Incidence Of Septic Arthritis Research Articles

Increased Incidence and Clinical Features of Septic Arthritis in Patients Aged 80 Years and above: A Comparative Analysis with Younger Cohorts.

This study aimed to determine the incidence of septic arthritis across adult age groups in Västra Götaland Region (VGR) of Sweden, while also comparing disease characteristics among different age groups with hematogenous septic arthritis. Using ICD-10 codes for septic arthritis from 2016 to 2019, we identified 955 patients in VGR. We reviewed the medical records of 216 adult patients with hematogenous septic arthritis and compared data across age groups. The overall incidence of septic arthritis in adults was 4 per 100,000 persons annually, rising to 14 per 100,000 in those ≥80 years. The median age of the 216 patients was 71. The comparison across age groups (18-64, 65-79, and ≥80) showed significantly longer hospital stays and higher mortality rate in the older groups. CRP levels were higher in the middle age group, SF-WBC counts were lower in the youngest age group, and synovial fluid crystals were more common in the oldest. No differences were found in joint involvement or the organisms isolated. The incidence of septic arthritis is 6.5 times higher in patients aged ≥ 80 compared to those under 65, highlighting the need to consider age-related differences in disease management.

The role of preoperative appendicular magnetic resonance imaging in cases of acute bone and joint infection in the paediatric age group

Background: Acute haematogenous osteomyelitis is mainly a disease of children. It is a challenge to differentiate it from septic arthritis as they have overlapping signs and symptoms. Septic arthritis is a surgical emergency while acute osteomyelitis, when presenting early, can be treated with parenteral antibiotics. There is paucity in imaging guidelines and treatment for cases where acute septic arthritis is associated with osteomyelitis.Objectives: To analyse the role of preoperative magnetic resonance imaging (MRI) in cases of suspected acute bone and joint infection in the paediatric age group.Method: This is a prospective study in 38 children suspected to have acute bone and joint infections. All the patients underwent emergency appendicular MRI on suspicion of bone and joint infections. Based on the MRI findings, the patients were classified into cases of isolated septic arthritis and cases of septic arthritis with concomitant osteomyelitis. There was a change in the treatment modality between the two categories of patients. Results: In our study 14 (36.8%) cases of suspected bone and joint infection had concomitant osteomyelitis with septic arthritis. These 14 cases were seen involving the knee, hip, elbow and shoulder joints. The incidence of septic arthritis with coexisting osteomyelitis was 36.8% in our study, which was diagnosed with preoperative emergency appendicular MRI.Conclusions: Our study concludes that MRI should be included in the work up for suspected bone and joint infections provided MRI is done in a timely fashion without unnecessarily delaying surgical intervention if needed.

Incidence of Septic Arthritis After Vancomycin Soaking of the Graft During Arthroscopic Anatomic Anterior Talofibular Ligament and Calcaneofibular Ligament Reconstruction

Background: Vancomycin soaking of the graft during arthroscopic anterior cruciate ligament reconstruction has been shown to be effective in reducing the rate of postoperative infection. Purpose/Hypothesis: The present study aimed to (1) analyze the effect of vancomycin-soaked grafts during arthroscopic anatomic reconstruction of the anterior talofibular ligament (ATFL) and the calcaneofibular ligament (CFL) on the incidence of infection and (2) evaluate the influence of infection on functional outcomes and identify the risk factors of infection. It was hypothesized that vancomycin soaking of the graft would reduce the postoperative infection rate. Study Design: Cohort study; Level of evidence, 3. Methods: Consecutive patients at 2 centers who underwent ATFL/CFL reconstruction between December 2011 and July 2022 were included. All patients had undergone anterolateral arthroscopic debridement of the ankle and anatomic ATFL/CFL reconstruction with a gracilis tendon autograft. Vancomycin soaking of the graft was begun in both centers in January 2021. Complications, functional scores, return to sports (RTS) rates, and the level of return were compared between patients with and without vancomycin-soaked grafts and between patients with and without infection. Results: Overall, 182 patients (48% men; mean age, 34 ± 11.9 years) were included, with a mean follow-up of 23 ± 16.1 months. The rate of postoperative infection was significantly lower in the group with vancomycin soaking versus without (0/92 [0%] vs 8/90 [8.9%]; P = .001). At the final follow-up, there were 26 complications (14.3%): 8 infections, 6 recurrent tears, and 12 peripheral neuropathies. The infections developed after a mean of 17 ± 11 days. The functional scores were excellent at the final follow-up (American Orthopaedic Foot and Ankle Society [AOFAS] Ankle-Hindfoot Score, 86.5 ± 18.7; Karlsson score, 85 ± 18.3). Patients with infection had significantly decreased AOFAS scores (52.8 ± 27.6 vs 83.3 ± 21.5; P = .003), Karlsson scores (57 ± 27.7 vs 83.6 ± 20; P = .006), and RTS rates (25% vs 77%; P = .005) versus patients without infection. Conclusion: Vancomycin-soaked grafts for arthroscopic anatomic ATFL/CFL reconstruction decreased the rate of postoperative infection. Infection led to a deterioration in results. Vancomycin-soaking of the graft did not have a negative effect on functional results.

Bone and joint infection complicated with sepsis in neonates and infants under three months of age

ObjectiveStudies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. MethodsNeonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. ResultsTwenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. ConclusionStaphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.

Clinical prediction rule for bacterial arthritis: Chi-squared automatic interaction detector decision tree analysis model.

Differences in demographic factors, symptoms, and laboratory data between bacterial and non-bacterial arthritis have not been defined. We aimed to identify predictors of bacterial arthritis, excluding synovial testing. This retrospective cross-sectional survey was performed at a university hospital. All patients included received arthrocentesis from January 1, 2010, to December 31, 2020. Clinical information was gathered from medical charts from the time of synovial fluid sample collection. Factors potentially predictive of bacterial arthritis were analyzed using the Student's t-test or chi-squared test, and the chi-squared automatic interaction detector decision tree analysis. The resulting subgroups were divided into three groups according to the risk of bacterial arthritis: low-risk, intermediate-risk, or high-risk groups. A total of 460 patients (male/female = 229/231; mean ± standard deviation age, 70.26 ± 17.66 years) were included, of whom 68 patients (14.8%) had bacterial arthritis. The chi-squared automatic interaction detector decision tree analysis revealed that patients with C-reactive protein > 21.09 mg/dL (incidence of septic arthritis: 48.7%) and C-reactive protein ⩽ 21.09 mg/dL plus 27.70 < platelet count ⩽ 30.70 × 104/μL (incidence: 36.1%) were high-risk groups. Our results emphasize that patients categorized as high risk of bacterial arthritis, and appropriate treatment could be initiated as soon as possible.

Incidence of septic arthritis in patients with ankylosing spondylitis and seropositive rheumatoid arthritis following TNF inhibitor therapy.

Septic arthritis (SA) is a serious complication occurring in the joints, and its risk increases with immunosuppressive therapy. This study investigated whether TNF inhibitors increase the risk of SA in patients with AS and seropositive RA (SPRA). We searched the South Korean Health Insurance Review and Assessment Service database for incident cases of AS and SPRA between 2010 and 2020. SA was defined using the diagnostic code M00 and hospital admission. Cox-proportional hazards analysis was conducted to compare the incidence of SA according to TNF inhibitor (infliximab, etanercept, adalimumab/golimumab) use during follow-up. Of the 145 129 patients analysed, 1170 (0.8%) developed SA during the follow-up period. Older age; male sex; SPRA diagnosis; comorbidities of hypertension (HTN), diabetes mellitus (DM) and chronic pulmonary disease (CPD); and infliximab and etanercept use increased the incidence of SA in the overall population. However, in patients with AS, only age and renal disease were predictors of SA, and TNF inhibitors did not increase the incidence of SA. Meanwhile, patients with SPRA treated with TNF inhibitors were prone to SA regardless of TNF inhibitor type, and age, HTN, DM and CPD were associated with SA. The incidence of SA was prominent after the first year of commencing TNF inhibitor therapy, for both AS and SPRA. TNF inhibitors increase the incidence of SA, specifically in patients with SPRA, but not AS. Importantly, age, comorbidities and the early time period after starting TNF inhibitors were associated with SA, which should be considered simultaneously when initiating TNF inhibitor therapy.

What is the incidence of septic arthritis in patients with infective endocarditis? A systematic review

• Incidence of osteoarticular infection in infective endocarditis was unknown. • Evaluation of the limited, available evidence to date would suggest septic arthritis occurs in 3.5–3.9% of cases. • Early identification of septic arthritis is shown to be of vital importance. • Predictive factors are herein identified to assist clinicians in diagnosis and management. The clinical scenario of a hospital inpatient receiving treatment for infective endocarditis who suddenly develops a painful joint will probably be familiar to most. Arthralgia and myalgia are common manifestations of acute, severe infection, and of systemic disease in general. Nevertheless a proportion of patients with infective endocarditis will develop secondary osteoarticular infections. These may be a focus for life-threatening sepsis and in the case of septic arthritis can result in irreversible and massively disabling destruction of major synovial joints. The aim of this systematic review is to establish the incidence of this clinical phenomenon based on the available literature, and to aid physicians in its identification and management by means of a proposed guidance summary. A targeted literature review was produced using appropriate medical subject heading terms to search the PUBMED database for pertinent studies. Dual author consensus was reached following independent assessment of the papers using a critical appraisal tool. 6 papers in total were found to have met the inclusion criteria and were included for review, ranging in study dates from 1992 to 2020. The reported incidence rates varied from 2.5% to 10.6%. However detailed analysis of methodologies and study populations facilitated more precise figures to be reached when focusing on those studies whose participants were felt to more closely reflect a modern European/North American case-mix. Although the quality of the available data does not allow for firm conclusions to be drawn in terms of an exact incidence, evaluation of the largest and most recent case-series available on this subject would indicate that the rate of patients with IE developing synchronous SA is in the region of 3.5–3.9%. This review also highlights the poor outcomes associated with such phenomena, and a proposed clinical guidance summary is also included in order to aid clinicians in its early identification and appropriate management.

The role of pre operative appendicular magnetic resonance imaging in cases of acute bone and joint infection in the paediatric age group

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Acute haemotogenous osteomyelitis can occur at any age group but is mainly a disease of children. They are a challenge to differentiate as they have overlapping signs and symptoms. Septic arthritis is considered a surgical emergency while acute osteomyelitis, when presented early can be treated with parenteral antibiotics. There is paucity in the approach (imaging guidelines and treatment) for cases where acute septic arthritis is associated with osteomyelitis. We aimed to analyses the role of pre operative appendicular MRI in the cases of acute bone and joint infection in paediatric age group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This is a prospective study done in 38 children suspected to have acute bone and joint infections. All the patients underwent emergency appendicular MRI in the suspicion of bone and joint infections. Based on the MRI findings, all the patients were classified into cases of isolated septic arthritis and cases of septic arthritis with concomitant osteomyelitis. There was a change in the treatment modality between the two categories of patients.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In our study 14 (36.84%) cases of the 38 suspected bone and joint infection had concomitant osteomyelitis with septic arthritis. These 14 cases were seen involving the knee, hip, elbow and shoulder joints. The incidence of septic arthritis with coexisting osteomyelitis was 36.84% in our study, which was diagnosed with pre operative emergency appendicular MRI.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Our study concludes that MRI should be included in the work up for suspected bone and joint infections provided MRI is done in a timely fashion without unnecessarily delaying surgical intervention if needed.&lt;/p&gt;&lt;p&gt;&lt;strong&gt; &lt;/strong&gt;&lt;/p&gt;

Septic Arthritis Complicating Arthroscopic Anterior Cruciate Ligament Reconstruction: An Experience from a Tertiary-Care Hospital.

BackgroundSeptic arthritis (SA) of the knee following anterior cruciate ligament reconstruction (ACLR) is considered a catastrophic complication in terms of reduced or loss function of the involved joint. The aims of this study were to gauge the incidence, risk factors, and causative organisms of SA after ACLR.MethodsWe conducted a retrospective review of 836 patients who underwent primary ACLR at our institution from October 2018 to September 2021. Patients’ demographics, onset of presentation, clinical symptoms, laboratory findings, and management details were obtained from patients’ electronic medical records.ResultsOut of the 836 primary ACLRs, 12 were complicated with SA (1.43%). Independent risk factors associated with SA included age (OR; 11.12, 95% CI; 1.3–94.97), obesity (OR; 8.51, 95% CI; 1.02–71.13), and diabetes mellitus (OR; 12.58, 95% CI; 2.39–66.3). Staphylococcus aureus was the most frequent culprit organism (66.7%), followed by Streptococcus species (25%), and Pseudomonas aeruginosa (8.3%). No fungal, mycobacterial, or polymicrobial growth were recovered from synovial fluid cultures. All of the infected cases underwent arthroscopic joint lavage and debridement in the operating room followed by intravenous antibiotics. Graft removal was not done in any of the involved patients, with eradication of infection in all cases.ConclusionSA after ACLR is uncommon, with S. aureus identified in about two-thirds of the patients. Prompt diagnosis and treatment are crucial to avoid graft loss and arthritis-associated joint damage. Orthopedic surgeons should consider rigorous implementation of infection control strategies to minimize the incidence of this devastating morbidity.

The Association between Iron-Deficiency Anemia (IDA) and Septic Arthritis (SA): The Real-World Data.

Background and Objectives: Iron-deficiency anemia (IDA) could predispose the afflicted individuals to various infections and musculoskeletal disorders. This study attempted to investigate the association between IDA and septic arthritis (SA), a musculoskeletal disease. Materials and Methods: We investigated all the eligible subjects in the Taiwanese longitudinal health insurance database (LHID) between 2000 and 2012. Subjects with the diagnosis of IDA (International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM): 280) were allocated to the IDA cohort. The control subjects were randomly matched to every subject with IDA coding by age and sex at the 1:4 ratio. All of the recruited subjects were followed since the index date to the onset of SA (ICD-9-CM: 711.0), withdrawal from the insurance (including death), or 31 December 2013. Results: The cumulative incidence of SA was assessed. We showed that the cumulative incidence of SA was higher in the IDA cohort than in the control cohort (p-value < 0.0001). After adjustment of the comorbidities, the IDA patients had a 2.53-fold risk of SA compared to control subjects (aHR = 2.53, 95% CI = 1.89–3.38). Conclusions: IDA was associated with an increased risk of SA.

Septic arthritis in childhood: A 24-year review.

We investigated the pathogenic, clinical, and laboratory characteristics of children diagnosed with septic arthritis (SA) during the past 24 years and identified the risk factors for SA-related sequelae. We retrospectively reviewed the records of patients admitted to Fukuoka University Hospital from 1997 to 2020. Causative pathogens were compared between the first (1997-2008) and second (2009-2020) periods. We also compared the clinical and laboratory characteristics in patients with known or unknown pathogens, and in patients with or without sequelae. A total of 37 patients with SA were identified, including 28 patients (76%) in the first period and nine patients (24%) in the second period. Sixteen of 37 patients (43%) were younger than 2 years, including two neonates. Pathogens were identified in 25 (68%) of 37 patients. Patients with known pathogens had a significantly higher C-reactive protein level on admission than those with unknown pathogens (P < 0.05). The predominant pathogen was Staphylococcus aureus (38%, 14/37). Although S. aureus and Hemophilus influenzae type b (Hib) were predominant pathogens in the first period, Hib was not found in the second period. Six (16%) of 37 patients with SA experienced sequelae. Moreover, the risk factors for the development of sequelae were significantly associated with infection at age <1 month and delayed surgical treatment (>4 days). The incidence of SA had decreased dramatically in the second period, and Hib was no longer the predominant pathogen. Earlier surgical drainage should be performed in neonates with SA.

Non-gonococcal septic arthritis of native joints in Western Australia. A longitudinal population-based study of frequency, risk factors and outcome.

To describe the incidence and long-term outcome of non-gonococcal septic arthritis (SA) in Western Australia (WA). Newman criteria were applied to define culture-positive SA and suspected SA cases in the state-wide West Australian Rheumatic Diseases Epidemiological Registry with longitudinally linked health data for patients >16years with a first diagnostic code of pyogenic arthritis (711.xx [ICD-9-CM] and M00.xx [ICD-10-AM]) between 1990-2010. Annual incidence rates/100000 (AIR) and standardized (against WA population) mortality rates/1000 person-years (SMR) and outcomes during 10.1years follow-up are reported. Among 2633 SA patients (68.6% male, age 47.4years), 1146 (43.5%) had culture-positive SA. The overall AIR for culture-positive (1.6-6.3) and total SA cases (4.3-12.9) increased between 1990 and 2010 as did age at onset (39.5-54years) and proportion of females (23-35.6%). Knees (33.6.%) were most frequently affected and 37.1% of cultures showed microorganisms other than Gram-positive cocci. Thirty-day rates for readmission and mortality were 25.4% and 3.2.%. During follow-up rates for serious infections (56.4%), osteoarthrosis (5.2%) and osteomyelitis (2.7%) were higher in culture-positive SA. SMR was increased for all SA patients but especially in those 17-40 years of age with culture-positive SA (24.2; 95% CI 2.3-261). The incidence of SA in WA has risen steeply over 20years. SA now occurs at higher age, affects females more often with over a third of cases caused by Gram-negative microorganisms. Not only culture-positive, but also suspected SA led to increased bone/joint complications, in-hospital and late mortality.

Common musculoskeletal disorders in chronic liver disease patients

Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia.

ObjectiveTo describe the incidence, risk factors and long-term outcomes in children hospitalised with septic arthritis (SA) in Western Australia (WA).MethodsWe extracted state-wide longitudinally linked administrative health data for patients aged < 16 years with a first diagnostic code of 711.X (ICD9-CM) and M00.X (ICD10-AM) in WA in the period 1990–2010. Annual incidence rates (AIR) per 100,000 with 95% confidence intervals (CIs), prior conditions during a median lookback period of 63.2 [interquartile range (IQR) 19.8–117.1] months and outcomes, including standardised mortality rates (SMR), during a median follow-up of 10 years are reported.ResultsA total of 891 patients [62% male, median age 6.4 (IQR 1.9–10.6) years with 34% aged < 3 years] were admitted for SA during the observation period. The overall AIR (per 100,000) was 9.85 (95% CI 4.79–14.41), and was higher in Indigenous Australians [34.9 vs. 5.5 (non-Indigenous), p < 0.001] and in males [11.9 vs. 7 (females), p < 0.01]; AIR showed no temporal or seasonal variation. Knees (43.9%), hips (34.6%) and ankles (13.3%) were most frequently affected, with Staphylococci predominant (49%) in patients with positive cultures (41.5%). Prior infection(s) (40.4%) and respiratory disease (7%) were the main pre-existing morbidities. Median hospital stay was 4.0 (IQR 2–8) days, with 1.9% requiring admission to the intensive care unit and 10.4% requiring readmission within 30 days. During follow-up, 26 patients (3.1%) developed osteomyelitis, nine patients were diagnosed with osteoarthrosis (1.1%) and five patients (0.6%) underwent joint replacement. Female patients developed other serious infections more often than male patients (40.5 vs. 27.1%, p < 0.01), as well as other comorbidities (Charlson Comorbidity Index > 0: 34.6 vs. 27.2%, p = 0.02), including diabetes (4.2 vs. 0%; p = 0.001), cardiovascular events (4.2 vs 1.4%, p = 0.002) and chronic arthritis (1 vs. 0%, p = 0.05). The crude mortality rate was low (0.3%), with 99.4% survival at 180 months and no increase in the SMR.ConclusionsThe incidence of SA in children in WA did not change over the 20-year observation period. SA did not lead to excess mortality, but bone and joint complications developed in 5% of patients. The high propensity to comorbid conditions in this young cohort suggests an underlying role of comorbidity in SA development.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40744-021-00307-x.

Risk Factors for Septic Arthritis After Anterior Cruciate Ligament Reconstruction: A Nationwide Analysis of 26,014 ACL Reconstructions

Background: Septic arthritis (SA) after anterior cruciate ligament reconstruction (ACLR) is a rare yet severe complication. The samples in previous studies have been small and without nationwide coverage, making analysis uncertain with a risk of bias. Conclusions to recommend preventive measures are therefore difficult to draw, and it has not been possible to perform a comprehensive risk factor analysis. Purpose: To study the incidence of SA after ACLR in a large, nationwide population and to study the risk factors for SA after ACLR. Study Design: Case-control study; Level of evidence, 3. Methods: All ACLRs, primary and revision, in the Swedish Knee Ligament Registry between 2006 and 2013 were linked with data from the Swedish National Board of Health and Welfare. The incidence of SA events was determined using entries from the day of surgery until 90 days postoperatively based on diagnosis codes and the prescription of antibiotics. All events of SA were verified via a review of medical records. Risk factors were analyzed based on data from the registries. Descriptive statistics were used to describe the findings, while logistic regression analysis was used for the risk analysis. Results: The cohort consisted of 26,014 primary and revision ACLRs. During the study period, 298 events of SA (1.1%) were identified. The high-volume units (≥500 ACLRs during the study period) had a distribution of SA between 2 and 47 (0.2%-2.9%). Independent risk factors of SA were male sex (OR, 1.65; 95% CI, 1.28-2.13), operating time ≥70 minutes (OR, 1.83; 95% CI, 1.42-2.36), hamstring tendon autograft (OR, 2.23; 95% CI, 1.21-4.08), and clindamycin as perioperative antibiotic prophylaxis (OR, 1.94; 95% CI, 1.10-3.41). Conclusion: The incidence of SA after ACLR in this nationwide cohort was 1.1%. Male sex, hamstring tendon autografts, and a longer operating time were all independent risk factors for SA. The use of clindamycin as perioperative antibiotic prophylaxis was a risk factor compared with the use of cloxacillin. Some high-volume units had a very low infection rate (0.2%).

Clinical and Pharmacological Evaluation of Pistacia atlantica Nut Extract on Septic Arthritis Caused by Staphylococcus aureus: An Experimental Study

Background: Today, the incidence of septic arthritis by Staphylococcus aureus has increased due to intra-articular injections, prosthetic joints, and underlying conditions such as rheumatoid arthritis and immunosuppression. Pistacia atlantica has significant antioxidant, anti-inflammatory, and antibacterial activities. Objectives: Considering S. aureus as the most important etiology of septic arthritis, this experimental study aimed to evaluate the effects of P. atlantica on septic arthritis. Methods: Septic arthritis was induced by intra-articular injection of S. aureus suspension in left stifles of rats, which were divided randomly into eight groups, containing ten per group, including normal: no intervention; control: septic arthritis was induced but not treated; Oral Placebo (OP): 14 days daily P.O.; Local Injected Placebo (LIP): a single dose intra-articular (IA injection) of normal saline; Oral P. atlantica (OPa): 14 days daily P.O. P. atlantica extract; Local Injected P.atlantica (LIPa): a single-dose IA injection of P. atlantica extract; Prophylactic Oral P. atlantica (ProOPa): prophylactic P.O. P. atlantica extract daily one week before the induction for 21 days; Prophylactic Local Injected P. atlantica (ProLIPa): a prophylactic single-dose IA injection of P. atlantica extract one week before the induction. For further evaluations, blood and histopathological samples were obtained. Results: Pistacia atlantica oral medication reduced the physical symptoms of inflammation. Although hematological analysis showed a fall in the control group compared to the normal group, all medicated groups increased. The OPa group showed the closest WBC count (9.46 ± 4.12 × 109/L) to the normal group (P = 0.073). All histopathological parameters had significantly higher scores in the control group compared to the normal group. Although the scores increased in the groups that received P. atlantica, they decreased in the groups that received placebo, except for synovitis degree. The OPa group demonstrated a lower degree of synovitis (1.40 ± 0.51) than the control group; however, it was not significant (P = 0.690). Local injections revealed higher erosion scores (2.80 ± 0.63 for the LIPa group and 2.70 ± 0.48 for the ProLIPa group) than the control group (P &lt; 0.05). Conclusions: Oral administration of P. atlantica alleviated the clinical symptoms. Cellular immunity activation and systemic benefits of oral P. atlantica were assessed. Histopathology confirmed the immune system involvement and antibacterial activity of P. atlantica. More erosion may be due to more bacterial debris with arthritogenic properties. Meanwhile, the probability of the stimulatory effect of P. atlantica extract for synovial content should not be ignored.

Clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis.

The aim of this study was to investigate the clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis (HD). We systematically reviewed medical records of 16 HD patients with septic arthritis admitted to our hospital from April 2008 to April 2018. A total of 16 HD in patients with bloodstream infection but without septic arthritis were randomly selected as controls. The incidence of septic arthritis in our patient group was 0.2% per year. Organisms isolated were Staphylococcus aureus in 11 (68.7%), Gram-negative bacilli in 3, streptococci in 1, and fungi in 1. Patients with septic arthritis were significantly older (72.7 ± 9.4 vs 63.5 ± 8.7years, p = 0.035) and had more joint diseases (62.5% vs 12.5%, p = 0.003) and a longer duration of hospitalization (35.2 ± 5.7 vs 22.1 ± 3.5days, p = 0.021) than the control group. In a logistic regression analysis, patients with older age and more joint diseases were more likely to have septic arthritis compared with controls (OR = 1.39, p = 0.024 and OR = 3.24, p = 0.003, respectively). These findings indicate that old age and joint diseases (osteoarthritis or inflammatory arthritis) were independent risk factors for septic arthritis in patients on HD when bloodstream infection occurred. Key Points • Patients with septic arthritis were significantly older and had more joint diseases than the control group. • Old age and joint diseases are independent risk factors for septic arthritis in patients on HD when bloodstream infection occurs.

Clinical Improvement after Surgical Debridement and Synovectomy on 4 Year Old Girl with Chronic Septic Arthritis of the Hip

Background: Incidence of septic arthritis in children less than 5 years old about 5 from 100,000 cases every year and adult above 64 years old about 8.4 cases every 100,000 people every year. The diagnosis of the chronic septic arthritis, especially in hip joint is still challenging, even for skilled doctor in musculo­skeletal. Delayed diagnosis and inadequate treatment can lead to permanent joint damage and impairment. Case presentation : In this case we discuss about clinical improvement of chronic septic arthritis in a 4 year old girl with hip pain that had been felt since 2 months before admission. Physical examination, laboratory examination, and ultrasonography examination was done and the diagnosis had been made. Results: A surgical debridement and syno­vec­tomy was done with addition antibiotic therapy. The patient not only felt the pain was relieved but also can return into good function of hip joint. Conclusion: Diagnosis with proper early treatment is expected to reduce permanent joint loss and improve the clinical outcome for the patient. Keyword s : septic arthritis, hip, synovectomy, surgical debridement Correspondence: Pamudji Utomo. Prof DR R Soeharso Ortho­paedic Hospital, Pabelan, Kartasura, Surakarta, Central Java. Email: scapoid@yahoo.com. Indonesian Journal of Medicine (2020), 05(03): 253-258 https://doi.org/10.26911/theijmed.2020.05.03.11

Pyogenic Arthritis.

The incidence of septic arthritis among children in developed countries is estimated to be 4 to 10 cases per 100,000 children per year, peaking at about age 3 years. The most common causative organism is Staphylococcus aureus, although the microbiology varies by age. Prompt diagnosis and treatment is critical to prevent long-term sequelae. Empiric therapy should target the most likely causative organism(s) and total duration generally falls between 10 days and 4 weeks depending on clinical course, patient age, and organism. A short intravenous course is sufficient in most cases. Unusual and alternate causes of arthritis should be considered in special cases. [Pediatr Ann. 2019;48(9):e354-e359.].

Professional Athletes Are Not at a Higher Risk of Infections After Anterior Cruciate Ligament Reconstruction: Incidence of Septic Arthritis, Additional Costs, and Clinical Outcomes From the French Prospective Anterior Cruciate Ligament Study (FAST) Cohort

Background: The rate of septic arthritis in the knee after anterior cruciate ligament (ACL) reconstruction varies in the literature but is generally less than 1%. It has been reported to be higher in professional athletes (5.7%). Purpose: The primary goal was to evaluate the rate of septic arthritis after ACL reconstruction in professional athletes compared with other patients. The secondary goals were to analyze the risk factors; increased cost of infections; return to sport, satisfaction, and functional results at 1-year follow-up; and resolution rate of infections at final follow-up. Study Design: Case-control study; Level of evidence, 3. Methods: This retrospective analysis of prospective data included a continuous series of patients who underwent isolated ACL reconstruction between 2012 and 2016. The main outcome criterion was the development of intra-articular infections in the operated knee. An infection was suggested clinically (knee pain with fever and/or chills) and confirmed bacteriologically in deep tissue samples obtained during revision surgery. All infected patients underwent an emergency reoperation with lavage and debridement along with dual antibiotic therapy first by an intravenous route and then orally for 6 weeks. Results: A total of 1809 of 1859 patients included in the cohort during this period fulfilled inclusion criteria; there were 1632 (90.2%) who underwent primary reconstruction and 177 (9.8%) who underwent revision. The series included 1249 (69%) men and 560 (31%) women, with a mean age of 29.1 ± 9.8 years. Ninety-eight percent of the patients participated in a sport, including 90 (5.0%) at a professional level and 712 (39.4%) competitively. Septic arthritis of the knee developed after a mean 15.7 ± 5.5 days in 7 (0.38%) patients: 5 of 1632 (0.31%) who underwent primary reconstruction and 2 of 177 (1.13%) who underwent revision. Septic arthritis did not develop in any professional or competitive athletes; all affected patients were recreational athletes (P = .02). The risk factors identified for the development of septic arthritis on multivariate analysis were prior knee surgery (odds ratio [OR], 15; P = .002) and hemarthrosis during the immediate postoperative period (OR, 127.2; P = .002). There were no recurrent infections after a mean follow-up of 2.8 ± 1.2 years. Conclusion: None of the professional athletes in this cohort had septic arthritis after ACL reconstruction. There are no particular precautions to be taken in this population. The risk factors identified for the development of septic arthritis on multivariate analysis were prior knee surgery and hemarthrosis during the immediate postoperative period. Similar to all studies published on the subject, there were very few infected patients, which limits the identification of risk factors. Registration: NCT02511158 (ClinicalTrials.gov identifier)