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Aitkens L, Winn M, Waller JL, Huber L, Baer SL, Mohammed A, Kheda M, Tran S, Siddiqui B, Padala S, Colombo RE, Bollag WB. Septic arthritis in the end-stage renal disease population. J Investig Med 2021; 70:383-390. [PMID: 34518317 DOI: 10.1136/jim-2021-001869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2021] [Indexed: 11/04/2022]
Abstract
Septic arthritis is important to consider in any patient who presents with joint pain because it is a medical emergency with an 11% fatality rate. Diagnosis and treatment may improve prognosis; however, many patients do not regain full joint function. In patients with end-stage renal disease (ESRD), immune dysfunction due to uremia and chronic vascular access leads to increased risk of infection. We examined the incidence, risk factors and sequelae of septic arthritis in a cohort of hemodialysis patients. The US Renal Data System was queried for diagnoses of septic arthritis and selected sequelae using International Statistical Classification of Diseases and Related Health Problems-9 and Current Procedural Terminology-4 codes in patients who initiated hemodialysis between 2005 and 2010. Multivariable logistic regression was used to determine potential risk factors for septic arthritis and its sequelae. 7009 cases of septic arthritis were identified, an incidence of 514.8 per 100,000 persons per year. Of these patients, 2179 were diagnosed with a documented organism within 30 days prior to or 14 days after the septic arthritis diagnosis, with methicillin-resistant Staphylococcus aureus infections (57.4%) being the most common. Significant risk factors for septic arthritis included history of joint disease, immune compromise (diabetes, HIV, cirrhosis), bacteremia and urinary tract infection. One of the four sequelae examined (joint replacement, amputation, osteomyelitis, Clostridioides difficile infection) occurred in 25% of septic arthritis cases. The high incidence of septic arthritis and the potential for serious sequelae in patients with ESRD suggest that physicians treating individuals with ESRD and joint pain/inflammation should maintain a high clinical suspicion for septic arthritis.
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Affiliation(s)
- Lorry Aitkens
- Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Matthew Winn
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jennifer L Waller
- Department of Population Health Sciences, Augusta University, Augusta, Georgia, USA
| | - Lu Huber
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Stephanie L Baer
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.,Charlie Norwood VA Medical Center, Augusta, Georgia, USA
| | - Azeem Mohammed
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Sarah Tran
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Budder Siddiqui
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Sandeep Padala
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Rhonda E Colombo
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Wendy B Bollag
- Department of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA .,Charlie Norwood VA Medical Center, Augusta, Georgia, USA.,Department of Physiology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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2
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Grushky AD, Im SJ, Steenburg SD, Chong S. Traumatic Injuries of the Foot and Ankle. Semin Roentgenol 2020; 56:47-69. [PMID: 33422183 DOI: 10.1053/j.ro.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alexander D Grushky
- Division of Emergency Radiology, Department of Radiology, University of Michigan, Ann Arbor, MI.
| | - Sharon J Im
- Department of Sports Medicine, Henry Ford Hospital, Detroit, MI
| | - Scott D Steenburg
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN
| | - Suzanne Chong
- Emergency Radiology Division, Department of Radiology and Imaging Sciences, Indiana University School of Medicine and Indiana University Health, Indianapolis, IN
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