Abstract
.Septic arthritis is a medical emergency, and if not treated appropriately, it can be associated with high morbidity and mortality. Melioidosis, a serious infectious disease caused by the Gram-negative bacillus Burkholderia pseudomallei, is highly endemic in South and Southeast Asia and northern Australia. We reviewed the medical charts of adult patients admitted with bacterial septic arthritis at Sunpasitthiprasong Hospital, Ubon Ratchathani, northeast Thailand from January 2012 to December 2014. Bacterial septic arthritis was defined as one or more hot swollen joints with isolation of a pathogenic organism from an affected joint or from blood. A total of 154 patients with septic arthritis were retrospectively evaluated. The most common causes were B. pseudomallei (48%, N = 74), Streptococcus spp. (29%, N = 44), and Staphylococcus aureus (10%, N = 16). Prevalence of diabetes, bacteremia, and pneumonia was higher in B. pseudomallei septic arthritis than in septic arthritis caused by the other bacteria (all P < 0.01). Seventy three percent (54/74) of patients infected with B. pseudomallei and 69% (55/80) of patients with the other bacteria received effective antimicrobials on the first day of admission (P = 0.60), but in-hospital mortality of the former group was considerably higher (34% versus 14%, P = 0.004). In conclusion, B. pseudomallei septic arthritis is common and associated with high mortality in northeast Thailand. Emergence of Streptococcus arthritis is observed. Difficulty in diagnosing melioidosis and identifying B. pseudomallei in areas where health care workers are not familiar with the disease is discussed. In melioidosis-endemic regions, parenteral ceftazidime could be considered as empirical antimicrobial therapy for patients with septic arthritis and underlying diseases.
Highlights
Septic arthritis is a common medical emergency and is associated with substantial morbidity and mortality.[1]
154 adult patients with culture-confirmed bacterial septic arthritis were included in the final analysis
Our study shows that B. pseudomallei is the most common cause of septic arthritis in northeast Thailand, and patients with septic arthritis caused by B. pseudomallei have a higher case fatality rate (CFR) compared with those caused by other bacterial pathogens
Summary
Septic arthritis is a common medical emergency and is associated with substantial morbidity and mortality.[1] The case fatality rate (CFR) for septic arthritis is about 5–15%, and irreversible loss of joint function develops in 25–50% of those who survive.[2] The infection is usually caused by hematogenous spread during a transient or persistent bacteremia, or by direct inoculation occurring with trauma or iatrogenically. Neisseria gonorrhoeae is a rare cause of septic arthritis in Europe and North America,[1] but is still prevalent in some parts of the world.[3,4] the initial antibiotic choice in patients suspected with septic arthritis is based on clinical risk factors and local epidemiology.[1]
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