and risk factors for longer hospital length of stay (LOS), positive blood culture, and in-hospital mortality in dialysis patients with septic arthritis. Materials and Methods: The medical records of 52 septic arthritis dialysis patients admitted to our hospital from 1 January 2009 to 31 December 2020 were analyzed. The primary outcomes were bacteremia and in-hospital mortality. Variables were compared, and risk factors were evaluated using linear and logistic regression models. Results: Twelve (23.1%) patients had positive blood cultures. A tunneled cuffed catheter for dialysis access was used in eight (15.4%) patients, and its usage rate was significantly higher in patients with positive blood culture than in those with negative blood culture (41.7 vs. 7.5%, p = 0.011). Fever was present in 15 (28.8%) patients, and was significantly more frequent in patients with positive blood culture (58.3 vs. 20%, p = 0.025). The most frequently involved site was the hip (n = 21, 40.4%). The most common causative pathogen was Gram-positive cocci, with MRSA (n = 7, 58.3%) being dominant. The mean LOS was 29.9 ± 25.1 days. The tunneled cuffed catheter was a significant predictor of longer LOS (Coef = 0.49; Cl 0.25−0.74; p < 0.001). The predictors of positive blood culture were fever (OR = 4.91; Cl 1.10−21.83; p = 0.037) and tunneled cuffed catheter (OR = 7.60; Cl 1.31−44.02; p = 0.024). The predictor of mortality was tunneled cuffed catheter (OR = 14.33; Cl 1.12−183.18; p = 0.041). Conclusions: In the dialysis population, patients with tunneled cuffed catheter for dialysis access had a significantly longer hospital LOS. Tunneled cuffed catheter and fever were independent predictors of positive blood culture, and tunneled cuffed catheter was the predictor of in-hospital mortality. The recognition of the associated factors allows for risk stratification and determination of the optimal treatment plan in dialysis patients with septic arthritis.
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Affiliation(s)
- Hsin-Tzu Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Shuh-Kuan Liau
- Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan;
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan; (K.-Y.N.); (C.-C.Y.)
| | - Chien-Han Hsiao
- Department of Linguistics, Indiana University, Bloomington, IN 47405, USA;
| | - Chung-Cheng Yeh
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung 20401, Taiwan; (K.-Y.N.); (C.-C.Y.)
| | - Jian-Xun Lu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
| | - Chieh-Ching Yen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan; (H.-T.Y.); (J.-X.L.); (C.-J.N.)
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Correspondence: ; Tel.: +886-033281200
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24
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Hua DT, Spiegel J, Fu PY, Yuchno D. A Case of Native Joint Septic Arthritis Caused by Bacteroides fragilis. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e934266. [PMID: 34965243 PMCID: PMC8721963 DOI: 10.12659/ajcr.934266] [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] [Indexed: 11/09/2022]
Abstract
Patient: Male, 65-year-old
Final Diagnosis: Sepsis
Symptoms: Knee pain
Medication:—
Clinical Procedure: Arthrocentesis
Specialty: Infectious Diseases
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Affiliation(s)
- Duong Tommy Hua
- Department of Internal Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Jaclyn Spiegel
- Department of Internal Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Pei-Yu Fu
- Department of Internal Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - David Yuchno
- Department of Internal Medicine, Harbor-University of California Los Angeles (UCLA) Medical Center, Torrance, CA, USA
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25
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Sunanda Laxmi P, Vidyavathi M, Venkata SKR. DoE approach for development of localized controlled release microspheres of Vancomycin for treatment of septic arthritis. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2021. [DOI: 10.1186/s43094-021-00382-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Septic arthritis is a worse condition of RA that is associated with significant morbidity and mortality. Septic arthritis develops due to direct introduction or invasion of pathogens. The objective of the present study was to formulate Vancomycin hydrochloride-loaded microspheres (VMS) based on Box–Behnken design (BBD) and evaluate its efficacy against septic arthritis. The intraarticular administration of optimized Vancomycin hydrochloride-loaded microspheres (OVMS) can reduce dose size, dosing frequency and systemic exposure with local targeted delivery.
Results
OVMS was further characterized for its drug–polymer compatibility using differential scanning calorimetry and Fourier transmission infrared spectroscopy. In vitro antibacterial activity was determined using the cup–plate method and in vivo anti-arthritic efficacy was evaluated by gross examination of septic arthritis. DSC and FTIR studies exhibited no interaction or incompatibilities between the drug and polymer. SEM images revealed that OVMS were spherical. It followed the first-order release rate according to Fick's law. The micromeritic properties indicated good flow property of OVMS. The zone of inhibition by OVMS was 1.5 cm against S. aureus. In vivo antibacterial study revealed that OVMS was significant in reducing septic arthritis and bacterial load, i.e., 110.1 CFU/ml in comparison with the control group (850 CFU/ml).
Conclusions
Thus, OVMS may be used as an effective formulation for the treatment of septic arthritis as compared to marketed IV vancomycin injection after clinical studies.
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26
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Balato G, de Matteo V, Ascione T, de Giovanni R, Marano E, Rizzo M, Mariconda M. Management of septic arthritis of the hip joint in adults. A systematic review of the literature. BMC Musculoskelet Disord 2021; 22:1006. [PMID: 34856966 PMCID: PMC8641144 DOI: 10.1186/s12891-021-04843-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The septic arthritis of the hip is a complex condition characterized by a variety of clinical presentations, a challenging diagnosis and different surgical treatment options, including arthroscopy, resection arthroplasty and one and two-stage total hip replacement. Each technique reports variable results in terms of infection eradication rate. The aim of this systematic review is to compare the most relevant studies available in current literature and to assess if a better treatment outcome can be predicted based on the microbiology, history, and type of infection (active vs quiescent) of each case. METHODS A systematic review of the literature was performed in accordance with the PRISMA guidelines, including the studies dealing with the treatment of hip septic arthritis in adult patients. Electronic databases, namely the MEDLINE, Scopus, and Web of Science, were reviewed using a combination of following keywords "septic arthritis" AND "hip joint" OR "hip" AND "adult". RESULTS The total number of patients included in this review was 1236 (45% of which females), for 1238 hips. The most common pathogen isolated was Staphylococcus aureus in its Methicillin-sensitive variant ranging from 2 to 37% of cases. Negative cultures were the second most common finding. It was also differentiated the type of infection of the hip, 809 and 417 patients with active and quiescent hip infection, respectively, were analyzed. Eradication rates for two-stage revision arthroplasty ranged between 85 and 100%, for one-stage approach between 94 and 100%, while for arthroscopic debridement/lavage between 89 and 100%. CONCLUSION Staphylococcus aureus is the most common microorganism isolated followed by culture negative infections. Arthroscopic, one and two stage procedures can be effective in the treatment of hip septic arthritis when the indication is consistent with the type of infection retrieved. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Giovanni Balato
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Vincenzo de Matteo
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Tiziana Ascione
- Service of Infectious Diseases, AORN Cardarelli Hospital, Naples, Italy
| | - Roberto de Giovanni
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Ernesto Marano
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Maria Rizzo
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Massimo Mariconda
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
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McMichael BS, Nickel AJ, Christensen EW, Frenn KA, Truong WH, Laine JC, Kharbanda AB. Discriminative Accuracy of Procalcitonin and Traditional Biomarkers in Pediatric Acute Musculoskeletal Infection. Pediatr Emerg Care 2021; 37:e1220-e1226. [PMID: 32149993 DOI: 10.1097/pec.0000000000001978] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Septic arthritis (SA) is responsible for 20% of pediatric musculoskeletal infections (MSKI) and can have significant consequences. Early detection of SA is critical, and procalcitonin (PCT) has emerged as a promising biomarker. This study assessed the test performance of PCT and traditional biomarkers for suspected SA. METHODS We conducted a prospective study at two pediatric emergency departments (ED). Data collected measured serum levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white blood cell (WBC) count, and PCT. Box and whisker plots were generated to compare the of the biomarkers by positive MSKI or a non-MSKI diagnosis. The diagnostic performance of biomarkers was examined using the area under the receiver operating characteristic curve (AUC), and optimal cut -points were identified using the Liu method. RESULTS Procalcitonin performed reasonably well for detection of MSKI (AUC, 0.72; confidence interval [95% CI], 0.59-0.84). However, CRP and ESR performed better (AUC, 0.88 and 0.78, respectively). White blood cell count was not predictive of MSKI. Patients with a PCT value >0.1 ng/mL, ESR values >19.5 mm/h, and a temperature higher than 99.0°F were more than twice as likely to have acute MSKI. A high CRP level was most predictive of acute MSKI, and patients with levels >2.38 mg/dL were 3.5 times more likely to have acute MSKI. CONCLUSIONS Procalcitonin is a potential biomarker for the clinical differential of MSKI in the pediatric ED. Additional research is warranted to establish the optimal diagnostic level for PCT, to increase sample size, and to examine any impact on cost.
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Affiliation(s)
| | - Amanda J Nickel
- From the Children's Minnesota Research Institute, Children's Minnesota
| | - Eric W Christensen
- Health Services Management, College of Continuing and Professional Studies, University of Minnesota, Minneapolis
| | | | - Walter H Truong
- Department of Orthopedic Surgery, Gillette Children's Specialty Healthcare, St Paul
| | - Jennifer C Laine
- Department of Orthopedic Surgery, Gillette Children's Specialty Healthcare, St Paul
| | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
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28
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Basilio-Razon PIE, Wong E. A Pain in the Foot: Delayed Diagnosis of Primary Septic Arthritis of Naviculocuneiform and Second/Third Tarsometatarsal Joints. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933233. [PMID: 34711795 PMCID: PMC8564783 DOI: 10.12659/ajcr.933233] [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] [Indexed: 11/24/2022]
Abstract
Patient: Male, 65-year-old
Final Diagnosis: Septic arthritis of midfoot
Symptoms: Foot pain
Medication: —
Clinical Procedure: Debridement • drainage
Specialty: Family Medicine • General and Internal Medicine • Orthopedics • Emergency Medicine
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Affiliation(s)
| | - Evelyn Wong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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29
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Gonzalez-Chapa JA, Peña-Martinez VM, Vílchez-Cavazos JF, Salinas-Carmona MC, Rosas-Taraco AG. Systemic and Local Cytokines Profile Determine Severity and Prognosis in Human Septic Arthritis: A Pilot Study. Arch Med Res 2021; 53:170-178. [PMID: 34702588 DOI: 10.1016/j.arcmed.2021.10.004] [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] [Received: 05/28/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Septic arthritis (SA) is a medical emergency. The most common etiological agents are bacteria, which activate the local immune response coordinated by cytokines; however, little is known about the cytokine profile in human SA. AIM To determine the association of local and systemic cytokine profiles with the severity and prognosis of patients with SA. METHODS Patients with clinical and laboratory diagnosed SA were enrolled as well as a control group. Serum and synovial fluid (SF) samples were obtained for determining cytokines and glucose levels; SF samples were used for histological analysis. Osteochondral damage and general health status and quality of life (SF-36) were evaluated during recruitment day. WOMAC osteoarthritis index score and SF-36 questionnaire were used a year after recruitment day as a follow up. RESULTS A systemic and local proinflammatory cytokine profile was found in patients compared to the control group (p <0.05). IL-6 was 28 and 525 times higher than controls in sera and SF, respectively (p <0.0001). Systemic IL-6 correlated negatively with general mental health score (p = 0.0184) and was associated with a higher osteoarthritis index after one year follow-up in the patients (p = 0.0352). HMGB1 in SF was found higher in patients with SA (p <0.0001), and it was associated with osteochondral damage (p = 0.0042). TNF-α in SF correlated negatively with SF-36 questionnaire one year after patients' recruitment in role limitation score (p = 0.0318), body pain score (p = 0.0315), and general mental health score (p = 0.0197). CONCLUSION Serum and SF cytokine signatures are associated with disease severity and prognosis in patients with SA.
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Affiliation(s)
- Jorge A Gonzalez-Chapa
- Departamento de Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Nuevo León, Monterrey, México
| | - Victor M Peña-Martinez
- Servicio de Ortopedia y Traumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Dr. José Eleuterio González, Nuevo León, Monterrey, México
| | - José F Vílchez-Cavazos
- Servicio de Ortopedia y Traumatología, Universidad Autónoma de Nuevo León, Hospital Universitario, Dr. José Eleuterio González, Nuevo León, Monterrey, México
| | - Mario C Salinas-Carmona
- Departamento de Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Nuevo León, Monterrey, México
| | - Adrian G Rosas-Taraco
- Departamento de Inmunología, Universidad Autónoma de Nuevo León, Facultad de Medicina, Nuevo León, Monterrey, México.
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30
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Nossent J, Raymond W, Keen H, Preen DB, Inderjeeth CA. Non-gonococcal septic arthritis of native joints in Western Australia. A longitudinal population-based study of frequency, risk factors and outcome. Int J Rheum Dis 2021; 24:1386-1393. [PMID: 34609074 DOI: 10.1111/1756-185x.14221] [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: 07/18/2021] [Revised: 09/21/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the incidence and long-term outcome of non-gonococcal septic arthritis (SA) in Western Australia (WA). METHODS Newman criteria were applied to define culture-positive SA and suspected SA cases in the state-wide West Australian Rheumatic Diseases Epidemiological Registry with longitudinally linked health data for patients >16 years with a first diagnostic code of pyogenic arthritis (711.xx [ICD-9-CM] and M00.xx [ICD-10-AM]) between 1990-2010. Annual incidence rates/100 000 (AIR) and standardized (against WA population) mortality rates/1000 person-years (SMR) and outcomes during 10.1 years follow-up are reported. RESULTS Among 2633 SA patients (68.6% male, age 47.4 years), 1146 (43.5%) had culture-positive SA. The overall AIR for culture-positive (1.6-6.3) and total SA cases (4.3-12.9) increased between 1990 and 2010 as did age at onset (39.5-54 years) and proportion of females (23-35.6%). Knees (33.6.%) were most frequently affected and 37.1% of cultures showed microorganisms other than Gram-positive cocci. Thirty-day rates for readmission and mortality were 25.4% and 3.2.%. During follow-up rates for serious infections (56.4%), osteoarthrosis (5.2%) and osteomyelitis (2.7%) were higher in culture-positive SA. SMR was increased for all SA patients but especially in those 17-40 years of age with culture-positive SA (24.2; 95% CI 2.3-261). CONCLUSIONS The incidence of SA in WA has risen steeply over 20 years. SA now occurs at higher age, affects females more often with over a third of cases caused by Gram-negative microorganisms. Not only culture-positive, but also suspected SA led to increased bone/joint complications, in-hospital and late mortality.
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Affiliation(s)
- Johannes Nossent
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Rheumatology Group, School of Medicine, University Western Australia, Perth, Western Australia, Australia
| | - Warren Raymond
- Rheumatology Group, School of Medicine, University Western Australia, Perth, Western Australia, Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, University Western Australia, Perth, Western Australia, Australia.,Department Rheumatology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - David B Preen
- School of Population and Global Health, University Western Australia, Perth, Western Australia, Australia
| | - Charles A Inderjeeth
- Department Rheumatology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Rheumatology Group, School of Medicine, University Western Australia, Perth, Western Australia, Australia
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31
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Phillips TF, Bleyaert HF. Retrospective evaluation of 103 cases of septic arthritis in dogs. Vet Rec 2021; 190:e938. [PMID: 34558080 DOI: 10.1002/vetr.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/19/2021] [Accepted: 08/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examines inciting causes, diagnosis, treatment and risk factors for the recurrence and outcome of septic arthritis (SA) in dogs. STUDY DESIGN Medical records spanning 17 years from five referral hospitals were surveyed for presumptive and confirmed cases of SA. RESULTS SA was identified in 103 cases. Spontaneous septic SA was the most common inciting cause. The most commonly affected joints were the stifle (40%) and elbow (24%). Pre-existing osteoarthritis (OA) was present in 63% of septic joints and was associated with recurrence (p = 0.03). Treatment with antibiotics prior to presentation was associated with a negative synovial fluid culture (p = 0.014). A successful outcome was associated with early treatment (p = 0.001) and SA due to direct penetration (p = 0.04) or spontaneous cause (p = 0.003). Recurrence was more likely in dogs with unsuccessful outcomes (p = 0.004) and bodyweights >30 kg (p = 0.009). CLINICAL SIGNIFICANCE SA should be considered as a differential diagnosis in large breed dogs with pre-existing OA presenting with either an acute or chronic monoarthropathy. In the majority of cases, a successful outcome was achieved regardless of treatment type. Recurrence rates were low, but associated with pre-existing OA and higher bodyweight. Although treatment should be implemented as soon as possible to maximise outcome success, synovial fluid samples should ideally be obtained before empiric antibiotic administration.
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Affiliation(s)
- Tessa F Phillips
- Surgery Department, BluePearl Veterinary Partners, Tampa, Florida, USA
| | - Helga F Bleyaert
- Surgery Department, BluePearl Veterinary Partners, Tampa, Florida, USA
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Beaufrère M, Pressat-Laffouilhère T, Marcelli C, Michon J, Lequerré T, Prum-Delépine C, Fiaux E, Rasoldier V, Etienne M, Savouré A, Dormoy L, Dargère S, Verdon R, Vittecoq O, Avenel G. Valvular and infection-associated risk factors as criteria to guide the use of echocardiography in patients with native joint infections. Semin Arthritis Rheum 2021; 51:1274-1281. [PMID: 34465446 DOI: 10.1016/j.semarthrit.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 07/28/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Native joint and bone infections (NJBI) are associated with infective endocarditis (IE) in 15% of cases. There are no studies analyzing the use of cardiac imaging in cases of NJBI. The objective of this study was to identify factors associated with echocardiography suggestive of IE in patients with NJBI. METHODS This medical records review was conducted in patients hospitalized for NJBI between 2007 and 2017 in Rheumatology and Infectious Diseases departments of 2 university hospitals. Patients included had a microbiologically proven NJBI during their hospitalization. RESULTS In this cohort of 546 patients, median age 66 years, echocardiography was suggestive of IE in 66 (12%). In multivariate analysis, factors associated with echocardiography suggestive of IE were 2 or more positive blood cultures (OR 11.55 (CI95% 3.24-74.20)), cardiac conditions with a high risk of IE (OR 7.34 (CI95% 2.95-18.61)), unknown heart murmur (OR 4.59 (CI95% 1.79-11.74)), multifocal infection (OR 2.26 (CI95% 1.21-4.23)) and an infection due to S. bovis (OR 3.52 (CI95% 1.26-9.79)). The factor associated with the absence of an echocardiography evocative of IE was infection due to unconventional bacteria for IE (OR 0.13 (CI95% 0.01-0.76)). According to the factors associated with echocardiography evocative of IE, we propose the Normandy score based on three kinds of data: cardiac condition, bacterial strain and NJBI mechanism. Echocardiography should be realized when this score, whose negative predictive value is 100% CI95% (98-100%) for prescription of echocardiography, is more than zero. CONCLUSIONS A score based on valvular condition, bacterial strain and NJBI mechanism could guide clinicians in prescribing echocardiography during NJBI with an excellent negative predictive value.
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Affiliation(s)
- Marie Beaufrère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France.
| | | | - Christian Marcelli
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Rheumatology, 14000 Caen, France
| | - Jocelyn Michon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Thierry Lequerré
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Camille Prum-Delépine
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Elise Fiaux
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Véro Rasoldier
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Manuel Etienne
- CHU Rouen, Department of Infectious Diseases, F-76000 Rouen, France
| | - Arnaud Savouré
- CHU Rouen, Department of Cardiology, F-76000 Rouen, France
| | - Laurent Dormoy
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Cardiology, 14000 Caen, France
| | - Sylvie Dargère
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Renaud Verdon
- Normandie Univ, UNICAEN, Caen University Hospital, Department of Infectious diseases, 14000 Caen, France
| | - Olivier Vittecoq
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
| | - Gilles Avenel
- Normandie Univ, UNIROUEN, CHU Rouen, Department of Rheumatology and Inserm CIC-CRB 1404, F-76000 Rouen, France
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Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia. Rheumatol Ther 2021; 8:877-888. [PMID: 33895983 PMCID: PMC8217357 DOI: 10.1007/s40744-021-00307-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/09/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To describe the incidence, risk factors and long-term outcomes in children hospitalised with septic arthritis (SA) in Western Australia (WA). Methods We extracted state-wide longitudinally linked administrative health data for patients aged < 16 years with a first diagnostic code of 711.X (ICD9-CM) and M00.X (ICD10-AM) in WA in the period 1990–2010. Annual incidence rates (AIR) per 100,000 with 95% confidence intervals (CIs), prior conditions during a median lookback period of 63.2 [interquartile range (IQR) 19.8–117.1] months and outcomes, including standardised mortality rates (SMR), during a median follow-up of 10 years are reported. Results A total of 891 patients [62% male, median age 6.4 (IQR 1.9–10.6) years with 34% aged < 3 years] were admitted for SA during the observation period. The overall AIR (per 100,000) was 9.85 (95% CI 4.79–14.41), and was higher in Indigenous Australians [34.9 vs. 5.5 (non-Indigenous), p < 0.001] and in males [11.9 vs. 7 (females), p < 0.01]; AIR showed no temporal or seasonal variation. Knees (43.9%), hips (34.6%) and ankles (13.3%) were most frequently affected, with Staphylococci predominant (49%) in patients with positive cultures (41.5%). Prior infection(s) (40.4%) and respiratory disease (7%) were the main pre-existing morbidities. Median hospital stay was 4.0 (IQR 2–8) days, with 1.9% requiring admission to the intensive care unit and 10.4% requiring readmission within 30 days. During follow-up, 26 patients (3.1%) developed osteomyelitis, nine patients were diagnosed with osteoarthrosis (1.1%) and five patients (0.6%) underwent joint replacement. Female patients developed other serious infections more often than male patients (40.5 vs. 27.1%, p < 0.01), as well as other comorbidities (Charlson Comorbidity Index > 0: 34.6 vs. 27.2%, p = 0.02), including diabetes (4.2 vs. 0%; p = 0.001), cardiovascular events (4.2 vs 1.4%, p = 0.002) and chronic arthritis (1 vs. 0%, p = 0.05). The crude mortality rate was low (0.3%), with 99.4% survival at 180 months and no increase in the SMR. Conclusions The incidence of SA in children in WA did not change over the 20-year observation period. SA did not lead to excess mortality, but bone and joint complications developed in 5% of patients. The high propensity to comorbid conditions in this young cohort suggests an underlying role of comorbidity in SA development. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00307-x. As more children are living with complex and chronic conditions, we investigated whether children in Western Australia (WA) have become more prone to joint infections. During a 20-year observation period we collected health data for all children admitted to any hospital in the state with an infected joint and recorded their health outcomes. We found that joint infection occurs in nearly ten out of 100,000 children each year, but we saw no change in the frequency over time. We did observe higher rates in Indigenous children (35/100,000) than in non-indigenous children (6/100,000) but found no noticeable influence of the seasons on the frequency of joint infections. Knees, hips and ankles were most often affected, and 15% had additional bone infection. Children needed to be treated in hospital for 4–5 days, and only a small minority (1.2%) were so ill they needed intensive care. Joint infections led to chronic, long-term complications in about 5% of patients, but we found no evidence that joint infections increased the risk of death compared to children in the general population.
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Perez J, Sorensen S, Rosselli M. Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19. BMJ Case Rep 2021; 14:14/4/e242370. [PMID: 33849885 PMCID: PMC8051413 DOI: 10.1136/bcr-2021-242370] [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] [Indexed: 11/30/2022] Open
Abstract
Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.
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Affiliation(s)
- Jiodany Perez
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Stefani Sorensen
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Michael Rosselli
- Department of Emergency Medicine, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Malipeddi R, Nema SK, Gopisankar B, Prabu M, Pasupathy P, Suresh Gandhi B. Clinical Outcomes and Global Health After Joint Debridement in Adult-Onset Septic Arthritis: A Prospective Observational Study. Indian J Orthop 2021; 55:912-917. [PMID: 34194647 PMCID: PMC8192621 DOI: 10.1007/s43465-021-00389-3] [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: 11/19/2020] [Accepted: 02/23/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE Despite several reports on risk factors for septic arthritis (SA) in adults, the outcomes on quality of life and joint function are sparsely reported. This study aimed to investigate the quality of life and joint function in adult patients treated for SA. METHODS This prospective observational study enrolled clinically diagnosed adult SA patients and estimated Euroqol 5-dimension 5 levels (EQ-5D-5L) questionnaire, Euroqol Visual Analog Scale (EQ-VAS) and a validated tool for joint function at 1, 3, 6 and 12 months after debridement. RESULTS Twenty seven patients (20 males/7 females) with 21 knees, four shoulders, and two elbows were evaluated. The mean age of the cases was 51(± 13.00) years. Three cases sustained mortality. EQ-5D-5L (P < 0.01) and EQ-VAS (P < 0.01) scores improved significantly between all time frames. Mean Knee society (P < 0.01), Shoulder QuickDASH, and Mayo elbow scores improved at all time frames. There was no difference in primary outcomes between early (< 14 days) and late (14 days or more) presentation. There was no difference in primary outcome measures between confirmed and suspected SA. Fifteen patients could ambulate without support, while 6 needed some support for walking at 1 year. CONCLUSION Improved outcomes can be expected in quality of life and joint function in adults' septic arthritis at the end of 1 year after surgical treatment; however, the effects of delay in presentation need to be investigated further. Isolation of the microorganism from an infected joint has no bearing on the outcome measures.
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Affiliation(s)
- Ranjith Malipeddi
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006 India
| | - Sandeep Kumar Nema
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006 India
| | - B. Gopisankar
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006 India
| | - M. Prabu
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006 India
| | - P. Pasupathy
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006 India
| | - B. Suresh Gandhi
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, 605006 India
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Huang YC, Ho CH, Lin YJ, Chen HJ, Liu SY, Wang CL, Lin CH, Wang JJ, Chien CC. Site-specific mortality in native joint septic arthritis: a national population study. Rheumatology (Oxford) 2021; 59:3826-3833. [PMID: 32442314 DOI: 10.1093/rheumatology/keaa162] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/08/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This national cohort study investigated the incidence, site-specific mortality and prognostic factors of native septic arthritis (SA). METHODS Tapping Taiwan's National Health Insurance Research Database, we identified inpatients with newly diagnosed SA between 1998 and 2012. They were categorized by site of infection and followed to calculate 30-day, 90-day and 1-year mortality. Predictors of mortality were calculated using Cox models. RESULTS A total of 31 491 patients were identified as having SA, the most common site of infection being the knee (50.1%), followed by the hip (14.4%), other sites (26.8%), the shoulder (5.5%) and multiple sites (1.2%). Knee joint involvement was the most common site for all subgroups. Incidence increased from 9.8/105 in 1998 to 13.3/105 in 2012. The 30-day, 90-day and 1-year mortality rates were 4.3, 8.6 and 16.4% respectively. Predictors for mortality were hip infection, shoulder infection, multiple-site infection, being male, age ≥65 years old and comorbidities. We derived a mortality scoring model over age/SA site/comorbidity, and age ≥65 years old had the greatest risk contribution to mortality. No matter whether 1-month, 3-month or 1-year mortality was being considered, patients with the higher risk scores had the higher mortality rates (P < 0.0001). CONCLUSION SA is an emerging infectious disease with a rising incidence, long duration of hospital stay and high mortality rate. The most common affected joint was knee for all subgroups. Patients aged ≥65 years old had a high SA incidence and the greatest risk contribution.
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Affiliation(s)
- Yi-Ching Huang
- Department of Internal Medicine, National Cheng Kung University Hospital
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center
| | - Yeong-Jang Lin
- Department of Allergy, Immunology and Rheumatology, Chi-Mei Medical Center
| | - Hung-Jui Chen
- Department of Infectious Diseases, Chi-Mei Medical Center
| | - Su-Yen Liu
- Nursing Department, Chi-Mei Medical Center
| | | | - Cheng-Heng Lin
- Department of Gastroenterology, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
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Larghi MM, Grassi M, Placenza E, Faugno L, Cerveri P, Manzotti A. Septic arthritis following joint injections: a 17 years retrospective study in an Academic General Hospital. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021308. [PMID: 35075093 PMCID: PMC8823561 DOI: 10.23750/abm.v92i6.10425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 11/27/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Septic arthritis following intra-articular infiltrations is an uncommon devastating complication correlated to high costs for the health service and often to poor outcomes. The purpose of this study is to assess a 17-years experience in a single academic multispecialist hospital managing this uncommon complication in Orthopaedic practice. METHODS Patients with diagnosis of septic arthritis following joint injections treated in our hospital from January 2002 to December 2019 were included in the study. Clinical and demographic data, pathogens, injected agent, conservative/surgical treatments were reviewed. Patient were classified according to the ore operative Charlson Comorbidity Index (CCI) and the Cierny-Mader Classification(CMC). Furthermore follow-up outcome and time occurred to infection eradication were registered. RESULTS We included in the study 11 patients with a median age of 74 years old (IQR= 61.5 - 79). The median CCI was 3 (IQR= 2 - 5) and the majority of patients belong to CMC = B class. Septic arthritis occurred mainly following corticosteroids injections and more frequently involving knees. The pathogen more often isolated was Staphylococcus aureus. Five (45%) patients referred an history of multiple intrarticular injections. 7 patients (64%) had a complete resolution following an arthroscopic debridement, 4 (36%) patients underwent to a 2-stage replacement and one of them hesitated in an arthrodesis because of a recurrent periprothesic joint infection and extensor apparatus insufficiency. CONCLUSION The authors observed a potential increased risk of septic arthritis following joint injection in patients with history of multiple injections and poor health/immunological conditions. They recommend an early arthroscopic debridement as the treatment of choice especially in septic knees performed in a multispecialist dedicated center.
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Affiliation(s)
- Marco Mattia Larghi
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano, Milan Italy
| | - Miriam Grassi
- Orthopaedic and Trauma Department, “Luigi Sacco” Hospital, ASST FBF-Sacco, Milan, Italy
| | - Emanuele Placenza
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano, Milan Italy
| | - Luca Faugno
- School of Medicine and Residency Program in Orthopaedics, Università degli studi di Milano, Milan Italy
| | - Pietro Cerveri
- Department of Electronics, Information and Bioengeenering, Politecnico di Milano, Milan, Italy
| | - Alfonso Manzotti
- Orthopaedic and Trauma Department, “Luigi Sacco” Hospital, ASST FBF-Sacco, Milan, Italy
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Nossent J, Raymond W, Keen H, Preen DB, Inderjeeth CA. Septic arthritis due to Neisseria gonorrhoea in Western Australia. Intern Med J 2020; 52:1029-1034. [PMID: 33347691 DOI: 10.1111/imj.15169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the frequency, risk factors and long-term outcome of gonococcal arthritis in Western Australia (WA). METHODS A population-based data linkage study of patients with a hospital-based diagnosis of gonococcal arthritis (GA) in WA between 1990-2014. Demographics, standardised incidence rates (IR) per million and comorbidity accrued before (lookback 186 months ,IQR 86-267) and after the index hospital contact for GA (follow-up 100 months, IQR 60-209). are presented as frequency (%), median (interquartile range) or rates /1,000 months. RESULTS In total 98 patients were diagnosed with GA. The annual incidence of GA increased from 1.35 to 2.10 per million between 1990 and 2014, but the rate of GA complicating all gonococcal infections was stable around 0.25%. Female patients with GA (54%, n=53/98) were younger (24 vs 38 years), and more frequently identified as Indigenous (88% vs 49%) than male patients (46%, n=45/98) (p=0.002). Female patients had higher rates of prior infections (15.5 vs 8.1 per 1,000 months, p=0.002) and diabetes mellitus (15.9% vs 2.5%, p=0.03) and a longer hospital stay (10 vs 8 days, p=0.02). GA recurrence rate during follow-up was low (2%), but a broad range of comorbidities developed contributing to a 14% crude death rate. CONCLUSIONS GA stably complicates 0.25% of gonococcal infections in WA with young Indigenous females and middle-aged non-Indigenous males most affected. Prior infectious disease and diabetes mellitus are potential risk factors for GA in females. GA recurs rarely, but its development reflects a high risk of morbidity and mortality over the following ten years. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Johannes Nossent
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, University, Western Australia
| | - Warren Raymond
- Rheumatology Group, School of Medicine, University, Western Australia
| | - Helen Keen
- Rheumatology Group, School of Medicine, University, Western Australia.,Dept. Rheumatology, Fiona Stanley Hospital, Perth, Australia
| | - David B Preen
- School of Population and Global Health, University, Western Australia
| | - Charles A Inderjeeth
- Dept. Rheumatology, Sir Charles Gairdner Hospital, Perth, Australia.,Rheumatology Group, School of Medicine, University, Western Australia
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Supreeth S, Al Ghanami S, Shanmugasundaram S, Al Rawi RS, Abdawani AR, Abdelmasih SR. Successful two-stage primary total knee arthroplasty for infective arthritis of the knee - our experience. J Clin Orthop Trauma 2020; 11:S746-S751. [PMID: 32999550 PMCID: PMC7503794 DOI: 10.1016/j.jcot.2020.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/21/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The incidence of septic arthritis is 2-10/100,000. Morbidity is higher with persistent joint dysfunction in up to 30%. Osteoarthritic knee with infection presents a rare challenge, with no established approach for treatment exists. We present our experience of managing infected degenerative joint disease (DJD) with two-stage primary arthroplasty similar to the management of periprosthetic joint infection. PATIENTS AND METHODS Four patients presented to us between 2016 and 2018 with advanced DJD associated with coexistent joint sepsis with or without adjacent osteomyelitis. The diagnosis of joint sepsis with periarticular osteomyelitis was made based on clinical presentation, radiographic findings, inflammatory serological markers, and culture of knee joint aspirate. All were operated with primary arthroplasty in two stages of debridement with a static spacer followed by antibiotics and implantation. DISCUSSION With no established method of treating DJD superadded with infection, our experience adds valuable information in treating the same. Our 2-staged primary arthroplasty had a short antibiotic duration between stages, a mean of 63.5 days, and stopped within 3 days of 2ndstage reducing hospital stay, morbidity, and cost.Our approach is a very viable method of treating infected DJD with a minimum drug holiday time of two weeks before implantation with a better outcome, reducing the recurrence rate of infection.Though a small number with a minimum follow-up of 24 months, we believe we provide valuable additional information. CONCLUSION All patients had painless return to early activities with no signs of recurrent infection. Our approach is a very viable and could serve as a cost-effective method treatment for an infected arthritic knee.
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Affiliation(s)
- Sam Supreeth
- Khoula Hospital, Muscat, Oman
- Corresponding author. Department of Orthopaedics, Khoula Hospital, Muscat, Oman.
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Massey PA, Feibel B, Thomson H, Watkins A, Chauvin B, Barton RS. Synovial fluid leukocyte cell count before versus after administration of antibiotics in patients with septic arthritis of a native joint. J Orthop Sci 2020; 25:907-910. [PMID: 31917066 DOI: 10.1016/j.jos.2019.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/16/2019] [Accepted: 11/24/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Antibiotics have been shown to affect the accuracy of cultures; so antibiotics are held prior to obtaining cultures intra-operatively. No study has evaluated the effects of antibiotics on synovial fluid leukocyte cell count. The purpose of the current study is to compare the leukocyte cell count of native joints with septic arthritis when antibiotics have been given before aspiration and when no antibiotics have been given prior to aspiration. METHODS This study was performed at a community hospital and a level 1 urban trauma hospital after IRB approval from both institutions from July 2007 to July 2017. Inclusion criteria comprised of a diagnosis of septic arthritis with positive cultures and a recorded arthrocentesis with cell count performed. Patients with septic arthritis were identified using ICD-9 codes 711.00-711.99 and ICD-10 codes M00 - M02. A retrospective chart review was performed and data was collected. Patients were placed into one of two groups. Group 1 received no antibiotics for two weeks prior to arthrocentesis, group 2 received antibiotics within 24 h prior to arthrocentesis. Demographic information, cell count number and differential, and blood lab values were collected. Timing data was also collected on timing of admission, antibiotics, joint irrigation, and discharge from the inpatient setting. RESULTS There were 81 patients meeting final inclusion criteria. The average cell count for the group which received antibiotics (n = 30) was 40,408 ± 29,433 while the average cell count for the group receiving no antibiotics (n = 51) was 93,824 ± 73,875 (p < .0001). The average length of stay was not significantly different between the antibiotic group versus no antibiotic group (14.0 days vs 12.1 days p = .4). The time from admission to arthrocentesis and admission to washout was longer for the antibiotic group versus no antibiotic group (p = .004 and p = .002, respectively). CONCLUSION When antibiotics are given prior to arthrocentesis of a septic joint, there is an associated lower synovial fluid leukocyte count compared to when no antibiotics are given prior. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- P A Massey
- LSU Health School of Medicine, LSU Health Department of Orthopaedics, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - B Feibel
- LSU Health School of Medicine, LSU Health Department of Orthopaedics, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA.
| | - H Thomson
- LSU Health School of Medicine, LSU Health Department of Orthopaedics, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - A Watkins
- LSU Health School of Medicine, LSU Health Department of Orthopaedics, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - B Chauvin
- LSU Health School of Medicine, LSU Health Department of Orthopaedics, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
| | - R S Barton
- LSU Health School of Medicine, LSU Health Department of Orthopaedics, 1501 Kings Highway, P.O. Box 33932, Shreveport, LA, 71130-3932, USA
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Couderc M, Bart G, Coiffier G, Godot S, Seror R, Ziza JM, Coquerelle P, Darrieutort-Laffite C, Lormeau C, Salliot C, Veillard E, Bernard L, Baldeyrou M, Bauer T, Hyem B, Touitou R, Fouquet B, Mulleman D, Flipo RM, Guggenbuhl P. 2020 French recommendations on the management of septic arthritis in an adult native joint. Joint Bone Spine 2020; 87:538-547. [PMID: 32758534 DOI: 10.1016/j.jbspin.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
Septic arthritis (SA) in an adult native joint is a rare condition but a diagnostic emergency due to the morbidity and mortality and the functional risk related to structural damage. Current management varies and the recommendations available are dated. The French Rheumatology Society (SFR) Bone and Joint Infection Working Group, together with the French Language Infectious Diseases Society (SPILF) and the French Orthopaedic and Trauma Surgery Society (SOFCOT) have worked according to the HAS methodology to devise clinical practice recommendations to diagnose and treat SA in an adult native joint. One new focus is on the importance of microbiological documentation (blood cultures and joint aspiration) before starting antibiotic treatment, looking for differential diagnoses (microcrystal detection), the relevance of a joint ultrasound to guide aspiration, and the indication to perform a reference X-ray. A cardiac ultrasound is indicated only in cases of SA involving Staphylococcus aureus, oral streptococci, Streptococcus gallolyticus or Enterococcus faecalis, or when infective endocarditis is clinically suspected. Regarding treatment, we stress the importance of medical and surgical collaboration. Antibiotic therapies (drugs and durations) are presented in the form of didactic tables according to the main bacteria in question (staphylococci, streptococci and gram-negative rods). Probabilistic antibiotic therapy should only be used for patients with serious symptoms. Lastly, non-drug treatments such as joint drainage and early physical therapy are the subject of specific recommendations.
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Affiliation(s)
- Marion Couderc
- Rheumatology Department, Gabriel-Montpied Hospital, Clermont-Ferrand University Hospital, Clermont-Ferrand, France
| | - Géraldine Bart
- Rheumatology Department, South Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Guillaume Coiffier
- Rheumatology Department, South Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France.
| | - Sophie Godot
- Rheumatology Department, Diaconesses Croix Saint-Simon Hospital Group, Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Raphaele Seror
- Rheumatology Department, Le Kremlin-Bicêtre Hospital, AP-HP, South Paris, France
| | - Jean-Marc Ziza
- Rheumatology Department, Diaconesses Croix Saint-Simon Hospital Group, Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Pascal Coquerelle
- Nephrology-Rheumatology Department, Bethune Hospital, Bethune, France
| | | | | | - Carine Salliot
- Rheumatology Department, Orléans Regional Hospital, Orléans, France
| | - Eric Veillard
- Rheumatology Practice, 6, rue des 4 Pavillons, 35400 Saint-Malo, France
| | - Louis Bernard
- Infectious Diseases Department, Bretonneau Hospital, Tours University Hospital, Tours, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Marion Baldeyrou
- Infectious Diseases Department, Pontchaillou Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
| | - Thomas Bauer
- Orthopaedic and Trauma Surgery Department, Ambroise-Paré Hospital, AP-HP, West Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Beate Hyem
- Biomedical Analysis Laboratory, Microbiology, Diaconesses Croix Saint-Simon Hospital Group, Paris, France; Greater Paris Reference Centre for Joint and Bone Infections (IOA-IDF), Paris, France
| | - Robert Touitou
- General Medical Practice, 3, avenue du Bel Air, 75012 Paris, France
| | - Bernard Fouquet
- Physical Medicine and Rehabilitation Department, Trousseau Hospital, Tours, France
| | - Denis Mulleman
- Rheumatology Department, Bretonneau Hospital, Tours University Hospital, Tours, France
| | - René-Marc Flipo
- Rheumatology Department, Salengro Hospital, Lille University Hospital, Lille, France
| | - Pascal Guggenbuhl
- Rheumatology Department, South Hospital, Rennes University Hospital, Rennes, France; Western France Reference Centre for Complex Bone and Joint Infections (CRIOGO), Rennes, France
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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.
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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.
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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
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Muñoz-Gallego I, Mancheño M, Pérez-Montarelo D, Viedma E, Chaves F, Lora-Tamayo J. Staphylococcus aureus native arthritis over 10 years. Med Mal Infect 2020; 50:257-262. [DOI: 10.1016/j.medmal.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/25/2018] [Accepted: 01/28/2020] [Indexed: 12/11/2022]
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Abram SGF, Alvand A, Judge A, Beard DJ, Price AJ. Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout. THE LANCET. INFECTIOUS DISEASES 2020; 20:341-349. [DOI: 10.1016/s1473-3099(19)30419-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/31/2019] [Accepted: 07/01/2019] [Indexed: 02/08/2023]
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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.
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Lee DK, Rhee SM, Jeong HY, Ro K, Jeon YS, Rhee YG. Treatment of acute shoulder infection: can osseous lesion be a rudder in guideline for determining the method of débridement? J Shoulder Elbow Surg 2019; 28:2317-2325. [PMID: 31377005 DOI: 10.1016/j.jse.2019.05.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. METHODS We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). RESULTS The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). CONCLUSIONS When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement.
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Affiliation(s)
- Dong Ki Lee
- Department of Orthopaedic Surgery, Narsha Hospital, Busan, Republic of Korea
| | - Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ho Yeon Jeong
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoon Sang Jeon
- Department of Orthopaedic Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Jinno S, Sulis CA, Dubreuil MD. Causative Pathogens, Antibiotic Susceptibility, and Characteristics of Patients with Bacterial Septic Arthritis over Time. J Rheumatol 2019; 45:725-726. [PMID: 29717095 DOI: 10.3899/jrheum.171115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sadao Jinno
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine;
| | - Carol A Sulis
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine
| | - Maureen D Dubreuil
- Section of Rheumatology, and Section of Clinical Epidemiology Research and Training Unit, Department of Medicine, Boston University School of Medicine, and VA Boston Healthcare System, Boston, Massachusetts, USA
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Solow M, Sarraj M, Johal H, Al-Asiri J. A Case Report of Pneumococcal Septic Arthritis Following a Respiratory and Gastrointestinal Prodrome with Accompanying Literature Review. J Foot Ankle Surg 2019; 58:1293-1297. [PMID: 31679684 DOI: 10.1053/j.jfas.2018.12.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/04/2018] [Accepted: 12/04/2018] [Indexed: 02/03/2023]
Abstract
We report an uncommon case of septic arthritis of the ankle from a Streptococcus pneumoniae infection and provide an update of the literature reported since 2002. A 58-year-old female presented to the hospital with right ankle pain and an inability to bear weight. She reported a history of productive cough, vomiting, diarrhea, and subjective fevers 4 days earlier. Streptococcus pneumonia was identified in her ankle aspirate, and she was treated urgently with operative incision and debridement, followed by postoperative intravenous antibiotics. At her 7-week follow-up, she demonstrated complete resolution of symptoms and near-complete recovery of range of motion. This case demonstrates the importance of early identification, as the majority of patients recover fully with prompt treatment. The literature review included 44 cases of pneumococcal septic arthritis and found that the knee was the most commonly affected joint, followed by the shoulder and ankle. Blood cultures were positive for S. pneumoniae in 27 of 38 adults (71%) and 4 of 6 children (67%). Comorbid conditions were present in 32 of 38 adults (84%) and 4 of 7 children (57%), the most frequent of which were alcoholism and osteoarthritis in adults and malignancy or immunosuppression in children. Additionally, roughly half of included adults had an extra-articular focus of pneumococcal disease, most frequently pneumonia. Operative treatment was undertaken in 32 of 38 adults (84%) and all 7 children. Of adults with data available, 24 of 33 (73%) recovered with complete joint function, compared with 5 of 7 children (71%).
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Affiliation(s)
- Max Solow
- Medical Student, St George's University Medical School, St. George's, West Indies, Grenada
| | - Mohamed Sarraj
- Medical Student, McMaster University Medical School, Hamilton, Ontario, Canada
| | - Herman Johal
- Orthopedic Surgeon, Department of Orthopaedics, Department of Surgery, Center for Evidence-Based Orthopaedics, McMaster University, Hamilton, Ontario, Canada
| | - Jamal Al-Asiri
- Orthopedic Surgeon, Department of Orthopedic Surgery, Hamilton General Hospital, Hamilton, Ontario, Canada.
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Horino T, Hori S. Metastatic infection during Staphylococcus aureus bacteremia. J Infect Chemother 2019; 26:162-169. [PMID: 31676266 DOI: 10.1016/j.jiac.2019.10.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/25/2019] [Accepted: 10/03/2019] [Indexed: 12/17/2022]
Abstract
Staphylococcus aureus causes various infections, including skin and soft tissue infections and pneumonia via both, community-associated and nosocomial infection. These infectious diseases can lead to bacteremia, and may subsequently result in metastatic infections in several cases. Metastatic infections are critical complications in patients with S. aureus bacteremia, since the optimal duration of the antimicrobial treatment differs in patients with and without metastatic infection. Notably, two weeks of antimicrobial treatment is recommended in case of uncomplicated S. aureus bacteremia, whereas in patients with S. aureus bacteremia-associated endocarditis or vertebral osteomyelitis, six weeks of antimicrobial administration is vital. In addition, misdiagnosis or insufficient treatment in metastatic infection is associated with poor prognosis, functional disability, and relapse. Although echocardiography is recommended to examine endocarditis in the patients with S. aureus bacteremia, it remains unclear which patients should undergo additional examinations, such as CT and MRI, to detect the presence of other metastatic infections. Clinical studies have revealed that permanent foreign body and persistent bacteremia are predictive factors for metastatic infections, and experimental studies have demonstrated that the virulence factors of S. aureus, such as fnbA and clfA, are associated with endocarditis; however, these factors are not proven to increase the risk of metastatic infections. In this review, we assessed the incidence, predictive factors, diagnosis, and treatment for metastatic infections during S. aureus bacteremia.
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Affiliation(s)
- Tetsuya Horino
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan.
| | - Seiji Hori
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan
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