Septic Arthritis Of Knee Research Articles

Knee septic arthritis caused by \u03b1-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

BackgroundArthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% - 3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus.Case presentationA 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m2) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution.ConclusionThe incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01–3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.

385. Arthroscopic vs. Open Surgery for Septic Arthritis of the Knee: A Systematic Review and Meta-Analysis

BackgroundSeptic arthritis is a joint-threatening and life-threatening infection, with the knee representing the most frequently involved joint. There is no definitive treatment algorithm for the management of this condition, which typically includes surgical debridement to decompress the joint, followed by organism-specific intravenous antibiotics.MethodsSearch Methods. MEDLINE (1965–2018), SCOPUS (1973–2018), The COCHRANE Library (2006–2017), EMBASE (1974–2018), reference lists, and scientific meetings were searched for relevant studies on the treatment of native knee septic arthritis by three independent reviewers. No language restrictions were used. Selection criteria included all studies reporting on native knee septic arthritis in adults treated with arthroscopy and open arthrotomy with irrigation and debridement. Data Collection and Analysis Studies were identified, subjected to inclusion and exclusion criteria, and reviewed by three independent reviewers. Patient characteristics, interventions, and outcomes were extracted, and the trials were rated for quality based on established criteria. A meta-analysis was conducted for the primary outcome, reoperation occurring after arthroscopic vs. open arthrotomy irrigation and debridement for the treatment of septic arthritis. We used a qualitative analysis for secondary outcomes physical function and hospital length of stay. ResultsFrom 624 abstracts, eight trials met inclusion criteria, one randomized controlled trial and seven retrospective cohorts. Quantitative meta-analysis showed arthroscopic irrigation and debridement resulted in fewer reoperations compared with open arthrotomy (RR = 0.76; 95% CI 0.59–0.97, P = 0.03, I2 = 24%), Figure 1. A qualitative summary of seven included studies assessing physical function showed arthroscopic debridement results in improved functional outcomes and range of motion compared with open arthrotomy. Based on four trials, qualitative summary demonstrated that arthroscopic debridement results in decreased hospital length of stay compared with open arthrotomy. ConclusionArthroscopic irrigation and debridement is favored over open arthrotomy with regard to lower rates of reoperation, improved functional outcomes, and shorter hospital length of stay. Disclosures All authors: No reported disclosures.

1490 Ursodeoxycholic Acid for the Management of Recurrent Clostridioides difficile Infection

INTRODUCTION: Fecal microbiota transplant (FMT) is an effective treatment for recurrent Clostridioides difficile infection (rCDI), but its precise mechanism remains unknown (1-2). Recent studies suggest that the restoration of gut bacteria, which carry necessary enzymes to convert primary bile acids (PBAs) to secondary bile acids (SBAs), may play a key role in rCDI risk (3, Figure 1). For example, in vitro studies have demonstrated that PBAs stimulate C. difficile spore germination and that deoxycholic acid, a SBA, inhibits toxin-producing C. difficile (4). As normal fecal bile acid pools consist predominantly of SBAs, we hypothesize that a contributor of rCDI risk is the decrease in SBAs from enteric bacteria loss following antibiotic use (5-8). We present the first case enrolled in our clinical trial using ursodeoxycholic acid (UDCA), a SBA, as an adjunct treatment to prevent future rCDI. CASE DESCRIPTION/METHODS: An otherwise healthy 46-year-old man presented with S. aureusbacteremia secondary to septic knee arthritis. While on an extended course of cefazolin, he developed profuse, watery diarrhea and stool C. difficile toxin PCR was positive. He was then treated with intravenous metronidazole for one week and oral vancomycin for two weeks, with resolution of symptoms. Six weeks later, CDI recurred and was successfully treated with oral vancomycin for two weeks, in conjunction with concurrent UDCA 300 mg twice daily for eight weeks. Stool samples were collected at two-week intervals and fecal bile acid compositions were assessed via liquid chromatography - mass spectrometry. Fecal bile acid analyses demonstrated a shift towards protective SBAs by the end of the 8-week course of ursodiol (Figure 2). This profile of increased SBAs remained consistent despite subsequent retreatment with cefazolin at 5 months for recurrent septic arthritis. The patient has been without rCDI now for almost 2 years. DISCUSSION: The findings in this case are consistent with our hypothesis that increasing SBAs through adjunct treatment with UDCA can be effective in breaking the rCDI cycle. While some CDI patients have adequate enteric bacteria to produce SBAs after antibiotic treatment, others may have a delayed normalization of their gut microbiome, and may therefore require “bridge therapy” with supplementary SBAs (e.g., UDCA) until their endogenous microbial community is restored. Treatment and analysis of additional patients with rCDI in this clinical trial are in progress.

Outcomes of paediatric septic arthritis of the hip and knee at 1-20 years in an Australian urban centre.

Septic arthritis in children is a joint threatening condition with potentially severe consequences; however, long-term outcome data is lacking. This study aims to determine 1-20-year outcomes following septic arthritis of hip and knee joints in children in an Australian population. All paediatric patients with septic arthritis of the hip or knee from 1995 to 2015 treated at our Australian institution were retrospectively assessed. Clinical features, treatment and investigation results were recorded. Long-term functional and radiological outcomes, infection recurrence and reoperation rate at final follow-up (mean 8.5 years, range 1.0-20.3; hip versus mean 7.7 years, range 1.1-20.3; knee) were recorded. Sixty-four patients (37 hip, 27 knee) met inclusion criteria. Fifty-two patients (81.3%) attended follow-up. No mortalities or late infection recurrence occurred. Three patients (1; hip versus 2; knee) had a later operation. Median Oxford scores were excellent (48; hip versus 48; knee); however, a significant proportion had a degree of impaired function (31.3%; hip versus 42.1%; knee). Radiological outcomes were excellent in knees more commonly than hips (81.3%; hip versus 100%; knee). Outcomes at 1-20 years for the majority of patients following septic arthritis of the hip and knee are excellent with early joint irrigation and intravenous antibiotics. Our results demonstrate a significant proportion of patients following septic hip arthritis have mild to moderately poor functional and radiological outcomes. Those with septic knee arthritis demonstrated universally excellent radiological outcomes and mild functional impairment in approximately one-third of cases.

Knee Arthritis in Children: When Can It Be Safely Treated With Needle Joint Aspiration? A Large Children's Tertiary Hospital Study.

Early joint decompression associated to antibiotic therapy is the most important procedure to reduce joint damage in septic knee arthritis in children. Several joint decompression methods have been described such as arthrotomy with open debriding, arthroscopic drainage or needle joint aspiration. The aim of the present study was to determinate which patients with acute septic knee arthritis could be safely treated with needle joint aspiration. Patients with an acute knee arthritis diagnosed between September 2003 and December 2013 in our children's tertiary hospital were retrospective review. All cases were initially treated with needle joint aspiration. Primary end-point was failure of joint aspiration. A total of 74 patients were included in the study. Forty-two (56.8%) were male and median age was 1.49 years. Mean delay between onset of symptoms and diagnosis was 3.6 days and in 25 (33.8%) cases patients needed more than 1 visit to the emergency room. Median C-reactive protein (CRP) value was 36.3 mg/L and was >20 mg/L in 59 (79.7%) cases. A total of 11 (14.9%) patients showed failure of the joint aspiration treatment between 3 and 21 days after initial joint aspiration. The stepwise forward logistic regression model only identified as independent predictor of joint aspiration failure an age older than 3 years old (odds ratio, 5.64; 95% confidence interval, 1.38-29.61; P=0.018). Joint aspiration did not fail in any patient younger than 12 months and neither in any patient younger than 3 years old with CRP value <20 mg/L. Otherwise, treatment failed in 38% of patients older than 3 years and in 16% of patients between 1 and 3 years with a CRP>20 mg/L. Septic knee arthritis treated with needle joint aspiration succeed in all patients younger than 1 year and in all patients between 1 and 3 years with a CRP<20 mg/L. Alternative treatment such as arthroscopy debridement should be early considered in patients older than 3 years and patients between 1 and 3 years with CRP>20 mg/L. Level III.

Arthroscopic irrigation and debridement is associated with favourable short-term outcomes vs. open management: an ACS-NSQIP database analysis.

Septic arthritis of the knee is an orthopaedic emergency that is associated with marked morbidity and can potentially be life threatening. Surgical debridement can be performed either arthroscopically or via an arthrotomy. The aim of this study was to compare the 30-day complications and adverse outcomes between the two procedures. Patients with a diagnosis of septic arthritis of the knee between 2011 and 2015 were identified using the ACS-NSQIP database. The study population included 695 patients, who had knee septic arthritis and underwent either an arthroscopic irrigation or debridement (I&D) (n = 464) or open irrigation and debridement (n = 231). Preoperative data included demographics, independent functional status, and comorbidities. Outcomes of interest included wound complications, infectious complications, cardiovascular events, hospital readmissions, and reoperations, or any of the previous adverse events. Both cohorts were similar in most baseline characteristics. Bleeding requiring transfusion was significantly lower in the arthroscopic (n = 13; 3.6%) compared to the open procedure (n = 31; 13.4%; p = 0.0001). Home discharge was significantly higher in the arthroscopic irrigation and debridement group (n = 310; 67.5%) compared to the open group (n = 126; 55%; p = 0.0013). The overall incidence of adverse events was lower in the arthroscopic group (n = 158; 34%) compared to the open group (n = 112; 49%; p = 0.0002). There was no difference in rates of infectious complications, thromboembolic events, hospital readmission, reoperation, or mortality between the groups. Open irrigation and debridement was associated with higher risk of bleeding requiring transfusion (OR = 3.79; 95% CI: 2.02-7.13; p = 0.0001), higher risk of incidence of adverse events (OR = 1.46; 95% CI: 1.02-2.08; p = 0.039), and lower home discharge (OR = 3.79; 95% CI: 2.02-7.13; p = 0.0001) within 30days after the procedure. Arthroscopic irrigation and debridement demonstrated favourable short-term outcomes. Patients who underwent arthroscopic irrigation and debridement had lower rates of blood transfusions, lower rates of adverse events, and higher home discharge rates compared to open irrigation and debridement. This study is the largest analysis comparing arthroscopic vs. open irrigation and debridement in a national database sample. These findings conclude that arthroscopic debridement can be an alternative first-line option in managing septic arthritis. III.

Septic arthritis of the hip and knee treated surgically in pediatric patients: Analysis of the Kids’ Inpatient Database

ObjectiveThis study evaluated incidence over time, any association between race and demographics, and hospital-related parameters in pediatric patients with septic hip or knee arthritis. MethodsThe Kids’ Inpatient Database was used to identify all children with a diagnosis of septic hip or knee arthritis who underwent incision and drainage (1997–2012). ResultsBetween 1997 and 2012, overall incidence of septic arthritis of the knee (0.20–0.33 per 100,000) and hip (0.12–0.18 per 100,000) increased. ConclusionIncidence of pediatric septic joint arthritis, an emergent orthopaedic condition, has increased over time. Patient demographics may vary with respect to both age and race.

The Septic Knee Arthritis Caused byKlebsiella pneumoniaein a Patient with Type 2 Diabetes Mellitus and Osteoarthritis of the Knee

The Septic Knee Arthritis Caused by<i>Klebsiella pneumoniae</i>in a Patient with Type 2 Diabetes Mellitus and Osteoarthritis of the Knee

Severe Pyogenic Arthritis in a 10-Year Old Girl Due to Streptococcus dysgalactiae

Introduction: We describe the case of a 10-year-old girl with an unusually severe and complicated episode of acute septic arthritis due to Streptococcus dysgalactiae, and systematically review the literature describing osteoarticular infections with this organism. Case Presentation: A 10-year-old girl with hereditary sensory and autonomic neuropathy type 5 and chronic (Charcot) arthropathy of the right knee presented with severe swelling and warmth of the right knee associated with 2 days of fever. She was ultimately diagnosed with septic arthritis of the right knee due to S. dysgalactiae. Her subsequent clinical course was abnormally prolonged and complicated, requiring an 8-week hospitalization, 7 arthrotomies and 8 months of total antimicrobial therapy. Conclusions: Group G Streptococci, including S. dysgalactiae, are unusual causes of septic arthritis. Our patients’ clinical course was more severe than typically seen with more common osteoarticular pathogens. We conducted a systematic review of the literature on this condition, which demonstrated 7 previously reported cases of septic arthritis due to this pathogen in children, and also review the most current nomenclature and classification scheme for the organism.

Erişkin Dizin Akut Septik Artrit Tedavisinde Üç Cerrahi Yöntemin Karşılaştırılması

Erişkin Dizin Akut Septik Artrit Tedavisinde Üç Cerrahi Yöntemin Karşılaştırılması

Not All Patients With Diabetes Have the Same Risks: Perioperative Glycemic Control Is Associated With Postoperative Infection Following Knee Arthroscopy

To determine the association between glycemic control and infection following knee arthroscopy, and to determine the clinical utility of a threshold HbA1c level. A national database identified patients who underwent knee arthroscopy from 2007 to 2016. Patients with concomitant open portions, more complex knee procedures, procedures performed for infection and patients with prior septic knee arthritis were excluded. Patients with an HbA1c level checked within 3months of surgery were compared to control groups of nondiabetics and diabetics undergoing knee arthroscopy without a perioperative HbA1c. The study group was then stratified based on their HbA1c. The incidence of deep infection within 6months was identified and compared to those in the control groups. A subgroup analysis was performed to investigate any trend in the timing of postoperative infection. A receiver operating characteristic (ROC) analysis was performed to determine and test a threshold value of HbA1c. 13,470 study patients were included, with an overall rate of infection of 0.33%. The rate of infection ranged from 0.25% to 1.03%. The rate of infection in study patients was greater than the nondiabetes control group's (P < .0001) and not significantly different from that in the nonstudy diabetes control (P= .765). The inflection point of the ROC curve corresponded to an HbA1c level of 8.0mg/dL (P= .006, specificity= 76%, sensitivity= 44%, area under curve [AUC]= 0.619). The risk of infection following knee arthroscopy increases as the perioperative HbA1c increases. ROC analysis determined that an HbA1c above 8.0mg/dL could serve as a threshold level; however, the AUC and low sensitivity reflected the poor utility of this test as an independent predictor for infection. Level III, retrospective comparative study.

Mini open surgical treatment of knee septic arthritis with local anesthesia: a prospective preliminary report

Mini open surgical treatment of knee septic arthritis with local anesthesia: a prospective preliminary report

Denture Misadventure: The Tooth About Your Colon

Foreign body ingestion occurs mainly in mentally impaired person, but rarely in healthy adults. We present a case of an accidental dental bridge ingestion in a 48-year-old male which was removed by colonoscopy. A 48-year-old man was admitted with recurrence of previously diagnosed right knee septic arthritis requiring multiple surgical interventions and treatment with high-dose narcotic analgesia. During his hospitalization, he attempted to place his upper left dental bridge, but he accidentally ingested it. On evaluation, the patient felt that the appliance was stuck in his upper chest and was associated with significant chest discomfort. Examination revealed audible upper airway wheezing, but normal bowel sounds and no abdominal tenderness. Chest X-ray showed radiopaque foreign body (denture) near the gastroesophageal junction, and emergent endoscopy (EGD) was done, but the appliance had passed beyond the reach of the EGD and was not visualized. Serial Abdominal X-rays were performed to observe denture passage through the GI tract where it eventually came to rest in the area of the cecum/ascending colon. There was no further advancement after three days and bowel preparation, and the patient continued to complain of abdominal pain. Therefore, a colonoscopy was performed for removal. On entry into the proximal ascending colon, the appliance was visualized clearly. A snare was used to grasp the exposed screw, and it was slowly removed with one attempt. The patient's abdominal pain resolved post-procedure and was discharged in a stable condition. The ingestion of foreign bodies is a serious event, common in children and adults with neuropsychiatric disorders that can have significant complications. More than 80% of ingested foreign bodies pass without the need for intervention2,3. Common symptoms include hoarseness, choking sensation, retrosternal pain, abdominal pain and melena. The approach to management depends upon the object ingested, the location, and the patient's clinical status. Conservative management is appropriate for the majority of patients, since most objects will pass uneventfully2,3. Sharp foreign objects can be observed initially for three days. If conservative management fails and the patient has persistent abdominal pain, either endoscopic or surgical intervention is required. In this case a patient with ingested dentures, which came to rest in the proximal colon, underwent successful removal via snare during colonoscopy.Figure: Abdominal X ray showing the foreign body overlying the right abdomen could be within the Proximal transverse colon, or could be within the right colon.

Similar 30-Day Complications for Septic Knee Arthritis Treated With Arthrotomy or Arthroscopy: An American College of Surgeons National Surgical Quality Improvement Program Analysis

The purpose of the current study was to use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) to determine whether there were differences in 30-day perioperative complications between open arthrotomy and arthroscopy for the treatment of septic knees in a large national sample. Patients who were diagnosed with a septic knee and underwent open arthrotomy or arthroscopy were identified in the 2005-2014 NSQIP data sets. Patient demographics and perioperative complications were characterized and compared between the 2 procedures. In total, 168 patients undergoing knee arthrotomy and 216 patients undergoing knee arthroscopy for septic knee were identified. There were no statistically significant differences in demographic variables between the 2 groups. On univariate analysis, the rate of minor adverse events (MAEs; 15.48% vs 8.80%, P= .043) was higher in the open arthrotomy treatment group, while the rate of serious adverse events (SAEs; 37.50% vs 26.19%, P= .019) was higher in the arthroscopic surgery treatment group. On multivariate analysis, which controlled for patient characteristics/comorbidities and used the Bonferroni correction for multiple comparisons, there were no statistically significant differences in risk of any adverse events (relative risk [RR]= 0.851; 99% confidence interval [CI], 0.598-1.211; P= .240), MAE (RR= 1.653; 99% CI, 0.818-3.341; P= .066), SAE (RR= 0.706; 99% CI, 0.471-1.058; P= .027), return to the operating room (RR= 0.810; 99% CI, 0.433-1.516; P= .387), or readmission (RR= 1.022; 99% CI, 0.456-2.294; P= .944) between open compared with arthroscopic surgery. Univariate analysis revealed a lower rate of MAE but a higher rate of SAE in the arthroscopic surgery treatment group. However, on multivariate analysis, similar perioperative complications, rate of return to the operating room, and rate of readmission were found after open and arthroscopic debridement for septic knees. Based on the lack of demonstrated superiority of either of these 2 treatment modalities for this given diagnosis, and the expectation that most differences in perioperative complications for this diagnosis would have declared themselves within the first 30days, deciding between the studied treatment modalities may be based more on other factors not included in this study. Retrospective comparative study, Level III.

Not all Patients with Diabetes have the Same Risks: The Association of Perioperative Glycemic Control with Deep Postoperative Infection Following Knee Arthroscopy in Patients with Diabetes

Objectives:Diabetes mellitus has been associated with an increased risk for postoperative infection following numerous orthopaedic surgical procedures including arthroscopy; however, among patients with diabetes, the level of perioperative glycemic control may affect the risk of postoperative infection. Diabetic patients with ideal glycemic control in the perioperative period may have a lower risk of infection than those patients with higher average glucose levels. The primary goal of the present study was to evaluate the association of perioperative glycemic control as demonstrated by hemoglobin A1c (HbA1c) in patients with diabetes with the incidence of deep postoperative infection requiring a subsequent procedure following knee arthroscopy. The secondary objective was to calculate a threshold level of HbA1c above which the risk of postoperative infection after knee arthroscopy increases significantly in patients with diabetes.Methods:A national administrative database was queried for patients who underwent knee arthroscopy, including arthroscopic meniscectomy and/or repair, shaving chondroplasty, arthroscopic-assisted cruciate ligament reconstruction, and debridement from 2007-2014. Patients with procedures performed for infection and patients with a prior diagnosis of septic knee arthritis were excluded. Patients who met these criteria with diabetes mellitus and a perioperative HbA1c level checked within 3 months of surgery were identified; these patients were then stratified into six mutually exclusive groups based on their HbA1c: 1) HbA1c 0 - 5.99, 2) HbA1c 6 - 6.99, 3) HbA1c 7 - 7.99, 4) HbA1c 8 - 8.99, 5) HbA1c 9 - 9.99 and 6) HbA1c > 10 mg/dL. The incidence of deep infection requiring operative intervention within 1 year for each HbA1c group, including both open and arthroscopic irrigation and debridement (I&D), were identified using CPT and ICD-9 codes. A receiver operating characteristic (ROC) analysis was performed to determine an optimal threshold value of the HbA1c above which the risk of postoperative infection was significantly increased.Results:11,384 patients who underwent arthroscopic knee procedures with diabetes and a perioperative HbA1c recorded in the database were included in the study. The overall rate of infection requiring subsequent I&D within 1 year postoperatively was 0.37% (42 of 11,384). The rate of deep infection stratified by HbA1c group is pictured in Figure 1. The rate of infection ranged from a low of 0.24% in patients with HbA1c < 6 mg/dL up to 1.23% for patients with HbA1c > 10 mg/dL (P < 0.001). The results of ROC analysis are depicted in Figure 2. The inflection point of the ROC curve corresponded to an HbA1c level between 8.0 and 9.0 mg/dL (P = 0.004, AUC = 0.63, specificity = 73%, sensitivity = 50%).Conclusion:The risk of deep postoperative infection requiring surgical intervention following knee arthroscopy in patients with diabetes mellitus increases significantly as the perioperative HbA1c increases. ROC analysis determined that a perioperative HbA1c above 8.0 mg/dL could serve as a threshold for a significantly increased risk of deep postoperative infection following knee arthroscopy.

Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate.

Purpose Septic knee arthritis following arthroscopy is a rare but dreaded complication. Definition and management of knee deep infections are quite discussed in literature. In this review, literature regarding infections after knee arthroscopy is analyzed highlighting the incidence, causative bacteria, risk factors as well as clinical outcomes. Methods We performed a review of the literature matching the following key words: “septic arthritis” OR “infection” AND “arthroscopy” AND “knee.” Knee arthroscopic procedures, such as debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release, were considered. Complex procedures, such as ligament reconstruction, fractures, or complex cartilage repair techniques, were not included. Results Thirteen studies were included in this review. Incidence of infection ranged from 0.009 to 1.1% in patients undergoing simple arthroscopic procedures. Staphylococci are the most commonly isolated organisms from postarthroscopy infection. Use of intraoperative intra-articular steroids, smoking, obesity, male sex, diabetes, number of procedures performed during surgery, time of surgery, and tourniquet time of more than 60 minutes have been certified as risk factors for knee infection. Conclusion Postarthroscopy septic arthritis of the knee causes significant morbidity, usually requiring readmission to the hospital, at least one additional operation, and prolonged antibiotic therapy, both intravenous and oral. Prompt diagnosis and treatment are associated with a high success rate. Level of Evidence Level IV, systematic review of I-IV studies.

Salmonella Typhi: A cause of septic arthritis knee: A Rare entity.

Salmonella species enterica subspecies enterica serovar Typhi infection may result in various presentations like enteric fever, septicaemia with and without local suppurative lesions, gastroenteritis and the carrier state. Arthritis is an uncommon and rare manifestation of salmonella infection. Here, we report a case of septic arthritis of knee in a patient with benign prostate hypertrophy and catheter in situ . The case is presented for its rarity and to highlight the atypical manifestations of Salmonella Typhi in endemic regions. Hence salmonella species must always be kept in mind for the differential diagnosis of septic arthritis in a clinically relevant setting. Although few case reports have been reported signifying Salmonella enteritidis as a cause of septic arthritis knee however this is the first report of septic arthritis knee caused by Salmonella Typhi .

Open Compared with Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee.

Acute native knee septic arthritis is a joint-threatening emergency. Operative treatments by open or arthroscopic methods are available to surgeons. To our knowledge, the literature to date has primarily consisted of case series and no large study has yet compared these methods. The aim of this study was to compare open and arthroscopic treatment for acute native knee septic arthritis. All adult patients with acute native knee septic arthritis treated at our institution with either open or arthroscopic irrigation from 2000 to 2015 were retrospectively evaluated. The clinical findings, laboratory evidence, arthrocentesis and microbiology results, knee radiographs, and outcomes were compared. There were 161 patients (166 knees) with acute native knee septic arthritis treated between 2000 and 2015. Initially, 123 knees were treated by arthroscopic irrigation and 43 knees were treated by open irrigation; however, 71% in the open treatment group required repeat irrigation compared with 50% in the arthroscopic treatment group. The superiority of an arthroscopic procedure persisted after adjustment for potential confounders by multivariable analysis, with an odds ratio of 2.56 (95% confidence interval, 1.1 to 5.9; p = 0.027). After 3 irrigation procedures, the cumulative success rate was 97% in the arthroscopic treatment group and 83% in the open treatment group (p = 0.011). The total number of irrigation procedures required was fewer in the arthroscopic treatment group (p = 0.010). In the arthroscopic treatment group, the mean postoperative range of motion was greater (p = 0.016) and there was a trend toward a shorter median length of stay (p = 0.088). Arthroscopic treatment for acute native knee septic arthritis was a more successful index procedure and required fewer total irrigation procedures compared with open treatment. Long-term postoperative range of motion was significantly greater following arthroscopic treatment. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Congenital insensitivity to pain syndrome accompanied by neglected orthopedic traumas and complications

Pain is a protective mechanism. Congenital insensitivity to pain syndrome is a very rare disease in which there is no ability to feel physical pain. It has been reported that it occurs with an incidence of 1 in 125 million newborn. Patients with congenital insensitivity to pain may have various orthopedic complications such as recurrent fractures, osteomyelitis and neuropathic joints. The most frequently affected body parts are lower extremities. Besides, curvature of spine can be seen. Injuries in epiphyseal points may cause incompatibility of extremity. Charcot joints may develop, which can lead to neuropathic arthropathy as a result of insensitivity to pain. Here, we present a patient with traumatic fracture-dislocation on left hip that neglected the treatment, had a bilateral femur fracture and then had septic arthritis of knee.

Organs from a Highly Virulent Zoonotic Outbreak Strain of Streptococcus agalactiae Serotype III, Multilocus Sequence Type 283 Infective Endocarditis Did Not Result in Transmission with Adequate Prophylactic Antibiotic Cover

BackgroundIn 2015, an outbreak of invasive Streptococcus agalactiae serotype III, multilocus sequence type (MLST) 283, related to raw freshwater fish consumption was reported in Singapore. Clinical manifestations of this strain of S. agalactiae were associated with severe clinical course, septicemia and higher incidence of neurological infection. Reports of successful solid organ transplantation from donors with infective endocarditis (IE) are uncommon.MethodsWe present a patient who received kidney transplantation from a donor with S. agalactiae IE.ResultsA 59-year-old man had disseminated S. agalactiae infection causing IE, endopthalmitis, septic arthritis of the right knee, and lumbar spondylodiscitis. Blood cultures, synovial fluid on admission grew S. agalactiae serotype III MLST 283. A transthoracic echocardiogram showed an aortic valve vegetation measuring 0.8 × 0.3 cm. He demised from an intracranial bleed 12 days after admission. Blood cultures prior to harvest, urine cultures and pre-implantation biopsies did not demonstrate infection.Our recipient is a 65-year-old woman with end-stage renal failure. She underwent dual deceased donor kidney transplantation. She received IV basiliximab, IV methylprednisolone followed by PO prednisolone, MMF, and tacrolimus. There was no delayed graft function. She was treated for pneumonia post-operatively and received IV Meropenem and later IV piperacillin–tazobactam for 7 days and subsequently IV ceftriaxone for 2 weeks. She remains well without evidence of S. agalactiae transmission 6 months later. On follow-up, urine cultures are negative with good graft function.ConclusionThis strain of bacteria is associated with invasive infection suggesting increased virulence, the experience from the 2015 outbreak in Singapore echoes this finding. To our knowledge, this is the first reported renal transplantation from a donor with a zoonotic S. agalactiae IE. Whilst IE is not an absolute contraindication to organ transplantation, caution should taken with administration of appropriate antibiotics to donor and recipient. This supports guidelines of a less-restrictive donor screening criteria and potentially increases the donor pool.Disclosures All authors: No reported disclosures.