Native Joint Septic Arthritis: Epidemiology, Clinical Features, and Microbiological Causes in a New Zealand Population

Kennedy, N. P.; Chambers, Stephen T.; Nolan, Imogen; Gallagher, Kate; Werno, Anja M.; Browne, Melanie; Stamp, Lisa K.

doi:10.3899/jrheum.150434

Cited by 87 publications

(102 citation statements)

References 20 publications

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“…This diagnostic code has been previously shown to be valid . NEDS includes reasons for ED visit (diagnoses and procedures); up to 15 ICD‐9‐CM diagnostic codes are listed in primary (first) or secondary positions . For this study, we included ED visits with septic arthritis as the primary diagnosis.…”

Section: Methodsmentioning

confidence: 99%

“…Diagnosis is mainly clinical, and questions about optimal management still remain . In a 5‐year study of 248 cases from a region of New Zealand, crystal arthritis commonly coexisted with septic arthritis, and autoimmune arthritis and immunosuppression were less of a factor than anticipated . In a Brazilian study from 2006–2011, among the 61 septic arthritis cases, 45%, 26%, and 20% had osteoarthritis, hypertension, and diabetes mellitus, respectively .…”

Section: Introductionmentioning

confidence: 99%

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Septic Arthritis in Emergency Departments in the US: A National Study of Health Care Utilization and Time Trends

Singh

2018

Arthritis Care & Research

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Septic Arthritis in Emergency Departments in the US: A National Study of Health Care Utilization and Time Trends

Singh

2018

Arthritis Care & Research

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“…In previous reports, this condition accounted for less than 5% of all joint infections [1]. In recent analyses of 248 cases of septic arthritis, 37 (14.9%) involved the hand and 20 (8.1%) involved the wrist [2]. The management of pyogenic small joint arthritis (SJA) is less standardized than that of septic arthritis of the large joints (eg, hip or knee joint) for both surgical treatment and antimicrobial therapy.…”

mentioning

confidence: 99%

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Meier¹,

Wirth²,

Hahn

et al. 2017

Open Forum Infectious Diseases

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Background.Pyogenic arthritis of the small joints of the hand and wrist is a known but poorly described entity. The objective of this work was to characterize the clinical presentation, antimicrobial treatment, and surgical interventions of native small joint arthritis (SJA) treated in our tertiary center.Methods.According to predefined variables, medical records of adult patients with SJA treated in a Swiss university hospital between 2005 and 2013 were retrospectively analyzed.Results.The median age of 97 patients (101 joints) was 52 years (interquartile range [IQR], 38–68 years); 52% had no comorbidity. Small joint arthritis of the second and third fingers accounted for 53% of infections, with metacarpal-phalangeal and proximal interphalangeal joints most commonly involved. Of 86 (89%) episodes with an exogenous source, 63 (65%) followed a trauma. The most commonly isolated microorganism was Staphylococcus aureus (38%), followed by β-hemolytic streptococci (13%) and Pasteurella spp (11%). Eighty-seven episodes (89 joints) in patients with follow-up examinations were included in treatment and outcome analyses. Up to 2 surgical interventions were required to cure infection in 74 (83%) joints. Median antimicrobial treatment duration was 14 days (IQR, 12–28 days), with amoxicillin/clavulanate administered in 74 (85%) episodes. At follow up, cure of infection was noted in all episodes and good functional outcome in 79% of episodes.Conclusions.Small joint arthritis shows considerable differences from clinical patterns reported for larger joints. In our series, the outcome was good with no more than 2 surgical interventions and median treatment duration of 14 days in 79% of episodes.

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“…Discerning the early stage of septic arthritis from noninfectious conditions might be di cult, especially considering the high incidence of osteoarthritis in the elderly. Moreover, even after the physician suspected an infectious condition, most cases were regarded as super cial wound infection, cellulitis, and early ngertip infections, except the 8 cases with surgical drainage [19]. Thus, the inaccurate diagnosis might be one of the main reasons that caused treatment delay, and we believe that suspecting septic arthritis can shorten the treatment delay, when old patients present with swollen joints of the digit.…”

Section: Discussionmentioning

confidence: 92%

“…Although septic arthritis is generally considered as a surgical emergency [2,19], treatments are often delayed when it affects the digits [1,3]. In addition, diagnosis is di cult in patients with native joints, and can be further impeded due to postoperative pain, particularly in patients after nger surgery [3].…”

Section: Discussionmentioning

confidence: 99%

Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

Kwak

Bae

et al. 2020

Preprint

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Background Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. Methods In this retrospective review of consecutive case series, 45 patients (primary, n =11; referred, n =34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. Results In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients. Conclusions This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.

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Native Joint Septic Arthritis: Epidemiology, Clinical Features, and Microbiological Causes in a New Zealand Population

Abstract: The incidence of septic arthritis in Canterbury, New Zealand, is higher than in previous studies. Crystal arthropathy commonly coexisted with infection although autoimmune arthritis and immunosuppression was less of a factor than anticipated.

Cited by 87 publications

References 20 publications

Septic Arthritis in Emergency Departments in the US: A National Study of Health Care Utilization and Time Trends

Septic Arthritis in Emergency Departments in the US: A National Study of Health Care Utilization and Time Trends

Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

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