Clinical Characteristics and Treatment Outcomes of Patients with Sternoclavicular Septic Arthritis Caused by Staphylococcus aureus

Abstract

Background Aggressive surgical therapy such as en-bloc resection of the joint is favored in the treatment of sternoclavicular (SC) septic arthritis. However, this practice is based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with S. aureus SC septic arthritis treated with medical therapy alone or with limited surgical therapy.Methods All adult patients with SC septic arthritis caused by S. aureus at the Asan Medical Center between September 2009 and December 2016 were retrospectively reviewed. Demographic characteristics, laboratory results, underlying diseases/conditions, patient management, and treatment outcomes were assessed. SC septic arthritis due to S. aureus was defined if patients had positive cultures of specimens from the SC joint, or if blood cultures yielded S. aureus, together with physical findings and imaging studies supporting the diagnosis of SC septic arthritis. Limited surgical therapy was defined as simple incision, drainage, and debridement of infected SC joint.ResultsIn total, 22 cases of S. aureus SC septic arthritis were enrolled. Of these 22 patients, 11 received medical therapy alone, 11 underwent limited surgical therapy, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes, and liver cirrhosis, and none had IV drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscess had a tendency to be treated with limited surgery than patients without them (73% vs. 27%, P = 0.09). The median duration of intravenous antibiotics in all patients was 35 days (IQR 25–46 days). After a median follow-up of 31 months (IQR 2–40 months), there was no relapse of SC septic arthritis or deterioration of joint function.Conclusion Medical therapy alone or with limited surgical therapy appears to be a successful therapeutic strategy for the complicated S. aureus SC septic arthritis in a selected patient.Disclosures All authors: No reported disclosures.