A narrative review of the last decade’s literature on the diagnostic accuracy of septic arthritis of the native joint

Abstract

While septic arthritis can be a straightforward diagnosis, there are many cases when the diagnosis is difficult to make. The aim of this study was to review the last decade’s literature on the diagnosis of septic arthritis of the native joint in adults and summarize that data in an easy to follow algorithm to clarify how the last decade’s data may be applied to the diagnosis of septic arthritis. A search of PubMed and CINAHL databases was performed to identify studies that compared results diagnostic tests for septic arthritis. We cross referenced this search with searches of additional databases (including Cochrane Library and Scopus) to confirm similar search results. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS) tool was used by two independent reviewers to determine study quality and risk of bias. After applying inclusion and exclusion criteria to the initial search, 15 papers total were included for analysis. All 15 papers were of high quality methodology as determined by the QUADAS tool. There were 26 different diagnostics tests used across the 15 papers included for review. Three of those diagnostic tests had specificity and sensitivity greater than 80%. Eight tests had a positive likelihood ratio of ≥10. Three tests had a negative likelihood ratio < 0.1, indicating that they may help to rule out septic arthritis. A flowchart was created to summarize the findings of our review, so that physicians may reference this visual in making the appropriate diagnosis when the commonly held standards of cell count, gram stain, and culture aren’t enough to make the diagnosis.

Staphylococcus aureus-induced septic arthritis of the ankle related to malum perforans in a diabetes patient

“…If initial needle aspiration does not provide fast relief or the purulent fluid is too thick for aspiration, open drainage through arthroscopy or arthrotomy are strongly recommended. Some studies found superior results for surgical approach in deeper joint, such as the hip or shoulder [ 24 , 25 , 26 ]. Patients who are unfit for surgery can benefit also from joint washing by means of an irrigation–drainage system, especially in the knee joint [ 27 ].…”

Enhancing Diagnostics in Orthopedic Infections

“…Synovial fluid sampling is obtained as standard of care in both suspected native and prosthetic joint septic arthritis. Synovial fluid white cell count of 50,000/μL is typically used as the cutoff for native joint septic arthritis ( 45 ). However, a recent large study using receiver operating curve analysis suggested a lower threshold of 33,000 cells/μL and 16,000 cells/μL for patients who did or did not receive prior antibiotics, respectively ( 46 ).…”

Análise Diferencial Da Artrite Séptica E Artrite Reativa Pós-Covid-19 Na Emergência

“…Entretanto, tiras reagentes para este marcador não confirmam o diagnóstico de AS, já que outras artrites inflamatórias também podem cursar com esse teste positivo. Pode-se, então, associar a presença de esterase de leucócitos em FS com teste de tiras de glicose negativo, o que geraria um valor preditivo positivo de 100 % e sugeriria o diagnóstico de AS (KOLBECK et al, 2021;TURNER et al, 2021).…”

“…• Artrocentese: >50.000 células • Relação lactato sinovial/glicose > 5 • Lactato sinovial > 10 • Calprotectina > 150 mg/l • % neutrófilos > 95%; cristais ausentes • Glicose sinovial > 1 • Leucócitos > 50.000; cristais ausentes • Esterase de leucócitos ++ ou +++ com teste de tira da glicose negativo (TURNER et al, 2021).…”

“…O manejo clínico da AS envolve antiobioticoterapia, reservando-se a abordagem cirúrgica por meio de artrotomia, desbridamento artroscópico ou aspiração em série para casos específicos (ELSISSY et al, 2020). Apesar da abordagem terapêutica rápida ser necessária, a coleta de amostras do fluido sinovial (FS) da articulação afetada por meio de artrocentese deve ser precedida para identificação do agente causador e confirmação diagnóstica (TURNER et al, 2021).…”