Increased Mortality and Reoperation Rates After Treatment for Septic Arthritis of the Knee in People Who Inject Drugs: Nationwide Inpatient Sample, 2000-2013

Oh, David Hyung Won; Wurcel, Alysse G.; Tybor, David J.; Burke, Dave; Menendez, Mariano E.; Salzler, Matthew J.

doi:10.1097/01.blo.0000534682.68856.d8

Cited by 30 publications

(17 citation statements)

References 20 publications

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“…This contrasts to the findings in one recently published nationwide study conducted in the US which reported that the proportion of patients with intravenous drug use-related joint sepsis increased to 11% in 2013. 20 Reasons for this disparity could include differences in rates of illicit drug users between Malta and the US, as well as the exclusion in our study of cases of osteomyelitis without definite joint involvement.…”

Section: Discussionmentioning

confidence: 96%

The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study

Vassallo¹,

Borg²,

Farrugia

et al. 2020

MJR

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Objective/Aim: Septic arthritis is an uncommon but important disease with significant morbidity and mortality, especially if inadequately managed. The aim of this epidemiological study was to identify the characteristics and outcomes of patients treated for septic arthritis at Mater Dei Hospital, Malta, over a 10-year period. Methods: This was a retrospective observational study. Patients diagnosed with septic arthritis between 2008 and 2018 were recruited. Cases were identified by reviewing all inhospital episodes of patients diagnosed with septic arthritis according to Newman criteria. Results: There were 124 cases of native joint septic arthritis and 138 of prosthetic joint infection. Cases were present amongst all age groups, with the highest incidence amongst those aged 61–70 years for both native and prosthetic infections. Fever was present in around 40% of cases. Raised white cell count was prevalent in 66.9% of native joint infections and 52.9% of prosthetic joints. Elevated C-reactive protein was overwhelmingly seen in most cases, present in 93.5% (median=159.5 mg/L; IQR=85.8–291) of native joints and 92.0% of prosthetic joint infections (median=68.7 mg/L; IQR=20.5–186). Over 55% of patients had one or more risk factors for joint sepsis, diabetes mellitus being the most prevalent clinical comorbidity (22.6% and 24.6% for native and prosthetic joint infections respectively). Synovial cultures were positive in 66% and 82% of native and prosthetic joint aspirates respectively. Staphylococcus aureus was the most commonly isolated organism from both native and prosthetic joint infection, followed by streptococcal infections in native joints and coagulase negative staphylococci and gram-negative infections in prosthetic joints. Fifteen deaths were directly attributed to joint sepsis. Conclusion: Absence of fever and elevated white cell count does not exclude the diagnosis. The mortality rate due to septic arthritis in this cohort of patients was found to be 5.7%. All deaths occurred in elderly patients with clinical comorbidities suggesting that this group is at highest risk.

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Section: Discussionmentioning

confidence: 96%

The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study

Vassallo¹,

Borg²,

Farrugia

et al. 2020

MJR

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“…Septic arthritis is a medical emergency that is known to be associated with significant morbidity and mortality. 8,10 In addition to irreversibly damaging the joint itself, untreated septic arthritis can spread the infection systemically, leading to severe problems such as epidural abscesses, infective endocarditis, and sepsis. 8,10 Mathews et al reported an 11% mortality rate in patients presenting with monoarticular septic arthritis, and the percentage increases as more joints are involved.…”

Section: Discussionmentioning

confidence: 99%

“…8,10 In addition to irreversibly damaging the joint itself, untreated septic arthritis can spread the infection systemically, leading to severe problems such as epidural abscesses, infective endocarditis, and sepsis. 8,10 Mathews et al reported an 11% mortality rate in patients presenting with monoarticular septic arthritis, and the percentage increases as more joints are involved. 8 Although septic arthritis of the foot and ankle represents only about 3% to 7% of all septic arthritis cases, early identification and treatment remain equally as important as septic arthritis in other joints.…”

Section: Discussionmentioning

confidence: 99%

“…11 A recent study noted that PWID who are found to have septic arthritis of the leg have higher rates of death during hospitalization, higher chances of repeat operations, more resource utilization, and higher probability of leaving AMA. 10 Considerations for patients with SA of the foot and ankle specifically include identification of systemic conditions such as diabetes, peripheral vascular disease, chronic liver or kidney disease, immunosuppressive status, and gout. The mainstay of treatment of septic arthritis of any joint, including within the foot and/or ankle, is arthrotomy, either arthroscopically or open, with irrigation and debridement of the joint space.…”

Section: Discussionmentioning

confidence: 99%

“…11 In light of the opioid epidemic, bacterial infections like endocarditis, septic arthritis, and epidural abscesses are increasing. 3,10…”

Section: Introductionmentioning

confidence: 99%

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Treatment Outcomes in Septic Arthritis of the Foot and Ankle in People Who Inject Drugs

Shields

Toppo

Menendez

et al. 2020

Foot & Ankle Orthopaedics

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Background: Although injection drug use (IDU) is a known risk factor for septic arthritis (SA) of the foot and ankle (F&A), disease and hospitalization outcomes are poorly characterized. We evaluated national trends, demographic characteristics, and hospitalization outcomes of SA of the F&A in people who inject drugs vs those who do not. Methods: Using the Nationwide Inpatient Sample, we identified all patients aged 15-64 with a principal discharge diagnosis of SA of the F&A from 2000 to 2013 and evaluated if they were related or unrelated to IDU. We assessed differences in demographic characteristics and in-hospital outcomes in these groups. Results: From 2000 to 2013, there were an estimated 14,198 hospitalizations for SA of the F&A in the United States, and 11% were associated with IDU (SA-IDU). Compared to SA unrelated to IDU, people with SA-IDU were significantly more likely to be younger, black, and have Medicaid or no insurance. People with SA-IDU were significantly more likely to leave against medical advice (9.7% vs 1.4%, P < .001), have a longer length of stay (9.2 vs 6.8 days, P < .001), and incur increased hospital charges ($58 628 vs $38 876, P = .005). People with SA-IDU were significantly less likely to receive an arthroscopy (1.5% vs 6.5%, P < .001) or arthrotomy (2.2% vs 11.0%, P < .001) of the foot. Conclusion: People with SA-IDU of the F&A had suboptimal hospitalization outcomes with greater costs. Recognizing risk factors and proactively addressing potential complications of substance use disorder in the hospital should be prioritized by the orthopedic community. Level of Evidence: Level III, retrospective cohort study.

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Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review

McKenna,

Miller,

McAleese

et al. 2024

J. exp. orthop.

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PurposeSeptic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy.MethodsA systematic review and meta‐analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all‐cause complications, length of inpatient stay and mortality secondary outcomes.ResultsA total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72–1.02], I2 = 36%). Eligible studies found in favour of arthroscopy for all‐cause complication rate (risk ratio 0.75 [95% CI: 0.6–0.93], I2 = 84%) and length of stay in hospital (mean difference −1.98 days [95% CI: −3.43 to −0.53], I2 = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52–2.63], I2 = 57%).ConclusionOur analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All‐cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates.Level of EvidenceLevel III.

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Increased Mortality and Reoperation Rates After Treatment for Septic Arthritis of the Knee in People Who Inject Drugs: Nationwide Inpatient Sample, 2000-2013

Abstract: Level III, therapeutic study.

Cited by 30 publications

References 20 publications

The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study

The Epidemiology and Outcomes of Septic Arthritis in the Maltese Islands: A Hospital-Based Retrospective Cohort Study

Treatment Outcomes in Septic Arthritis of the Foot and Ankle in People Who Inject Drugs

Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review

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