Clinical Features and Treatment Outcomes of Bone-Joint Infection Between Bacteria and Mycobacterium Tuberculosis

Abstract

Background Bone-joint infection is an emergency condition that requires immediate management. Delayed in treatment or improper management can lead to a significant morbidity and mortality.Methods The medical records of patients with bone-joint infection seen at Maharaj Nakorn Chiang Mai Hospital between 1 November 2010 and 30 September 2015 were reviewed. The diagnosis of bone-joint infection was confirmed by pathogen identification or pathohistological report. Only those with adequate clinical features and treatment outcomes were included for analysis.ResultsOf 125 bone-joint infected patients seen during the study period, 92 patients were caused by bacterial infection and 33 from tuberculous infection. Their mean ± standard deviation age was 55.3 ± 17.7 years, and had total disease duration of 7.1 ± 8.2 months. Sixty-four percent were men. Of 33 TB cases, 24 (72.7%) had spinal involvement. Among 92 cases with bacterial infection, 52 (56.5%) had non-spinal joint involvement, and 38 (41.3%) had non-spinal bone involvement. Regarding clinical features, TB cases had mean duration of symptom of 5.3 ± 6.1 months. Multivariate logistic regression analyses showed that neurological manifestations (adjusted OR = 314.1, 95% CI 14.4–6831, P < 0.001), pulmonary symptoms (AOR = 222.1, 95% CI 3.0–16,560, P = 0.014), symptom duration over 1 month (AOR = 67.4, 95% CI 4.2–1070, P = 0.003), afebrile illness (AOR = 24.1, 95%CI 1.2–493.7, P = 0.039), ESR <70 mm/hour (AOR = 4.7, 95% CI 1.1–19.9, P = 0.039), and CRP <30 mg/l (AOR = 7.0, 95% CI 1.6–31.2, P = 0.010) were risk factor of TB bone-joint infection. There were 120 (96.0%) patients with clinical improvement, and five (4.0%) died patients. There were no significant differences among the clinical improvement, recurrent infection, and mortality between the two groups.Conclusion Distinguish of bone-joint infection between bacteria and mycobacterium tuberculosis is difficult. However, patients with TB bone-joint infections significantly had more symptom duration over 1 month, the presence of paraplegia, the presence of pulmonary symptoms, and the presence of afebrile illness than those with bacterial infection. There were no significant differences among treatment outcomes and mortality between the two groups.Disclosures All authors: No reported disclosures.