The Management of Patients with Acute Septic Arthritis: An Epidemiological Study

Yıl 2023, Cilt: 13 Sayı: 2, 165 - 171, 10.05.2023

Özlem Aydın , Aykut Çelik , Erhan Okay , Pinar Ergen , Korhan Özkan

https://doi.org/10.33631/sabd.1180680

Cited By: 1

Öz

Aim: The aim of this study is to evaluate the causative agents, diagnosis, treatment, and outcomes of acute septic arthritis cases.
Material and Methods: In this retrospective, single-center study, patients over 18 years of age diagnosed with acute septic arthritis were searched from the hospital database between January 2015 and April 2021. Demographic characteristics, diagnostic procedures, therapeutic management, and outcomes were recorded.
Results: A total of 59 patients and 60 septic joints were included in the study. The causative microorganisms were isolated in 52.54% of the cases. Staphylococcus aureus grew in 70.96% of the cases and among these, 31.82% were methicillin-resistant. The most frequently affected body part was the knee (73.33%). The cases were found to have fever at a rate of 42.37%. Diabetes was the most common comorbidity (30.51%), and immunosuppression was found in 39% of the cases. Arthrotomy was the most commonly used surgical method for the management of septic arthritis (43.55%). The mortality rate was 6.78%. The cases were categorized as groups with and without microorganisms isolated in culture. When these two groups were compared, no statistically significant difference was found except for the duration of hospitalization (p=0.001).
Conclusion: Septic arthritis should be considered in the differential diagnoses of a warm and swollen single joint, especially in the presence of risk factors, until it is excluded. Knowledge of regional epidemiological data is essential in planning treatment approaches.

Anahtar Kelimeler

risk factors, septic arthritis, Staphylococcus aureus, treatment

Akut Septik Artritli Hastaların Yönetimi: Epidemiyolojik Bir Çalışma

Öz

Amaç: Bu çalışmada akut bakteriyel septik artrit vakalarında etken, tanı ve tedavi sonuçlarını irdelenmesi amaçlandı.
Gereç ve Yöntemler: Bu retrospektif, tek merkezli yürütülen çalışmada, Ocak 2015 ile Nisan 2021 tarihleri arasında, akut septik artrit tanısı ile izlenen 18 yaş ve üzerindeki hastalar, hastane veri tabanından taranarak belirlendi. Bu hastaların demografik özellikleri, tanı konulma prosedürleri, tedavi yönetimi ve sonuçları dosyalara kaydedildi.
Bulgular: Çalışmaya toplam 59 hasta, 60 eklem septik artriti dahil edildi. Olguların %52,54’ünde etken mikroorganizma izole edildi. Vakaların %70,96’sında Staphylococcus aureus üredi ve bunların %31,82’i methisilline dirençli idi. En fazla tutulan eklem, diz eklemi olarak saptandı (%73,33). Olguların %42,37’sinde ateş yüksekliği tespit edildi. Komorbiditeler arasında en sık diyabet yer almakta olup (%30,51), olguların %39'unda immun supresyona yol açacak bir neden saptandı. Septik artrit tedavi yönetiminde en sık kullanılan cerrahi yöntem artrotomi idi (%43,55). Tedavi sonuçları değerlendirildiğinde ölüm oranı %6,78 olarak tespit edildi. Olgular kültürde mikroorganizma izole edilen ve edilmeyen grup olarak kategorize edildi. Bu iki grup karşılaştırıldığında hastanede yatış süreleri dışında istatistiksel olarak anlamlı bir fark saptanmadı (p=0,001).
Sonuç: Sadece bir eklemde ısı artışı ve şişlik olması durumunda, özellikle risk faktörleri varlığında, ayırıcı tanıda aksi kanıtlanana kadar septik artrit tanısı öncelikle yer almalıdır. Tedavi yaklaşımlarının planlanmasında, bölgesel epidemiyolojik verilerin bilgisi esastır.

Anahtar Kelimeler

risk faktörleri, septik artrit, Staphylococcus aureus, tedavi

Kaynakça

• Elsissy JG, Liu JN, Wilton PJ, Nwachuku I, Gowd AK, Amin NH. Bacterial septic arthritis of the adult native knee joint: A review. JBJS Rev. 2020; 8(1): e0059. https://doi.org 10.2106/JBJS.RVW.19.00059.
• Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet. 2010; 375(9717): 846-55. https://doi.org/10.1016/S0140-6736(09)61595-6.
• Garcia-Arias M, Balsa A, Mola EM. Septic arthritis. Best Pract Res Clin Rheumatol. 2011; 25(3): 407-21. https://doi.org/10.1016/j.berh.2011.02.001.
• Hassan AS, Rao A, Manadan AM, Block JA. Peripheral Bacterial Septic Arthritis: Review of Diagnosis and Management. J Clin Rheumatol. 2017; 23(8):435-42. https://doi.org/10.1097/RHU.0000000000000588.
• Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D, et al. BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford). 2006; 45(8): 1039-41. https://doi.org/10.1093/rheumatology/kel163a.
• Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis. 1999; 58(4): 214-9. https://doi.org/10.1136/ard.58.4.214.
• Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997; 56(8): 470-5. https://doi.org/10.1136/ard.56.8.470.
• Margaretten ME, Kohlwes J, Moore D, Bent S. Does this adult patient have septic arthritis? JAMA. 2007; 297(13): 1478-88. https://doi.org/10.1001/jama.297.13.1478.
• Goldenberg DL. Septic arthritis. Lancet. 1998; 351(9097): 197-202. https://doi.org/10.1016/S0140-6736(97)09522-6.
• D'Angelo F, Monestier L, Zagra L. Active septic arthritis of the hip in adults: what's new in the treatment? A systematic review. EFORT Open Rev. 2021; 6(3): 164-72. https://doi.org/10.1302/2058-5241.6.200082.
• Newman JH. Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis. 1976; 35(3): 198-205. https://doi.org/10.1136/ard.35.3.198.
• Madruga Dias J, Costa MM, Pereira da Silva JA, Viana de Queiroz M. Septic arthritis: patients with or without isolated infectious agents have similar characteristics. Infection. 2014; 42(2): 385-91. https://doi.org/10.1007/s15010-013-0567-z.
• Helito CP, Teixeira PR, Oliveira PR, Carvalho VC, Pecora JR, Camanho GL, et al. Septic arthritis of the knee: clinical and laboratory comparison of groups with different etiologies. Clinics (Sao Paulo). 2016; 71(12): 715-9. https://doi.org/10.6061/clinics/2016(12)07.
• Eberst-Ledoux J, Tournadre A, Mathieu S, Mrozek N, Soubrier M, Dubost JJ. Septic arthritis with negative bacteriological findings in adult native joints: a retrospective study of 74 cases. Joint Bone Spine. 2012; 79(2): 156-9. https://doi.org/10.1016/j.jbspin.2011.04.019.
• Westerling R, Daryani A, Gershuni O, Czabanowska K, Brand H, Erdsieket F, et al. Promoting rational antibiotic use in Turkey and among Turkish migrants in Europe- implications of a qualitative study in four countries. Global Health. 2020; 16(1): 108. https://doi.org/10.1186/s12992-020-00637-5.
• Earwood JS, Walker TR, Sue GJC. Septic arthritis: Diagnosis and treatment. Am Fam Physician. 2021; 104(6): 589-97.
• Long B, Koyfman A, Gottlieb M. Evaluation and management of septic arthritis and its mimics in the emergency department. West J Emerg Med. 2019; 20(2): 331-41. https://doi.org/10.5811/westjem.2018.10.40974.
• George J, Chandy VJ, Premnath J, Hariharan TD, Oommen AT, Balaji V, et al. Microbiological profile of septic arthritis in adults: Lessons learnt and treatment strategies. Indian J Med Microbiol. 2019; 37(1): 29-33. https://doi.org/10.4103/ijmm.IJMM_19_134.
• Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). 2001; 40(1): 24-30. https://doi.org/ 10.1093/rheumatology/40.1.24.
• Helito CP, Noffs GG, Pecora JR, Gobbi RG, Tirico LE, Lima AL, et al. Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo. Braz J Infect Dis. 2014; 18(1): 28-33. https://doi.org/ 10.1016/j.bjid.2013.04.010.
• Li SF, Henderson J, Dickman E, Darzynkiewicz R. Laboratory tests in adults with monoarticular arthritis: can they rule out a septic joint? Acad Emerg Med. 2004 ;11(3): 276-80. https://doi.org/ 10.1111/j.1553-2712.2004.tb02209.x.
• Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med. 2011; 18(8): 781-96. https://doi.org/10.1111/j.1553-2712.2011.01121.x.
• Colston J, Atkins B. Bone and joint infection. Clin Med (Lond). 2018; 18(2): 150-4. https://doi.org/10.7861/clinmedicine.18-2-150.
• Munoz-Egea MC, Blanco A, Fernandez-Roblas R, Gadea I, Garcia-Canete J, Sandoval E, et al. Clinical and microbiological characteristics of patients with septic arthritis: A hospital-based study. J Orthop. 2014; 11(2): 87-90. https://doi.org/10.1016/j.jor.2014.04.002.
• Clerc O, Prod'hom G, Greub G, Zanetti G, Senn L. Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy. J Antimicrob Chemother. 2011; 66(5): 1168-73. https://doi.org/10.1093/jac/dkr047.
• Lotz H, Strahm C, Zdravkovic V, Jost B, Albrich WC. Septic arthritis due to streptococci and enterococci in native joints: a 13year retrospective study. Infection. 2019; 47(5): 761-70. https://doi.org/ 10.1007/s15010-019-01301-w.
• Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA. Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum. 1995; 38(12): 1819-25. https://doi.org/ 10.1002/art.1780381215.
• Sharff KA, Richards EP, Townes JM. Clinical management of septic arthritis. Curr Rheumatol Rep. 2013; 15(6): 332. https://doi.org/10.1007/s11926-013-0332-4.
• Peres LR, Marchitto RO, Pereira GS, Yoshino FS, de Castro Fernandes M, Matsumoto MH. Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc. 2016; 24(10): 3155-62. https://doi.org/10.1007/s00167-015-3918-8.
• Aim F, Delambre J, Bauer T, Hardy P. Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthop Traumatol Surg Res. 2015; 101(1): 61-4. https://doi.org/10.1016/j.otsr.2014.11.010.