Sandbox:septic arthritis: Difference between revisions

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== Risk Factors ==
== Risk Factors ==
=== Common Risk Factors ===
Common risk factors that predespose septic arthritis are as follows:<ref name="pmid3792229">Dickie AS (1986) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3792229 Current concepts in the management of infections in bones and joints.] ''Drugs'' 32 (5):458-75. PMID: [https://pubmed.gov/3792229 3792229]</ref><ref name="pmid8849354">Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849354 Risk factors for septic arthritis in patients with joint disease. A prospective study.] ''Arthritis Rheum'' 38 (12):1819-25. PMID: [https://pubmed.gov/8849354 8849354]</ref><ref name="pmid8972665">Morgan DS, Fisher D, Merianos A, Currie BJ (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8972665 An 18 year clinical review of septic arthritis from tropical Australia.] ''Epidemiol Infect'' 117 (3):423-8. PMID: [https://pubmed.gov/8972665 8972665]</ref><ref name="pmid1602850">Rozadilla A, Nolla JM, Mateo L, del Blanco J, Valverde J, Roig D (1992) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1602850 [Septic arthritis induced by pyogenic germs in patients without parenteral drug addiction. Analysis of 44 cases].] ''Med Clin (Barc)'' 98 (14):527-30. PMID: [https://pubmed.gov/1602850 1602850]</ref>
* Age >60 years
* Recent history of bacteremia
* Degenerative joint diseases such as rheumatoid arthritis ( Prosthetic joint > Rheumatoid arthritis > Osteoarthritis)<ref name="pmid8849354">Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849354 Risk factors for septic arthritis in patients with joint disease. A prospective study.] ''Arthritis Rheum'' 38 (12):1819-25. PMID: [https://pubmed.gov/8849354 8849354]</ref>
* Corticosteroid therapy
* Diabetes mellitus
* Leukemia
* Cirrhosis
* Granulomatous diseases
* Hypogammaglobulinemia
* Intravenous substance abuse
* Chronic kidney disease
* Cytotoxic chemotherapy
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! '''Microorganism''' !! '''Associated risk factors'''
! '''Microorganism''' !! '''Associated risk factors'''

Revision as of 15:23, 10 January 2017

Overview

Septic arthritis is a very much important consideration in adults presenting with acute monoarticular arthritis.

Defintion

Historical perspective

Causes

The most common etiological agent of all nongonococcal causes of septic arthritis in the United States is Staphylococcus aureus.[1] Gram-negative bacilli account for 10 to 20% of septic arthritis causes.[1] ~10% of patients with nongonococcal septic arthritis are due to polymicrobial cause of infections. Anaerobes are also can cause septic arthritis in few cases.

Most common cause of septic arthritis in children age < 2 years are Haemophilus influenzae (in immunized children), Staph. aureus, group A Streptococcal infections and Kingella kingae.[2]

Pathophysiology

Hematogenous spread: Septic arthritis most commonly develop as a result of hematogenous spreading bacteria into the vascular synovial membrane.[3]

Direct inoculation: Direct inoculation of microorganisms may occur during joint surgery, particularly in association with knee and hip arthroplasties.

Contiguous spread: Bone infection can spread by breaking through its outer cortex and then into the intracapsular region that lead to joint infection. This kind of spread is more common in children as the small capillaries can cross the epiphyseal growth plate and permit extension of infection into the epiphysis and joint space.[4][5]

Risk Factors

Common Risk Factors

Common risk factors that predespose septic arthritis are as follows:[6][7][8][9]

  • Age >60 years
  • Recent history of bacteremia
  • Degenerative joint diseases such as rheumatoid arthritis ( Prosthetic joint > Rheumatoid arthritis > Osteoarthritis)[7]
  • Corticosteroid therapy
  • Diabetes mellitus
  • Leukemia
  • Cirrhosis
  • Granulomatous diseases
  • Hypogammaglobulinemia
  • Intravenous substance abuse
  • Chronic kidney disease
  • Cytotoxic chemotherapy
Microorganism Associated risk factors
Staphylococcus aureus
  • Rheumatioid arthritis[10]
  • Diabetes mellitus[11]
  • HIV patients[12]
Streptococcus pyogenes

Streptococcal pneumonia

  • Autoimmune diseases[8]
  • Chronic skin infections[11]
  • Trauma
Groups B Streptococcal infection
  • Immunocompromised patients[13]
  • Diabetes mellitus
  • Malignancy
  • Severe genitourinary or gastrointestinal infections
Gram-negative bacilli

Most common gram-negative organisms are Pseudomonas aeruginosa

and Escherichia coli.

  • History of intravenous drug abuse[1]
  • Extremes of age
  • Immunocompromised patients
Haemophilus influenzae
  • Unimmunized children[14]
Anaerobes
  • Diabetes mellitus
  • Patients with prosthetic joints



  • Recent history of joint aspiration or local corticosteroid joint injection.[15][3]
  • History of Rhematoid arthritis[10]
  • History of diabetes mellitus[8]

References

  1. ↑ 1.0 1.1 1.2 Deesomchok U, Tumrasvin T (1990) Clinical study of culture-proven cases of non-gonococcal arthritis. J Med Assoc Thai 73 (11):615-23. PMID: 2283490
  2. ↑ Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R (1995) Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med 149 (5):537-40. PMID: 7735407
  3. ↑ 3.0 3.1 Klein RS (1988) Joint infection, with consideration of underlying disease and sources of bacteremia in hematogenous infection. Clin Geriatr Med 4 (2):375-94. PMID: 3288326
  4. ↑ Barton LL, Dunkle LM, Habib FH (1987) Septic arthritis in childhood. A 13-year review. Am J Dis Child 141 (8):898-900. PMID: 3498362
  5. ↑ Buckholz JM (1987) The surgical management of osteomyelitis: with special reference to a surgical classification. J Foot Surg 26 (1 Suppl):S17-24. PMID: 3559051
  6. ↑ Dickie AS (1986) Current concepts in the management of infections in bones and joints. Drugs 32 (5):458-75. PMID: 3792229
  7. ↑ 7.0 7.1 Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38 (12):1819-25. PMID: 8849354
  8. ↑ 8.0 8.1 8.2 Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117 (3):423-8. PMID: 8972665
  9. ↑ Rozadilla A, Nolla JM, Mateo L, del Blanco J, Valverde J, Roig D (1992) [Septic arthritis induced by pyogenic germs in patients without parenteral drug addiction. Analysis of 44 cases.] Med Clin (Barc) 98 (14):527-30. PMID: 1602850
  10. ↑ 10.0 10.1 Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60 (3):369-77. PMID: 769545
  11. ↑ 11.0 11.1 Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B et al. (1996) Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 63 (2):103-10. PMID: 8689280
  12. ↑ Vassilopoulos D, Chalasani P, Jurado RL, Workowski K, Agudelo CA (1997) Musculoskeletal infections in patients with human immunodeficiency virus infection. Medicine (Baltimore) 76 (4):284-94. PMID: 9279334
  13. ↑ Schattner A, Vosti KL (1998) Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 77 (2):122-39. PMID: 9556703
  14. ↑ De Jonghe M, Glaesener G (1995) [Type B Haemophilus influenzae infections. Experience at the Pediatric Hospital of Luxembourg.] Bull Soc Sci Med Grand Duche Luxemb 132 (2):17-20. PMID: 7497542
  15. ↑ Hunter JA, Blyth TH (1999) A risk-benefit assessment of intra-articular corticosteroids in rheumatic disorders. Drug Saf 21 (5):353-65. PMID: 10554051
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