Management of septic arthritis: a systematic review

Mathews, Catherine J; Kingsley, Gabrielle; Field, Max; Jones, Adrian; Weston, Vivienne; Phillips, M; Walker, David; Coakley, Gerald

doi:10.1136/ard.2006.058909

Cited by 188 publications

(222 citation statements)

References 34 publications

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“…The absence of a raised WBC count is not sufficient to rule out joint infection [10]. In our patient population less than half of the patients with septic ankle arthritis had an elevated WBC on admission.…”

Section: Discussionmentioning

confidence: 97%

Hematogenous Septic Ankle Arthritis

Holtom

Borges

Zalavras

2008

Clinical Orthopaedics &Amp; Related Research

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Ankle infection is a serious problem with limited published information on microbiology and associated morbidities. We describe the laboratory findings, microbiology, and occurrence of adjacent osteomyelitis in patients with hematogenous septic ankle arthritis. We retrospectively reviewed 30 patients with hematogenous septic arthritis of the ankle admitted over a 10-year period. Twenty-two patients were male and eight female. The mean age was 46 years (range, 23-67 years). C-reactive protein and erythrocyte sedimentation rate were elevated in all patients, but the peripheral white blood cell count was elevated in only 47% of patients. Staphylococcus aureus (S. aureus) was the most common pathogen, isolated in 13 (54%) of the 24 patients with positive cultures; four of these isolates (four of 24; 17% of positive cultures) were oxacillin-resistant. Four (17%) of the 24 patients with positive cultures had a mycobacterial infection. We identified adjacent osteomyelitis in 30% of patients, which was considerably associated with the presence of patient comorbidities. S. aureus is the most common pathogen in septic ankle arthritis and empiric antibiotic therapy is recommended. Adjacent osteomyelitis may be present and a high index of suspicion is necessary in patients with comorbidities.

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Section: Discussionmentioning

confidence: 97%

Hematogenous Septic Ankle Arthritis

Holtom

Borges

Zalavras

2008

Clinical Orthopaedics &Amp; Related Research

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“…Ausgehend von einem Focus, beispielsweise einer Endokarditis, disponiert eine geschwächte Immunitätslage, insbesondere im höheren Alter, zu einer raschen Ausbreitung der Erreger [11]. Begünstigt wird dies zusätz-lich durch Grunderkrankungen wie Diabetes mellitus, Nieren-oder Leberinsuffizienz, aber auch Drogenabusus und in diesem Zusammenhang nicht selten auftretende HIV-Infektionen (HIV: "human immunodeficiency virus", [14]). Endogen verursachte Infektionen betreffen vornehmlich das Handgelenk.…”

Section: Endogene Ursachenunclassified

“…Mathews et al [14] verglichen eine Reihe von Markern wie die Leukozytenzahl, TNF-α (Tumornekrosefaktor α), Interleukine 6 und 8 sowie die Glukosekonzentration der Synovialflüssigkeit. Sie stellten fest, dass keiner der Marker eine ausreichende Spezifität und Sensitivität aufwies, um einen Gelenkinfekt von einer nichtinfektiösen Arthritis zu unterscheiden.…”

Section: Diagnostische Gelenkpunktionunclassified

Akute Gelenkinfektionen an Hand und Handgelenk

Cakmak

Spies

Unglaub

2014

Trauma Berufskrankh

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“…If the patients met the clinical criteria [11,14], a diagnosis of septic arthritis was made. The standard treatment regimen at both hospitals was as follows.…”

Section: Methodsmentioning

confidence: 99%

“…The role of clinical suspicion in diagnosis of septic arthritis cannot be overemphasised. A systematic review performed by Mathews et al found that no investigation is more reliable than clinical diagnosis of an experienced doctor [11]. Arthroscopic lavage has been shown to be effective in the surgical management of infectious arthritis [12,13].…”

Section: Introductionmentioning

confidence: 99%

Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter?

Kodumuri

Geutjens

Kerr

2012

International Orthopaedics (SICOT)

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Purpose Septic arthritis is a life-threatening emergency with high mortality of up to 11 %. We investigated if delay of arthroscopic lavage of infected major joints would have a bearing on the mortality and morbidity such as admission to an intensive care unit (ICU). Methods We retrospectively reviewed patients presenting with septic arthritis to two regional hospitals over a period of seven years from 1 January 2005 to 31 December 2011. We divided our sample of 82 patients into four groups based on the time delay between clinical diagnosis and arthroscopic lavage ranging from less than six hours to more than 24 hours. Results We determined that 35.4 % of patients had prosthetic joints. Knee joints were predominantly involved (74.4 %). Staphylococcus aureus was the most commonly isolated pathogen (41.5 %). There were ten (12.2 %) deaths and the same number of admissions to an ICU. Our study revealed there was no statistical significance between the time delay and mortality (P00.25) or ICU admission (P00.74) or the number of washouts (P00.08) in all four groups.Conclusions Up to 48 hours delayed arthroscopic lavage for septic arthritis does not increase the risk of mortality. Further prospective large sample studies are recommended to investigate this and the risk of long-term morbidity.

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Management of septic arthritis: a systematic review

Abstract: Objective: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints. Design: Systematic review.

Cited by 188 publications

References 34 publications

Hematogenous Septic Ankle Arthritis

Hematogenous Septic Ankle Arthritis

Akute Gelenkinfektionen an Hand und Handgelenk

Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter?

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