Bacterial (Suppurative) Arthritis in the Adult

Abstract

Bacterial (suppurative) arthritis is a serious and often unrecognized cause of a painful joint in adult patients. The commonest infecting organism is a penicillin-G resistant staphylococcus. Nine of the seventy-eight patients in our series were infected with gram-negative bacillary organisms. Death of twelve patients probably was attributable to the infectious process. Three deaths resulted from other causes. Bacterial arthritis is infrequent and this may account for failure to make an early diagnosis; nonetheless, failure to do so may lead to death and most certainly results in severely compromised function of the involved joint. The most important aid to diagnosis is culture of the joint fluid. Suspicion should be directed to any elderly, anemic patient who has joint pain with or without effusion and who has an elevated sedimentation rate. Treatment must be based on proper bacteriologic diagnosis, selection of appropriate antibacterial agents, and drainage of the affected joint. If the disease progresses, then excision of all infected material is necessary. Arthrodesis is probably the treatment of choice for the chronically infected knee; in the hip either arthrodesis or arthroplasty can be given consideration.