Abstract
Objective/Aim:Septic arthritis is an uncommon but important disease with significant morbidity and mortality, especially if inadequately managed. The aim of this epidemiological study was to identify the characteristics and outcomes of patients treated for septic arthritis at Mater Dei Hospital, Malta, over a 10-year period.Methods:This was a retrospective observational study. Patients diagnosed with septic arthritis between 2008 and 2018 were recruited. Cases were identified by reviewing all inhospital episodes of patients diagnosed with septic arthritis according to Newman criteria.Results:There were 124 cases of native joint septic arthritis and 138 of prosthetic joint infection. Cases were present amongst all age groups, with the highest incidence amongst those aged 61–70 years for both native and prosthetic infections. Fever was present in around 40% of cases. Raised white cell count was prevalent in 66.9% of native joint infections and 52.9% of prosthetic joints. Elevated C-reactive protein was overwhelmingly seen in most cases, present in 93.5% (median=159.5 mg/L; IQR=85.8–291) of native joints and 92.0% of prosthetic joint infections (median=68.7 mg/L; IQR=20.5–186). Over 55% of patients had one or more risk factors for joint sepsis, diabetes mellitus being the most prevalent clinical comorbidity (22.6% and 24.6% for native and prosthetic joint infections respectively). Synovial cultures were positive in 66% and 82% of native and prosthetic joint aspirates respectively. Staphylococcus aureus was the most commonly isolated organism from both native and prosthetic joint infection, followed by streptococcal infections in native joints and coagulase negative staphylococci and gram-negative infections in prosthetic joints. Fifteen deaths were directly attributed to joint sepsis.Conclusion:Absence of fever and elevated white cell count does not exclude the diagnosis. The mortality rate due to septic arthritis in this cohort of patients was found to be 5.7%. All deaths occurred in elderly patients with clinical comorbidities suggesting that this group is at highest risk.
Highlights
Septic arthritis is the most serious cause of an inflamed, swollen joint.[1,2,3,4] It has significant morbidity and mortality
Patients were classified according to the Newman criteria[11]; cases were considered as confirmed if they had an organism isolated from infected synovial fluid (Grade A), organisms isolated from elsewhere (Grade B) or no organism isolated but with clinical examination and investigations strongly suggestive of septic arthritis (Grade C)
The knee is known to be the most commonly affected joint according to various studies; 12,16 this was reflected well in our study with over 60% of both native and prosthetic joint infections (PJIs) occurring in knees (Table 1). 50 cases of prosthetic hip infections were encountered in the 10-year period of observation; this was in contrast to only 7 cases of native hip infection encountered which was shown to be statistically significant (p=
Summary
Septic arthritis is the most serious cause of an inflamed, swollen joint.[1,2,3,4] It has significant morbidity and mortality. Diagnosis and targeted treatment are imperative as inadequately treated infections may result in irreversible joint destruction with consequent long-term disability.[7,8] joint aspiration and positive cultures are useful to pin the diagnosis, septic arthritis often
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