Clinical Characteristics and Causative Pathogens of Infective Arthritis and Risk Factors for Gram-Negative Bacterial Infections

Abstract

Background:The aim of this study was to describe the clinical and microbiological characteristics of infective arthritis and to analyze risk factors for Gram-negative bacterial infections that cause infective arthritis. Materials and Methods: Patients admitted between 2009 -2018 with infective arthritis in a single-tertiary hospital were evaluated retrospectively. Results: A total of 181 patients were enrolled in this study. Of them, 135 were native joint infection patients and 46 were prosthetic joint infection patients. The most common site of infective arthritis was the knee (63.6%), followed by the shoulder (17.7%), and the hip (9.9%). The most frequently identified microorganisms were Staphylococcus aureus (51.1%), followed by Streptococci sp. (21.1%), Enterobacteriaceae (8.4%), and coagulase-negative-Staphylococci (CNS; 8.4%). Infections due to Gram-negative bacteria and fungi made up 13.7% and 3.2% of all cases, respectively. Additionally, 20% and 4.2% of the cases involved methicillin-resistant S. aureus (MRSA) and MRCNS. We found that bacteriuria, infective arthritis in the hip, and steroid use at admission are independent risk factors for Gram-negative bacterial infections. Conclusion: Infective arthritis with methicillin-resistant microorganisms reached up to about 25% in a single-tertiary hospital in Korea. In case of suspected urinary tract infection, infective arthritis of the hip joint, or steroid use at admission time among infective arthritis patients, empirical treatment covering Gram-negative microorganisms can be considered.

Causative Pathogens and Antibiotic Resistance in Infectious Arthritis

“…In a study by Lee et al, methicillin-resistant S. aureus (MRSA) was identified as the causative agent in 39% of the total cases of S. aureus arthritis. The MRSA ratio was three times higher in healthcare-associated infections than in community-acquired infections [2]. This finding is similar to that reported by a previous domestic study in which MRSA was identified as the causative agent in 44% of the overall cases of S. aureus osteoarticular infections [3].…”

“…MRSA has also been reported to be the causative agent in 38 -43% cases of native vertebral osteomyelitis in Korea [4,5]. Lee et al showed that a high MRSA ratio was associated with high resistance rates to ciprofloxacin (34.3%) and clindamycin (42.9%) in cases of S. aureus infection [2]. Although the clinical data on early conversion from intravenous to oral antibiotics for osteoarticular infections caused by methicillin-susceptible S. aureus are relatively abundant, the clinical data on early switch to oral antibiotics for MRSA osteoarticular infections are insufficient [6,7].…”

“…Lee et al reported that 14% of the cases of infectious arthritis were caused by gramnegative bacteria, and the ciprofloxacin resistance rate was 57.0% [2]. The prevalence of bacteriuria is high in elderly women, and urinary tract infections caused by gram-negative bacteria is a common source of hematogenous osteoarticular infections in this population.…”

“…Attention should be paid to the fluoroquinolone resistance in cases of urinary tract infections, which is constantly high or increasing in Korea [9]. Lee et al reported that bacteriuria, hip joint infection, and steroid infection were independent risk factors of infectious arthritis caused by Gram-negative bacteria [2]. The hip joint is a difficult site for intra-articular procedures, and only one of 18 infected patients had a history of intra-articular procedures [2].…”

“…Lee et al reported that bacteriuria, hip joint infection, and steroid infection were independent risk factors of infectious arthritis caused by Gram-negative bacteria [2]. The hip joint is a difficult site for intra-articular procedures, and only one of 18 infected patients had a history of intra-articular procedures [2]. This data indicated that hematogenous spread may be possible mechanisms of development of hip joint arthritis.…”