Septic arthritis of the fingers: is short-term oral antibiotic therapy appropriate?

The management of septic arthritis of the hand is poorly described and there is no consensus. It is based on how septic arthritis of the large joints is managed, despite certain specificities related to the hand, typically involving inpatient management and intravenous antibiotic therapy. The primary objective of this work was to evaluate our postoperative protocol for the management of septic arthritis of the hand with short-term antibiotic therapy. The secondary objective was to determine the risk factors for treatment failure. We conducted a retrospective, descriptive, single-center study and analyzed the medical records of patients managed for septic arthritis of the fingers over a 1-year period from January 2018 to December 2018. We collected patient demographics and all pre-, intra-, and postoperative data. A total of 128 patients were included. The median age was 52.4 years (41-66). An exogenous source of contamination was reported in 98% of cases (animal bite, plant thorn, wound, cyst trituration, etc.). The most frequently isolated microorganism was Staphylococcus aureus (45%), followed by Streptococcus spp. (22%) and Pasteurella spp. (18%). The vast majority of patients (79%) were treated with oral amoxicillin/clavulanic acid. This treatment was continued in 91% of patients after microbiological results were obtained for a median treatment duration of 8 days (7-15). Nine percent of patients failed treatment. The risk factors identified were crush wounds (p = 0.04), initial radiological abnormalities (chondrolysis and/or osteolysis) (p = 0.016) and infection with Pasteurella spp. (p = 0.015). Our study suggests that simplified antibiotic therapy is feasible for the management of septic arthritis of the hand with short duration, broad spectrum oral antibiotics in the absence of identified risk factors.

Clinical and microbiological findings of septic arthritis caused by Haemophilus parainfluenzae

OBJECTIVES

To report a case of septic arthritis due to H. parainfluenzae and to review the clinical and microbiological characteristics of published case patients.

PATIENTS AND METHODS

Data was collected on age, sex, infection localization, underlying risk factors, symptom onset-diagnosis interval, analytical findings, microbiological diagnosis, treatment, outcome, and follow-up of the present patient (presenting with septic arthritis of the pubic symphysis due to H. parainfluenzae) and those identified in a literature analysis.

RESULTS

Data of 18 patients, including 17 reported case patients, was collected. Mean age at presentation was 51±9 years. Underlying diseases for septic arthritis were recorded in 11 patients. The infection site was the knee in eight patients, hip and/or acromioclavicular joint in five. Pain was observed in 15 patients and fever in 10; the mean symptom onset-diagnosis interval was 9.4 days. Diagnosis was obtained from synovial fluid aspirate in 12 patients and from blood cultures in four. Susceptibility of H. parainfluenzae strains was reported in 12 cases. Eight patients were treated with cephalosporins and 10 with penicillins. A favorable outcome was observed in 13 patients.

CONCLUSIONS

Septic arthritis caused by H. parainfluenzae is a rare entity that requires a high level of suspicion before application of laboratory methods for rapid diagnosis and treatment.

[A case of gonococcal arthritis: Diagnostic difficulties and usefulness of synovial fluid PCR]

INTRODUCTION

The incidence of Neisseria gonorrhoeae septic arthritis remains low in the general population. Its clinical and microbiological diagnostic remains difficult.

CASE REPORT

We report a 44-year-old man who presented with a monoarthritis of the right ankle. The diagnosis of gonoccocal septic arthritis was obtained by PCR from the joint fluid. Treatment with ceftriaxone was effective.

CONCLUSION

In patients with high risk of N. gonorrhoeae infection, PCR for detection of gonorrhea in synovial fluid could potentially facilitate the diagnostic of gonococcal septic arthritis.

[Primitive sternoclavicular septic arthritis]

INTRODUCTION

Sternoclavicular infections are unusual, and it even more unusual for infection to occur here as a primary site.

CASE REPORT

We report the case of a 53-year-old patient with no prior medical history or risk factor who consulted because of sternal swelling of inflammatory character. CT-scan, bacteriological and histological analysis of samples concluded the diagnosis of primary sternoclavicular staphylococcal septic arthritis. Management consisted of antibiotics and was associated with a flattening of the lesion. The outcome at 6 months was favorable.

CONCLUSION

Sternoclavicular infections should be evoked early in the course of sternoclavicular pain in order to avoid any locoregional complications and mostly mediastinitis.