A Retrospective Review of Native Septic Arthritis in Patients: Can We Diagnose Based on Laboratory Values?

Rasmussen, L. G.; Bell, Jared; Kumar, Arun; Heckman, Michael G.; Lesser, Elizabeth R.; Whalen, Joseph L.; Shi, Glenn G.; Ledford, Cameron K.; Wilke, Benjamin K

doi:10.7759/cureus.8577

Cited by 8 publications

(10 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The overall rate of positive cultures in this study was 41.5%, which is in line with other studies that do not solely rely on the presence of a positive culture to diagnose SA [31]. Given the fact that cultures often remain negative [32][33][34][35], this should also not deter physicians from instituting therapy for presumed SA in a compatible clinical picture as this may lead to poor outcomes [1]. While an increasing role for Kingella infections has been described in culture-negative paediatric SA [31,36], we were unable to investigate the role of this relatively new agent as there is no Kingella-specific diagnostic code in discharge summaries.…”

Section: Discussionsupporting

confidence: 88%

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

et al. 2021

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionsupporting

confidence: 88%

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Biochemical investigations are an important diagnostic tool for septic arthritis [17, 19, 26, 27]. This study found that a higher initial TW cell count of ≥ 20 × 10 9 /L significantly increased the risk of secondary surgery, with a hazard ratio of 2.42.…”

Section: Discussionmentioning

confidence: 92%

“…It is well established that targeted intravenous antibiotic therapy coupled with early surgical intervention can lead to effective eradication of infection [6, 8, 27, 28, 32]. However, some patients may still require multiple surgeries for infection control [24, 25, 25, 30, 34].…”

Section: Discussionmentioning

confidence: 99%

Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee

Yeo

Cuttilan

et al. 2022

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

PurposeSeptic arthritis is an orthopaedic emergency with high morbidity and mortality. The aim of this study is to determine the risk factors associated with secondary surgery for septic arthritis of the native knee joint. MethodsThis is a retrospective study reviewing all patients who underwent surgery for septic arthritis of the knee from 2012 to 2019 in a single institution. A total of 117 patients were recruited. Patients were divided into 2 groups: Group I (79/117, 67.5%) underwent one surgery and Group II (38/117, 32.5%) underwent more than one surgery. ResultsPatients with a raised initial total white (TW) cell count of > 20 × 109/L had a significantly higher risk of secondary surgery. (Adjusted hazard ratio 2.42, p < 0.05) A decline of CRP level of less than 20% within 24 h from initial operation was also a risk for secondary surgery. (Adjusted hazard ratio 0.34, p < 0.01) Patients in group II also had significantly higher post‐operative median TW cell count and neutrophil count. There was no significant difference in the offending microbe, surgical approach, and duration of operation from initial presentation between the groups. ConclusionsPatients with septic arthritis of the native knee joint who present with raised initial total white cell count of > 20 × 109/L and decline of CRP level of less than 20% within 24 h from initial operation are at higher risk of secondary operation. In these patients, more aggressive treatment strategies and appropriate counselling on the risks of repeated surgery are recommended. Level of evidenceLevel IV.

show abstract

“…A complex imagistic and laboratory assessment allowed us to establish an accurate diagnosis, but the several associated risk factors and consecutive complications did not allow us to apply all the necessary therapeutic measures, making the case difficult to have a good short- and long-term good prognosis [ 30 , 31 ].…”

Section: ⧉ Discussionmentioning

confidence: 99%

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

Bărbulescu¹,

Firulescu²,

Chisălău³

et al. 2022

Rom J Morphol Embryol

View full text Add to dashboard Cite

Septic arthritis (SA) is a less common joint pathology with potentially fatal outcome. It is considered a medical emergency, in which prompt diagnosis and differentiation of bacterial etiology is essential for appropriate management. The knee is the most prevalent site for SA (~50% of cases), followed by hip, shoulder, and elbow. Early intervention requires an accurate diagnosis and imaging techniques enable both a positive diagnosis, as well as arthrocentesis and liquid analysis, the "gold standard" criteria. We report the case of a 70-year-old patient, with history of rheumatoid arthritis (RA), diabetes mellitus (DM) and persistent left malum perforans in the last year, with development of a severe and debilitating Staphylococcus aureus-related SA of the left ankle, which posed significant therapeutic challenges. He developed a plantar lesion at the ball of the left foot, in the past one year, which was labeled as malum perforans in the setting of DM. Musculoskeletal ultrasound was the primary imaging technique used to define the location and extent of the infectious process. Cultures drawn from the tissue were positive for S. aureus. After an antibiotic course, the apparent infectious features were remitted but the long-lasting open wound failed to improve. Antibiotic therapy was initiated in accordance with culture sensibility tests but short-and long-term outcome was unfavorable with both treatment unresponsiveness and comorbidity burden posing considerable difficulties. The association and interrelation between different comorbidities (such as hypertension, diabetes, or obesity), chronic systemic inflammation (e.g., C-reactive protein level, disease activity), and RA medication is sometimes difficult to understand and to address in daily practice, and this case report highlights multiple toils encountered in a SA patient with RA on immunosuppressive therapy and complicated DM.

show abstract

A Retrospective Review of Native Septic Arthritis in Patients: Can We Diagnose Based on Laboratory Values?

Abstract: Open Access Original Article

Cited by 8 publications

References 16 publications

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee

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

Contact Info

Product

Resources

About