scholarly journals Acute Septic Arthritis

2002 ◽  
Vol 15 (4) ◽  
pp. 527-544 ◽  
Author(s):  
Mark E. Shirtliff ◽  
Jon T. Mader
Keyword(s):  
Septic Arthritis ◽  
Antimicrobial Therapy ◽  
Bacterial Species ◽  
Good Prognosis ◽  
Medical Emergency ◽  
Laboratory Findings ◽  
Mortality And Morbidity ◽  
Joint Infections ◽  
Prosthetic Joint Infections ◽  
Focus Of Infection

SUMMARY Acute septic arthritis may develop as a result of hematogenous seeding, direct introduction, or extension from a contiguous focus of infection. The pathogenesis of acute septic arthritis is multifactorial and depends on the interaction of the host immune response and the adherence factors, toxins, and immunoavoidance strategies of the invading pathogen. Neisseria gonorrhoeae and Staphylococcus aureus are used in discussing the host-pathogen interaction in the pathogenesis of acute septic arthritis. While diagnosis rests on isolation of the bacterial species from synovial fluid samples, patient history, clinical presentation, laboratory findings, and imaging studies are also important. Acute nongonococcal septic arthritis is a medical emergency that can lead to significant morbidity and mortality. Therefore, prompt recognition, rapid and aggressive antimicrobial therapy, and surgical treatment are critical to ensuring a good prognosis. Even with prompt diagnosis and treatment, high mortality and morbidity rates still occur. In contrast, gonococcal arthritis is often successfully treated with antimicrobial therapy alone and demonstrates a very low rate of complications and an excellent prognosis for full return of normal joint function. In the case of prosthetic joint infections, the hardware must be eventually removed by a two-stage revision in order to cure the infection.

scholarly journals Novel therapeutic interventions towards improved management of septic arthritis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian Wang ◽  
Liucai Wang
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Clinical Success ◽  
Treatment Protocol ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Medical Emergency ◽  
Success Rates ◽  
Joint Infections ◽  
Novel Therapeutic

AbstractSeptic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

Rare case of Ureaplasma parvum septic arthritis in an immunocompetent patient

2020 ◽  
Vol 13 (9) ◽  
pp. e236396
Author(s):  
Abuzar Ali Asif ◽  
Moni Roy ◽  
Sharjeel Ahmad
Keyword(s):  
Septic Arthritis ◽  
Rare Case ◽  
Immunocompetent Patient ◽  
Next Generation ◽  
Ureaplasma Parvum ◽  
Urogenital Infections ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Diagnostic Modalities

Mycoplasmatacea family comprises two genera: Mycoplasma and Ureaplasma. Ureaplasma parvum (previously known as U. urealyticum biovar 1) commonly colonises the urogenital tract in humans. Although Ureaplasma species have well-established pathogenicity in urogenital infections, its involvement in septic arthritis has been limited to prosthetic joint infections and immunocompromised individuals. We present a rare case of native right knee infection due to U. parvum identified using next-generation sequencing of microbial cell-free DNA testing and confirmed with PCR assays. This rare case of Ureaplasma septic arthritis was diagnosed using newer next-generation DNA sequencing diagnostic modalities and a literature review of prior cases, antibiotic coverage and antimicrobial resistance is incorporated as part of the discussion.

Septic arthritis in adults

2013 ◽  
Author(s):  
Laura McGregor ◽  
Monica N. Gupta ◽  
Max Field
Keyword(s):  
Septic Arthritis ◽  
Inflammatory Responses ◽  
Joint Disease ◽  
Medical Emergency ◽  
British Society ◽  
Future Research ◽  
Mortality And Morbidity ◽  
Medical Disorders ◽  
Sources Of Infection ◽  
Joint Prostheses

Septic arthritis (SA) is a medical emergency with mortality of around 15%. Presentation is usually monoarticular but in more than 10% SA affects two or more joints. Symptoms include rapid-onset joint inflammation with systemic inflammatory responses but fever and leucocytosis may be absent at presentation. Treatment according to British Society of Rheumatology/British Orthopaedic Association (BSR/BOA) guidelines should be commenced if there is a suspicion of SA. At-risk patients include those with primary joint disease, previous SA, recent intra-articular surgery, exogenous sources of infection (leg ulceration, respiratory and urinary tract), and immunosupression because of medical disorders, intravenous drug use or therapy including tumour necrosis factor (TNF) inhibitors. Synovial fluid should be examined for organisms and crystals with repeat aspiration as required. Most SA results from haematogenous spread-sources of infection should be sought and blood and appropriate cultures taken prior to antibiotic treatment. Causative organisms include staphylococcus (including meticillin-resistant Staphylococcus aureus, MRSA), streptococcus, and Gram-negative organisms (in elderly patients), but no organism is identified in 43%, often after antibiotic use before diagnosis. Antibiotics should be prescribed according to local protocols, but BSR/BOA guidelines suggest initial intravenous and subsequent oral therapy. Medical treatment may be as effective as surgical in uncomplicated native SA, and can be cost-effective, but orthopaedic advice should be sought if necessary and always in cases of infected joint prostheses. In addition to high mortality, around 40% of survivors following SA develop limitation of joint function. Guidelines provide physicians with treatment advice aiming to limit mortality and morbidity and assist future research.

scholarly journals The difference between native septic arthritis and prosthetic joint infections: A review of literature

2019 ◽  
Vol 27 (2) ◽  
pp. 230949901986046 ◽  
Author(s):  
Ramon Lucas Roerdink ◽  
Henricus Johannus Theodorus Antoniu Huijbregts ◽  
Antoine Willy Tonny van Lieshout ◽  
Martijn Dietvorst ◽  
Babette Corine van der Zwaard
Keyword(s):  
Septic Arthritis ◽  
Current Literature ◽  
Treatment Strategies ◽  
Review Of Literature ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Difference

Current literature occasionally considers septic arthritis in native joints and prosthetic joint infections as equal pathologies. However, significant differences can be identified. The aim of this review of literature is to describe these differences in definitions, pathology, diagnostic workups, treatment strategies, and prognosis.

scholarly journals Predictors of Treatment Failure for Hip and Knee Prosthetic Joint Infections in the Setting of 1- and 2-Stage Exchange Arthroplasty: A Multicenter Retrospective Cohort

2019 ◽  
Vol 6 (11) ◽  
Author(s):  
Christopher E Kandel ◽  
Richard Jenkinson ◽  
Nick Daneman ◽  
David Backstein ◽  
Bettina E Hansen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Retrospective Cohort ◽  
Proportional Hazards Model ◽  
Bacterial Species ◽  
Cox Proportional Hazards Model ◽  
Joint Infections ◽  
Prosthesis Retention ◽  
Prosthetic Joint Infections ◽  
Prosthesis Removal

AbstractBackgroundProsthetic hip and knee joint infections (PJIs) are challenging to eradicate despite prosthesis removal and antibiotic therapy. There is a need to understand risk factors for PJI treatment failure in the setting of prosthesis removal.MethodsA retrospective cohort of individuals who underwent prosthesis removal for a PJI at 5 hospitals in Toronto, Canada, from 2010 to 2014 was created. Treatment failure was defined as recurrent PJI, amputation, death, or chronic antibiotic suppression. Potential risk factors for treatment failure were abstracted by chart review and assessed using a Cox proportional hazards model.ResultsA total of 533 individuals with prosthesis removal were followed for a median (interquartile range) of 814 (235–1530) days. A 1-stage exchange was performed in 19% (103/533), whereas a 2-stage procedure was completed in 88% (377/430). Treatment failure occurred in 24.8% (132/533) at 2 years; 53% (56/105) of recurrent PJIs were caused by a different bacterial species. At 4 years, treatment failure occurred in 36% of 1-stage and 32% of 2-stage procedures (P = .06). Characteristics associated with treatment failure included liver disease (adjusted hazard ratio [aHR], 3.12; 95% confidence interval [CI], 2.09–4.66), the presence of a sinus tract (aHR, 1.53; 95% CI, 1.12–2.10), preceding debridement with prosthesis retention (aHR, 1.68; 95% CI, 1.13–2.51), a 1-stage procedure (aHR, 1.72; 95% CI, 1.28–2.32), and infection due to Gram-negative bacilli (aHR, 1.35; 95% CI, 1.04–1.76).ConclusionsFailure of PJI therapy is common, and risk factors are not easily modified. Improvements in treatment paradigms are needed, along with efforts to reduce orthopedic surgical site infections.

Epidemiology, Management, and Outcomes of Large and Small Native Joint Septic Arthritis in Adults

2019 ◽  
Vol 70 (2) ◽  
pp. 271-279 ◽  
Author(s):  
Stephen McBride ◽  
Jessica Mowbray ◽  
William Caughey ◽  
Edbert Wong ◽  
Christopher Luey ◽  
...  
Keyword(s):  
Treatment Failure ◽  
Septic Arthritis ◽  
Surgical Procedures ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Total Incidence ◽  
Large Joint ◽  
Prosthetic Joint Infections ◽  
Small Joint ◽  
Antibiotic Duration

Abstract Background Native joint septic arthritis (NJSA) is poorly studied. We describe the epidemiology, treatment, and outcomes of large joint NJSA (LNJSA) and small joint NJSA (SNJSA) in adults at Middlemore Hospital, Auckland, New Zealand. Methods This was a coding-based retrospective study of patients ≥16 years old admitted between 2009 and 2014. Prosthetic joint infections were excluded. Results Five hundred forty-three NJSA episodes were included (302 LNJSA, 250 SNJSA). Only 40% had positive synovial fluid culture. Compared to SNJSA, LNJSA has higher incidence (13 vs 8/100 000 person-years [PY]), occurs in older, more comorbid patients, and is associated with greater rates of treatment failure (23% vs 12%) and mortality, despite longer antibiotic treatment. Total incidence is higher than previously reported (21/100 000 PY), with marked interethnic variation. Incidence rises with age (LNJSA only) and socioeconomic deprivation (LNJSA and SNJSA). Tobacco smokers and males are overrepresented. The most commonly involved joints were knee (21%) and hand interphalangeal (20%). Staphylococcus aureus was the most common pathogen (53%). Mean antibiotic duration was 25 days for SNJSA and 40 days for LNJSA, and the mean number of surgical procedures was 1.5 and 1.6, respectively. Treatment failure was independently associated with LNJSA, age, intra-articular nonarthroplasty prosthesis, and number of surgical procedures. Conclusions This is the largest contemporary series of adult NJSA. SNJSA has better outcomes than LNJSA and may be able to be safely treated with shorter antimicrobial courses. Incidence is high, with significant ethnic and socioeconomic variation. Microbiological NJSA case ascertainment underestimates case numbers as it frequently excludes SNJSA.

scholarly journals A Real Pain: Diagnostic Quandaries and Septic Arthritis

2017 ◽  
Vol 56 (2) ◽  
Author(s):  
Cristina Costales ◽  
Susan M. Butler-Wu
Keyword(s):  
Septic Arthritis ◽  
Laboratory Tests ◽  
Joint Infection ◽  
Rapid Diagnosis ◽  
Accurate Diagnosis ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Many ◽  
Future Utility

ABSTRACT Rapid diagnosis and treatment of an infected joint are paramount in preserving orthopedic function. Here, we present a brief review of the many challenges associated with the diagnosis of both septic arthritis and prosthetic joint infections. We also discuss the many laboratory tests currently available to aid in the accurate diagnosis of joint infection, as well as emerging diagnostics that may have future utility in the diagnosis of these challenging clinical entities.

scholarly journals Cutibacterium acnes Septic Arthritis of the Nonoperated Knee: A Case Report

2017 ◽  
Vol 03 (03) ◽  
pp. e107-e109 ◽  
Author(s):  
Kelechi Okoroha ◽  
Michael Gabbard ◽  
Jamal Fitts ◽  
Trevor Banka
Keyword(s):  
Septic Arthritis ◽  
Clinical Judgment ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Cutibacterium Acnes ◽  
Antibiotic Management ◽  
Uncommon Case ◽  
Selection For ◽  
Septic Knee Arthritis

Abstract Cutibacterium (Propionibacterium) acnes, a gram-positive bacillus with low pathogenicity, is an uncommon but known cause of prosthetic joint infections, particularly related to shoulder surgery. C. acnes, however, is an extremely rare pathogen in the nonoperated knee joint. This report details an uncommon case of C. acnes septic knee arthritis after multiple intra-articular steroid injections in a 56-year-old male patient. After an indolent presentation and late diagnosis, the patient underwent surgical debridement with IV antibiotic management. This case illustrates that intra-articular corticosteroid injections for the management of osteoarthritis are not without risk. Literature supporting their use remains limited and clinicians should use proficient clinical judgment for appropriate patient selection for these injections. Vigilance following injections or aspirations of the knee should be maintained to identify the indolent clinical presentation of C. acnes septic arthritis.

scholarly journals A Case of a Late and Atypical Knee Prosthetic Infection by No-Biofilm Producer Pasteurella multocida Strain Identified by Pyrosequencing

2013 ◽  
Vol 62 (4) ◽  
pp. 435-438 ◽  
Author(s):  
CARLO L. Romanò ◽  
ELENA DE VECCHI ◽  
CHRISTIAN VASSENA ◽  
GIOVANNI MANZI ◽  
LORENZO DRAGO
Keyword(s):  
Total Knee Arthroplasty ◽  
Knee Arthroplasty ◽  
Inflammatory Markers ◽  
Pasteurella Multocida ◽  
Prosthetic Infection ◽  
Laboratory Findings ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Total Knee

Prosthetic joint infections due to Pasteurella multocida are rarely but increasingly reported but no data on production of biofilm are available. We report the case of a woman with a late, haematogenous peri-prosthetic infection of cemented total knee arthroplasty caused by a strain of P. multocida identified by pyrosequencing and unable to produce biofilm. Comparison of clinical and laboratory findings with those reported in other patients evidenced differences mainly in the period of symptoms' onset and in the behaviour of some inflammatory markers.

scholarly journals 401. Predictors of Treatment Failure for Hip and Knee Prosthetic Joint Infections in the Setting of Prosthesis Removal: A Multi-Center Retrospective Cohort

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S205-S205
Author(s):  
Christopher Kandel ◽  
Richard Jenkinson ◽  
Nick Daneman ◽  
David Backstein ◽  
Matthew P Muller ◽  
...  
Keyword(s):  
Risk Factors ◽  
Treatment Failure ◽  
Retrospective Cohort ◽  
Bacterial Species ◽  
Musculoskeletal Infection ◽  
Joint Infections ◽  
Prosthesis Retention ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Prosthesis Removal

Abstract Background Prosthetic hip and knee joint infections (PJIs) are challenging to eradicate despite prosthesis removal and long courses of antibiotics. We aimed to describe the risk factors for PJI treatment failure in a multicenter retrospective cohort. Methods A retrospective cohort of individuals who underwent prosthetic joint removal for a PJI at one of five hospitals in Toronto, Ontario, Canada from 2010–2014. Individuals eligible for the cohort were obtained by searching operative listings and PJIs were defined according to the criteria of the Musculoskeletal Infection Society. Treatment failure was defined as recurrent PJI, amputation, death or chronic antibiotic suppression. Potential risk factors for treatment failure were abstracted by chart review and assessed using a Cox proportional hazards model. Results 533 PJIs were analyzed over a median follow-up duration of 1102 days with 21 surgeons performing more than 5 revision arthroplasties for a PJI. Two-stage procedures were performed in 81% (430/533) and the most common organism was coagulase negative staphylococci (32%). Treatment failure occurred in 28% (150/533) over 1443 patient-years and was caused by a different bacterial species in 53% (56/105). On multivariate analysis the characteristics associated with PJI treatment failure included liver disease (adjusted hazard ratio (aHR) 3.12, 95% confidence interval (95% CI) 2.09–4.66), the presence of a sinus tract (aHR 1.53, 94% CI (1.12–2.10), preceding debridement with prosthesis retention (aHR 1.68, 95% CI 1.13–2.51), a one-stage procedure (aHR 1.72, 95% CI (1.28–2.32), and infection due to Gram-negative bacilli (aHR 1.35, 95% CI 1.04–1.76). Conclusion PJI treatment failure remains high despite prosthesis removal and the patient risk factors identified are non-modifiable. Novel treatment paradigms are urgently needed along with efforts to reduce orthopedic surgical site infections. Disclosures All authors: No reported disclosures.

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