Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis (original) (raw)
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Evaluation of synovial fluid culture in patients with high suspicion for septic arthritis
2012
Septic arthritis is the infection of joints and delay in treatment may lead to irrecoverable injuries such as joint destruction and dissemination of infection to other organs. The aims of this study were to evaluate synovial fluid cultures in patients with high suspicion for septic arthritis, their clinical and laboratory findings and to determine probable causes of true/false negative cultures. In this cross-sectional study, 25 patients with painful and swollen joint and high clinical suspicion for septic arthritis enrolled the study. Sterile synovial fluid aspiration was performed and specimens were evaluated direct smear for gram staining and 3 different cultures using chocolate agar, Mac-Conkey and blood agar for 24 hours. Blood samples were also obtained for culture. Data were analyzed using SPSS software (version 15). Fever, joint pain, swelling, warmth and tenderness were reported by all patients. Ten patients (40%) suffered from chilling and 24 patients (96%) from restricted...
Rheumatology Advances in Practice
Objective Diagnosing septic arthritis can be challenging and frequently involves clinical assessment, laboratory investigations and synovial fluid analysis. We sought to determine the utility of synovial aspiration and intra-operative synovial fluid and tissue culture for the accurate diagnosis of septic arthritis. Methods We carried out a retrospective review of the records of patients referred to a tertiary orthopaedic unit with possible septic arthritis between 2015 and 2019 inclusive, including clinical and laboratory data for this cohort study. Performance characteristics were determined for synovial aspiration, intra-operative synovial fluid and tissue culture in diagnosing expert review-determined true septic arthritis. Concordance between discharge diagnosis, antibiotic prescribing and true septic arthritis was determined. Results Of 268 patients identified with suspected septic arthritis, 143 underwent both synovial fluid aspiration and intra-operative synovial fluid and ti...
Clinical Rheumatology, 2013
The aim of this retrospective study, was to determine the epidemiological and clinical characteristics, co-existing conditions, causative organisms and outcome of all adult patients 15 years of age or older who had definite septic arthritis seen at Hamad general hospital, Qatar from 2006 to 2011. During this period, 56 patients were diagnosed with septic arthritis with a mean age (±SD) of 49.0 ±16.6 years. In 53/56 (94.6%) patients, arthritis was diagnosed in a single joint while polyarthritis was diagnosed in 3/56 (5.4%) and the commonest joint involved was the knee 40/59 (67.7%). The most frequent coexisting condition was diabetes mellitus 24/56 (42.8%), while joint pain and restriction of movement were reported by all patients. Gram positive bacteria accounted for 36/57 (63.0%) of all isolated microorganisms, and Staphylococcus aureus was the commonest pathogen 20/57 (35.0 %). Three cases of tuberculous arthritis were seen. The most favored antibiotic combinations were cloxacillin/ciprofloxacin; cefazolin/ciprofloxacin and vancomycin/ciprofloxacin. Repeated needle aspirations were used in 18/56 (32.1%) patients and open drainage of the joints was performed on 22/56 (39.3%) patients, while
A prospective 2‐year study of 75 patients with adult‐onset septic arthritis
Rheumatology, 2001
Aims and methods. To assess the clinical features of septic arthritis and characterize therapeutic strategies and outcome in a prospective study of 75 patients selected by positive synovial¯uid culture. Results. Underlying joint disease was present in 46 patients, 25 of whom had rheumatoid arthritis and 15 osteoarthritis. Eleven patients were i.v. drug abusers. Fifty-six per cent of cases involved the knee, 15% involved two or more joints, and staphylococci and streptococci were cultured in > 90%. Seventy-eight per cent of patients lived in areas of high social deprivation. Fever was present in 64% and the white cell count (WCC) was normal in 38%. The C-reactive protein was elevated in 98%. Leg ulcers were present in 11% of all patients but in 38% of patients who died (P-0.006). Median duration of antibiotic therapy was 15 days i.v. with subsequent oral treatment for 21 days. Thirty-seven per cent of cases required surgical intervention. Mortality was 11%. A raised WCC at presentation (P-0.02) and the development of abnormal renal function (P-0.015) were predictors of poor prognosis.
Clinical and laboratory characteristics in septic arthritis patients with and without isolated germs
The Egyptian Rheumatologist, 2018
Background: The management of septic arthritis without bacteriological evidence is not well codified. Aim of the work: To compare the features of septic arthritis with and without isolated germs. Patients and Methods: This is a retrospective study including all patients with septic arthritis, discharged from the Rheumatology Department of Charles Nicolle Hospital, Tunisia over a period of 17 years [1998-2014]. The epidemiological and clinical data were evaluated. Patients were grouped according to the presence and absence of isolated germs. Results: Fifty-nine septic arthritis patients were collected with an average of 3.5 cases/year. The mean age of the patients was 54.6 ± 19 years [15-95] without sex predominance: 28 were male and 31 were female. At least one risk factor for SA was founded in 41 patients (69.5%). It was monoarticular in 50 cases (84.7%), oligoarticular in 6 (10.2%) and polyarticular in 3 (5.1%). The knee was the most often affected (49.2%). Germ was isolated in cultures and/or synovial fluids in 27 patients (45.8%). The age tended to be older in those with isolated germs and the elderly were more frequently infected compared to the non-elderly (51.8% versus 21.9%) (p = .01). The synovial fluid analysis, clinical and laboratory characteristics were comparable but the functional disability was significant higher in those without isolated germs (p = .024). Sternoclavicular joint was more common in patients with isolated germs (p = .016). There was no difference between the two groups regarding the course of the infection. Conclusion: Patients with isolated and non-isolated germs have similar epidemiologic, clinical, biological and radiological characteristics.
Journal of clinical microbiology, 1997
Synovial fluid specimens obtained from patients with arthritis were plated onto solid media (conventional cultures) or inoculated into an Isolator 1.5 microbial tube (Isolator cultures), and the yield and time to detection of organisms were compared. Overall, 144 specimens obtained from 137 patients were processed, and 31 (21.5%) cultures obtained from 29 patients were positive by at least one method. Staphylococcus aureus was isolated from 12 patients, Streptococcus pneumoniae and Kingella kingae were isolated from 4 patients each, group G streptococci were isolated from 3 patients, Staphylococcus epidermidis and members of the family Enterobacteriaceae were isolated from 2 patients each, and Streptococcus mitis and Peptostreptococcus prevotii were isolated from 1 patient each. Overall, the causative organism was detected in 31 of 31 (100.0%) Isolator cultures and 24 of 31 (77.4%) conventional cultures (P < 0.02). Twenty-nine of 31 (93.5%) positive Isolator cultures and 20 of 24...
Septic arthritis of the knee: clinical and laboratory comparison of groups with different etiologies
Clinics (Sao Paulo, Brazil), 2016
To clinically and epidemiologically characterize a population diagnosed with and treated for septic arthritis of the knee, to evaluate the treatment results and to analyze the differences between patients with positive and negative culture results, patients with Gram-positive and Gram-negative bacterial isolates and patients with S. aureus- and non-S. aureus-related infections. One hundred and five patients with septic knee arthritis were included in this study. The clinical and epidemiological data were evaluated. Statistical analysis was performed to compare patients with and without an isolated causative agent, patients with Gram-positive and Gram-negative pathogens and patients with S. aureus-related and non S. aureus-related infections. Causative agents were isolated in 81 patients. Gram-positive bacteria were isolated in 65 patients and Gram-negative bacteria were isolated in 16 patients. The most commonly isolated bacterium was S. aureus. Comparing cases with an isolated path...
Open Journal of Orthopedics, 2015
Introduction & aims: Septic arthritis is an emergency, potentially causing irreversible joint destruction and disability. Synovial WCC and polymorphonuclear cell percentage are the best predictors of septic arthritis likelihood. Yet, synovial white cell and differential count are not routinely assessed. We aim to investigate the incidence of failure to perform these tests, and to develop correct synovial fluid analysis practices. Method: This is a retrospective analysis of native joints having undergone arthrocentesis for suspicion of septic arthritis at Box Hill Hospital (BHH) during September 2011 and September 2013 inclusive. Recruitment was from the Eastern Health Decision Support Service (DSS), a database compiled from all systems within Eastern Health, of which BHH is a member. The study was limited to large joints, including hip, knee and shoulder. All prosthetic joints were excluded from the patient population. All patient histories were examined for suspicion of septic arthritis and subsequent arthrocentesis. Pathology records were accessed to determine incidence of cell count and differential. Results: One hundred and thirty-six cases of joint aspirations were identified within the time frame, of which sixty-seven fitted our criteria for evaluation. All but two cases were delivered using the DSS, which was limited to data compiled only until June 2013. The two remaining cases were identified with a manual search of the radiology and pathology databases from June to September 2013. 22 of the 67 joint aspirates studied did not have a cell count carried out. Four of these 22 cases had a diagnosis of septic arthritis. In five aspirates, there was a failure to confirm a definite diagnosis and they were thus conservatively treated as a septic joint. The remaining acute joints in which no cell count was done were gout (7 cases), pseudogout (5 cases) and rheumatoid arthritis (1 case). Cell counts were not routinely detected for a variety of reasons. Eleven aspirates were deemed too viscous, and in eight cases the sample had clotted prior to pathologist assessment. Two cases had insufficient volume, and one sample was too bloodstained to calculate a cell count and differential; likely due to traumatic aspiration. Conclusions: 33% of acute monoarthritis' evaluated over the study period failed to have a synovial fluid WCC and differential. This may be due to inadequate samples, or lack of K. Perera 401 appropriate collection tube. Better education is required for appropriate collection and test requesting wherein a diagnosis of septic arthritis is in question.
CJEM, 2015
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. 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...