Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis

Gupta, Monica; Sturrock, R D; Field, Max

doi:10.1136/ard.62.4.327

Cited by 134 publications

(101 citation statements)

References 25 publications

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“…In our patient population less than half of the patients with septic ankle arthritis had an elevated WBC on admission. The elevation of nonspecific markers of inflammation such as ESR and CRP has been associated with septic arthritis [2,4,5]. Our data support these notions, because every patient in our study had an elevated ESR and CRP levels on admission.…”

Section: Discussionsupporting

confidence: 80%

“…Our data support these notions, because every patient in our study had an elevated ESR and CRP levels on admission. Staphylococci and streptococci are the most common causative organisms of septic arthritis [1,2,4,5]. In 2000, Lee et al [8] reported, among a cohort of 29 adults and children diagnosed with septic ankles, S. aureus was the most common offending organism.…”

Section: Discussionmentioning

confidence: 99%

“…Synovial fluid analysis for cell count, Gram stain, and culture is the fundamental diagnostic tool for septic arthritis [15]. Staphylococci and streptococci are identified in the literature as the offending organisms in the majority of joint infections [1,2,4,5,8]. However, most of the studies report primarily patients with knee and hip infection and include only a small number of patients with ankle or other joint infection [4,12].…”

Section: Introductionmentioning

confidence: 99%

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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: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hematogenous Septic Ankle Arthritis

Holtom

Borges

Zalavras

2008

Clinical Orthopaedics &Amp; Related Research

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“…The above findings raise the spectre of a group of patients with suspected septic arthritis but culture-negative synovial fluid. Gupta et al in their prospective study comparing patients with culturenegative septic arthritis to patients with culture-proven septic arthritis found that the demographics, clinical examination, laboratory parameters, complications rates and the use of supportive measures were similar in the two groups [17].…”

Section: Discussionmentioning

confidence: 99%

Role of Newman’s classification in predicting outcomes in patients with crystal arthritis

Hujazi

Ambler

Arora

et al. 2012

International Orthopaedics (SICOT)

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Purpose The aim of the study was to evaluate the utility of Newman's classification in predicting outcomes in patients presenting with crystal arthritis. Methods Between January and December 2009, all patients who presented to our institution with acute crystal arthritis and were investigated with microbiological assessment of their synovial fluid were included in the study. Patients were divided into two groups depending on the fulfilment of Newman's criteria for culture-negative septic arthritis. Group 1 included patients that fulfilled Newman's B criteria. Group 2 included patients that fulfilled Newman's C criteria. A database looking at the demographics, mode of presentation, investigations, treatment and outcomes was then established and the results compared between the two groups. Results A total of 58 patients were identified (group 1: n0 13; group 2: n045). The average age was 71 years (range 33-96). The joint most commonly involved was the knee followed by the wrist. Clinical findings at presentation were comparable in both groups; however, WBC and C-reactive protein (CRP) were more likely to be raised in group 1. Although most patients in group 1 were treated with antibiotics (62%) there was still a higher rate of morbidity, greater use of supportive therapy and a longer hospital stay (22.3 days, SD 17.4) in comparison with group 2, where most patients were treated by observation only (76%, mean hospital stay 3.5 days, SD±4.4). The difference in length of hospital stay was statistically significant (p<0.0001).Conclusions Newman's criteria are a good indicator for prognosis in patients with crystal arthritis. However, the presence of crystals in an acutely inflamed joint does not exclude the need for supportive therapy and long hospital stay even in the absence of positive synovial fluid culture.

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“…A similar frequency (22 of 104, 21%) was shown in a recent study, and the presence of microcrystals did not exclude SA. 13 Finally, the opinion of the clinician who has the basic biological results possibly even the macroscopic appearance of the synovial fluid but not the result of its analysis, is relevant but not consistent; SA was not the most probable diagnosis in 5/38 (13%) of the SA cases. This could be explained by an over-reliance on the diagnostic value of fever and elevated inflammatory markers.…”

Section: Discussionmentioning

confidence: 99%

Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis

Couderc¹,

Pereira²,

Mathieu³

et al. 2015

CJEM

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Objective: To determine the sensitivity and specificity of clinical and laboratory signs for the diagnosis of septic arthritis (SA). Patients and methods: This prospective study included all adult patients with suspected SA seen in the emergency department or rheumatology department at the University Hospital, Clermont-Ferrand, France, over a period of 18 months. Results: In total, 105 patients with suspected SA were included, 38 (36%) presenting with SA (29 [28%] with bacteriologically documented SA). In the univariate analysis, chills (p = 0.015), gradual onset (p = 0.04), local redness (p = 0.01), as well as an entry site for infection (p = 0.01) were most often identified in SA. A history of crystal-induced arthritis (p = 0.004) was more frequent in non-SA cases. An erythrocyte sedimentation rate (ESR) > 50 mm (p = 0.005), a C-reactive protein (CRP) level >100 mg/L (p = 0.019), and radiological signs suggestive of SA (p = 0.001) were more frequent in the SA cases. Synovial fluid appearance: purulent (p < 0.001) and clear (p = 0.007), synovial white blood cell (WBC) count >50,000/μL (p < 0.001), differentiated between SA and non-SA.In multivariate analysis, only chills (odds ration [OR] = 4.7, 95% confidence interval [CI] 1.3-17.1), a history of crystalinduced arthritis (OR = 0.09, 95% CI 0.01-0.9), purulent appearance of the joint fluid (OR = 8.4, 95% CI 2.4-28.5), synovial WBC count >50,000/mm 3 (OR = 6.8, 95% CI 1.3-36), and radiological findings (OR = 7.1, 95% CI 13-37.9) remained significant. Conclusion:No clinical sign or laboratory test (excluding bacteriological test), taken alone, is conclusive for the differentiation between SA and non-SA, but the association of several signs, notably chills, history of crystal-induced arthritis, radiological findings, and the appearance and cellularity of joint fluid may be suggestive.

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Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis

Cited by 134 publications

References 25 publications

Hematogenous Septic Ankle Arthritis

Hematogenous Septic Ankle Arthritis

Role of Newman’s classification in predicting outcomes in patients with crystal arthritis

Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis

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