1
|
Cadiou S, Tuil R, Le Goff B, Hoppé E, Mulleman D, Langbour C, Le Pabic E, Charret L, Cormier H, Lecomte R, Arvieux C, Guggenbuhl P. Septic arthritis of the facet joint is also a severe vertebral infection: A multicenter retrospective study of 65 patients. Joint Bone Spine 2024; 91:105703. [PMID: 38336272 DOI: 10.1016/j.jbspin.2024.105703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/17/2024] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE Septic arthritis of the Facet Joints (SAFJ) is a rare condition. Little data has been published on the subject. We aimed to describe the clinical, biological and imagery presentations, as well as the course of this rare infection. METHODS We included patients hospitalized between January 1st, 2016 and December 31th, 2019, in the Departments of Infectious Diseases or Rheumatology in 5 French centres in the CRIOGO network. We defined septic arthritis according to Newman's criteria and facet joint arthritis using imagery. RESULTS Sixty-five patients were included, predominantly males (64.6%), with a mean age of 68.1 years. The mean time to diagnosis was 25.0 days. The principal symptoms at diagnosis were acute back pain (95.2%) and fever (76.9%). Neurological symptoms were present for 60.7% of the patients, including 16.4% motor deficit or cauda equina syndrome. SAFJ was located on the lumbosacral spine (73.4%) and was rarely multifocal (4.7%). Bacteriological identification was performed by blood cultures in 84.4% of the cases, and the pathogen was mainly Staphylococcus aureus (49.2%). Infective endocarditis was present for 26.9% of patients assessed by echocardiography. On MRI, soft tissue abscess or inflammation, epiduritis and epidural abscess were present in 87.1%, 66.7% and 33.9% of cases, and the pathogen was significantly more frequently Staphylococcus aureus. Mortality reached 9.2%, 18.5% and 23% at one, two, and three years respectively. CONCLUSION SAFJ is a rare but severe disease. Microbiological diagnosis is primarily made on blood cultures, and S. Aureus was the main pathogen. Our results highlight the fact that SAFJ is associated with high morbidity and mortality, and with infective endocarditis.
Collapse
Affiliation(s)
- Simon Cadiou
- Department of Rheumatology, Rennes University Hospital, Rennes, France.
| | - Rachel Tuil
- Department of Rheumatology, Rennes University Hospital, Rennes, France; Rennes University, Faculty of Medicine, Rennes, France
| | - Benoît Le Goff
- Regenerative Medicine and Skeleton, RMeS, UMR 1229, Oniris, Inserm, Nantes university, Nantes, France; Department of Rheumatology, Nantes University Hospital, Nantes, France
| | - Emmanuel Hoppé
- Department of Rheumatology, Angers University Hospital, Angers, France
| | - Denis Mulleman
- Department of Rheumatology, Tours University Hospital, University of Tours, Tours, France
| | - Camille Langbour
- Department of Rheumatology, Tours University Hospital, University of Tours, Tours, France
| | - Estelle Le Pabic
- Inserm, CIC UMR 1414, Rennes University Hospital, Rennes University, Rennes, France
| | - Laurie Charret
- Rheumatology Department, Hospital of Vendée, La Roche-Sur-Yon, France
| | - Helene Cormier
- Department of Infectious Diseases, Angers University Hospital, Angers, France
| | - Raphael Lecomte
- Department of Infectious Diseases, Centre d'Investigation Clinique 1413, Inserm, University Hospital of Nantes, Nantes, France
| | - Cédric Arvieux
- Department of Infectious Diseases and Intensive Care Medicine, Rennes University Hospital, Rennes, France
| | - Pascal Guggenbuhl
- Department of Rheumatology, Rennes University Hospital, Rennes, France; University of Rennes, Inserm, INRAE, CHU of Rennes, Institut NUMECAN (Nutrition Metabolisms and Cancer), Rennes, France
| |
Collapse
|
2
|
Charret L, Bart G, Hoppe E, Dernis E, Cormier G, Boutoille D, Le Goff B, Darrieutort-Laffite C. Clinical characteristics and management of olecranon and prepatellar septic bursitis in a multicentre study. J Antimicrob Chemother 2021; 76:3029-3032. [PMID: 34293150 DOI: 10.1093/jac/dkab265] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/01/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND No current guidelines are available for managing septic bursitis (SB). OBJECTIVES To describe the clinical characteristics and management of olecranon and prepatellar SB in five French tertiary care centres. METHODS This is a retrospective observational multicentre study. SB was diagnosed on the basis of positive cultures of bursal aspirate. In the absence of positive bursal fluid, the diagnosis came from typical clinical presentation, exclusion of other causes of bursitis and favourable response to antibiotic therapy. RESULTS We included 272 patients (median age of 53 years, 85.3% male and 22.8% with at least one comorbidity). A microorganism was identified in 184 patients (67.6%), from bursal fluids in all but 4. We identified staphylococci in 135 samples (73.4%), streptococci in 35 (19%) and 10 (5.5%) were polymicrobial, while 43/223 bursal samples remained sterile (19.3%). Forty-nine patients (18%) were managed without bursal fluid analysis. Antibiotic treatment was initially administered IV in 41% and this route was preferred in case of fever (P = 0.003) or extensive cellulitis (P = 0.002). Seventy-one (26%) patients were treated surgically. A low failure rate was observed (n = 16/272, 5.9%) and failures were more frequent when the antibiotic therapy lasted <14 days (P = 0.02) in both surgically and medically treated patients. CONCLUSIONS Despite variable treatments, SB resolved in the majority of cases even when the treatment was exclusively medical. The success rate was equivalent in the non-surgical and the surgical management groups. However, a treatment duration of <14 days may require special attention in both groups.
Collapse
Affiliation(s)
- Laurie Charret
- Rheumatology Department, CHU Nantes, Nantes, France.,Rheumatology Department, CHD Vendée, La Roche-Sur-Yon, France
| | - Géraldine Bart
- Rheumatology Department, CHU Rennes, Rennes, France.,Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043, Rennes cedex, France
| | | | | | | | - David Boutoille
- Centre de référence en infections ostéoarticulaires complexes du Grand Ouest (CRIOGO), CHU de Rennes, 35043, Rennes cedex, France.,Department of Infectious Diseases, CHU Nantes, Nantes, France.,Centre d'Investigation Clinique, Unité d'Investigation Clinique 1413 INSERM, CHU Nantes, Nantes, France
| | | | | |
Collapse
|
3
|
Charret L, Lamberet R, Desplantes V, Achille A, Agard C, Néel A. Une pneumopathie anormalement confusogène chez une grand-mère. Rev Med Interne 2019. [DOI: 10.1016/j.revmed.2019.10.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|