Predictive value of the usual clinical signs and laboratory tests in the diagnosis of septic arthritis (original) (raw)
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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.
Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department
Western Journal of Emergency Medicine
Septic arthritis is a dangerous medical condition associated with significant morbidity and mortality. However, the differential diagnosis can be broad with conditions that mimic this disease and require different evaluation and treatment. This narrative review presents the emergency medicine evaluation and management, as well as important medical conditions that may mimic this disease. Septic arthritis commonly presents with monoarticular joint pain with erythema, warmth, swelling, and pain on palpation and movement. Fever is present in many patients, though most are low grade. Blood testing and imaging may assist with the diagnosis, but the gold standard is joint aspiration. Management includes intravenous antibiotics and orthopedic surgery consult for operative management vs. serial aspirations. Clinicians should consider mimics, such as abscess, avascular necrosis, cellulitis, crystal-induced arthropathies, Lyme disease, malignancy, osteomyelitis, reactive arthritis, rheumatoid arthritis, and transient synovitis. While monoarticular arthritis can be due to septic arthritis, other medical and surgical conditions present similarly and require different management. It is essential for the emergency clinician to be aware how to diagnose and treat these mimics. [West J Emerg Med. 2019;20(2)331-341.] the literature. 1-6 Based on the literature, higher rates of septic arthritis are present in immunocompromised patients and those with prosthetic joints, where disease incidence increases to 70 cases per 100,000 patients annually. 7-13 Septic arthritis possesses a bimodal incidence, with peaks in both childhood and adults over the age of 55 years. 4-9 Septic arthritis consists of a bacterial infection of the joint space that is associated with rapid joint destruction
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...
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.
Annals of the Rheumatic Diseases, 2003
Objective: To investigate whether patients with acute septic arthritis (SA) diagnosed by positive synovial fluid (SF) culture (Newman grade A) have different clinical and serological features from those with sterile SF in whom there is nonetheless a high suspicion of SA (Newman grades B and C). Patients and methods: A prospective 12 month multicentre hospital based study of adult patients with SA recruited 47 patients with culture positive SA and 35 patients with clinically suspected SA but sterile SF. Results: Patient demography, clinical and laboratory features at presentation were similar irrespective of the underlying diagnosis, SF culture, and the presence of prosthetic joints. Medical and surgical treatment and outcome were comparable in the two patient groups. Patients with both suspected and proven SA were more likely to be from the more socially deprived areas of our community (p<0.0001). Conclusion: Patients in whom there is a high clinical suspicion of SA are comparable to those patients with SA with a positive SF culture and have similar morbidity and mortality on follow up. Therefore, if clinical suspicion of SA is high then it is correct to treat as SA in the absence of bacterial proof.
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...