What are we doing about septic arthritis? A survey of UK-based rheumatologists and orthopedic surgeons

Abstract

This study aims to determine the current practices and beliefs of United Kingdom (UK)-based rheumatologists and orthopedic surgeons (OS) in managing septic arthritis (SA) and to determine awareness levels of national guidance. Two-hundred OS and 200 rheumatologists were sent a link to a web-based survey tool via email. Questions posed related to the management of SA, including the respondent's views on antibiotic therapy, joint drainage, which specialty should manage these cases, and also the clinician's evidence base. There were 354 functioning addresses with 182 responses (51%). One hundred fifty-one (77 OS, 74 rheumatologists) (43%) responses were complete and included for analysis. Eighty percent of rheumatologists and 82% of OS recommended 6-weeks total antibiotic therapy. Seventy-three percent in each group recommended 1-2 weeks intravenous therapy initially followed by oral continuation therapy. In patients at risk of methicillin-resistant Staphylococcus aureus (MRSA), 25% rheumatologists and 14% OS would ensure MRSA cover. Seventy-seven percent of rheumatologists and 66% of OS recommended surgical joint drainage; 22% and 27%, respectively, recommended repeated closed needle aspiration as their chosen method of joint drainage. Sixty-six percent of rheumatologists and 65% of OS believed OS should manage SA. Twenty-three percent of rheumatologists and 22% of OS quoted published guidance as their main evidence base in the treatment of SA. Only 24% of rheumatologists and 34% of OS quoted British Society of Rheumatology (BSR) guidance when asked if they were aware of any guidelines. Views of rheumatologists and OS are not that dissimilar in managing SA. Surprisingly, rheumatologists are more aggressive regarding the recommendation for surgical joint drainage. Within both groups, significant variation in management principles exists often discrepant to recommendations laid out by the BSR. There are poor awareness levels of the BSR guidelines.

Clinical Improvement after Surgical Debridement and Synovectomy on 4 Year Old Girl with Chronic Septic Arthritis of the Hip

“…A systematic review and metaanalysis showed no difference in clinical and bacteriological effects between one antibiotic regimen and another (Bureau et al, 1999;Ravindran et al, 2009;Sammer and Shin, 2009). The choice of empirical antibiotics depends on the clinical picture, patient risk factors, and germ prevalence patterns (Butt et al, 2011;Sammer & Shin, 2009;Shirtliff and Mader, 2002). In patients at high risk of sexually transmitted diseases and staining of aspirate joints showing negative ram, ceftriaxone can be combined with azithromycin or doxycycline for eradication of Gonococcus and Chlamydia infections.…”

“…In patients at high risk of sexually transmitted diseases and staining of aspirate joints showing negative ram, ceftriaxone can be combined with azithromycin or doxycycline for eradication of Gonococcus and Chlamydia infections. If the patient is not clear of a high risk of sexually transmitted diseases or negative ram, ceftriaxone can be combined with vancomycin (Butt et al, 2011;Sammer & Shin, 2009).…”

Streptococcus gordonii septic arthritis : two cases and review of literature

“…There is controversy over which mode of drainage should be used. Recently, Butt et al found that 77% of rheumatologists and 66% of orthopaedic surgeons (OS) in the UK recommended surgical joint drainage; 22% and 27%, respectively, recommended repeated closed needle aspiration as their chosen method of joint drainage [35]. However, Ravindran et al, in a recent study comparing medical treatment (serial closed-needle aspiration) and surgical treatment (arthroscopy/arthrotomy combined with joint washout), showed that for native joint SA, surgical treatment was not superior to medical treatment and, therefore, highlighted the need for careful case selection for surgical intervention [36].…”

Advances in the management of bacterial septic arthritis

“…22% of rheumatologists and 27% of orthopedic surgeons would prefer closed-needle aspiration. Only a minority of doctors would prefer an open joint washout [43]. In reality, so far, there is no randomized controlled trial with results that can identify which method is superior [45].…”

“…However, only 7% of rheumatologists and 4% of orthopedic surgeons would continue antibiotics until inflammatory markers normalized [43].…”