Primarily treated patients versus referred patients in the treatment of native septic arthritis of digits: a retrospective comparative study

Abstract

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.

Microbubble cavitation restores Staphylococcus aureus antibiotic susceptibility in vitro and in a septic arthritis model

“…For AMK, the inoculum effect is attributable to irreversible binding between AMK and the 30 S ribosomal subunit 42 . While in vitro results often don’t predict in vivo results, data showing decreased antibiotic sensitivity at higher bacterial numbers is consistent with clinical experience of improved outcome when treatment is initiated early in the time course of septic arthritis 43 , 44 .…”

Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections—A Five-Year Retrospective Study

“…These findings highlight the critical importance of the early recognition and treatment of septic arthritis to optimize patient outcomes and minimize the risk of long-term disability. Educating patients and healthcare providers about the signs and symptoms of septic arthritis can facilitate quicker diagnosis and treatment, ultimately improving the prognosis [ 55 ].…”

Septic arthritis of the hand: Current issues of etiology, pathogenesis, diagnosis, treatment

“…Recommendations for the treatment of patients with septic arthritis of the small joints of the hand are based on data from retrospective studies and expert opinion. The choice of sanitation method depends on the nature and severity of pathological changes and may include: repeated punctures, arthroscopic drainage and open sanitation[ 13 , 41 ]. Puncture treatment is effective only at the earliest stages of the disease, and arthroscopic sanitation of small joints of the hand is very difficult, so open sanitation of the joint is the most frequently performed surgical intervention[ 4 , 42 ].…”