Septic arthritis risk factors

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Jumana Nagarwala, M.D., Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital; Cafer Zorkun, M.D., Ph.D. [2]Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [3]

Overview

Risk Factors

Common Risk Factors

Most common risk factors that predisposes septic arthritis are rheumatoid arthritis, prosthetic joint or joint replacement and skin infections.^[1]^[2]^[3]^[4]

Other common risk factors that predispose septic arthritis are as follows:^[5]^[4]^[6]^[7]^[8]

Type of risk factor	Examples
Host phagocytic defects	Complement deficiencies especially C7 and C8 Inherited disorders of chemotaxis
Impaired host defense mechanisms	Age >80 years^[9] Cancer Immunosuppressive drugs (e.g. azathioprine, methotrexate, or cyclophosphamide) Glucocorticosteroids
Direct penetration	Intravenous drug use Puncture wonds Intra articular steroid injection
Joint damage	Prosthetic joint surgery Degenerative joint diseases such as rheumatoid arthritis ( Prosthetic joint > Rheumatoid arthritis > Osteoarthritis)^[4]
Other risk factors	Recent history of bacteremia Cirrhosis Chronic kidney disease Hypogammaglobulinemia Systemic lupus erythematosis Gout Psuedo gout^[10] Charcot's arthropathy^[11]

Micrbiological Clue Based on Risk factors

Type of risk factor	Examples
Rheumatoid arthritis	Staphylococcus aureus^[12]^[13]^[8]^[14]^[4]
Immunocompromised patients	Staphylococcus aureus Streptococci Enteric gram-negative bacilli Listeria monocytogenes
Recent joint surgery	Staphylococcus aureus
Intravenous drug use	Staphylococcus aureus Pseudomonas aeruginosa
Diabetes mellitus	Staphylococcus aureus Streptococcus agalactiae
Sexually active young adults Menstruating females	Neisseria gonorrhea
Elderly adults	Staphylococcus aureus, streptococci, Gram-negative bacilli
Post-aspiration or injection	Staphylococcus aureus
Trauma	Gram-negative bacilli, anaerobes, Staphylococcus aureus
Animal bite (e.g.Cat or dog)	Pasteurella multocida Capnocytophaga spp Anaerobes
Human bite	Eikenella corrodens Viridans streptococci Anaerobes
Rat bite	Streptobacillus moniliformis
Neonates and children age < 4 years	Kingella kingae Gram-negative bacilli
Unvaccinated children	Haemophilus influenza
Systemic lupus erythematosus	Salmonella
Sickle cell anemia	Salmonella
Hemophilia	Staphylococcus aureus, streptococci, Gram-negative bacilli
Ingestion of unpasteurized dairy products	Brucella spp

The following conditions increase the risk for septic arthritis:

Artificial joint implants
Bacterial infection somewhere else in the body
Chronic illness or disease (such as diabetes, rheumatoid arthritis, and sickle cell disease)
Intravenous (IV) or injection drug use
Medications that suppress the immune system
Recent joint injury
Recent joint arthroscopy or other surgery

Septic arthritis may be seen at any age. In children, it occurs most often in those younger than 3 years. The hip is often the site of infection in infants. Septic arthritis is uncommon from age 3 to adolescence. Children with septic arthritis are more likely than adults to be infected with Group B streptococcus or Haemophilus influenza, if they have not been vaccinated.

References

↑ Esterhai JL, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22 (3):503-14. PMID: 1852426
↑ Dubost JJ, Fis I, Soubrier M, Lopitaux R, Ristori JM, Bussière JL et al. (1994) [Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature.] Rev Rhum Ed Fr 61 (3):153-65. PMID: 7920511
↑ Gristina AG, Giridhar G, Gabriel BL, Naylor PT, Myrvik QN (1993) Cell biology and molecular mechanisms in artificial device infections. Int J Artif Organs 16 (11):755-63. PMID: 8150521
↑ ^4.0 ^4.1 ^4.2 ^4.3 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
↑ Dickie AS (1986) Current concepts in the management of infections in bones and joints. Drugs 32 (5):458-75. PMID: 3792229
↑ 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
↑ 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
↑ ^8.0 ^8.1 Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
↑ Lagaay AM, van Asperen IA, Hijmans W (1992) The prevalence of morbidity in the oldest old, aged 85 and over: a population-based survey in Leiden, The Netherlands. Arch Gerontol Geriatr 15 (2):115-31. PMID: 15374369
↑ Lurie DP, Musil G (1983) Staphylococcal septic arthritis presenting as acute flare of pseudogout: clinical, pathological and arthroscopic findings with a review of the literature. J Rheumatol 10 (3):503-6. PMID: 6887177
↑ Rubinow A, Spark EC, Canoso JJ (1980) Septic arthritis in a Charcot joint. Clin Orthop Relat Res (147):203-6. PMID: 6989540
↑ Goldenberg DL (1998) Septic arthritis. Lancet 351 (9097):197-202. DOI:10.1016/S0140-6736(97)09522-6 PMID: 9449882
↑ Frazee BW, Fee C, Lambert L (2009) How common is MRSA in adult septic arthritis? Ann Emerg Med 54 (5):695-700. DOI:10.1016/j.annemergmed.2009.06.511 PMID: 19665261
↑ Mathews CJ, Coakley G (2008) Septic arthritis: current diagnostic and therapeutic algorithm. Curr Opin Rheumatol 20 (4):457-62. DOI:10.1097/BOR.0b013e3283036975 PMID: 18525361

Template:WikiDoc Sources

[pmid1852426-1] Esterhai JL, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22 (3):503-14. PMID: 1852426

[pmid7920511-2] Dubost JJ, Fis I, Soubrier M, Lopitaux R, Ristori JM, Bussière JL et al. (1994) [Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature.] Rev Rhum Ed Fr 61 (3):153-65. PMID: 7920511

[pmid8150521-3] Gristina AG, Giridhar G, Gabriel BL, Naylor PT, Myrvik QN (1993) Cell biology and molecular mechanisms in artificial device infections. Int J Artif Organs 16 (11):755-63. PMID: 8150521

[pmid8849354-4] 4.0 ^4.1 ^4.2 ^4.3 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

[pmid3792229-5] Dickie AS (1986) Current concepts in the management of infections in bones and joints. Drugs 32 (5):458-75. PMID: 3792229

[pmid8972665-6] 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

[pmid1602850-7] 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

[pmid3883171-8] 8.0 ^8.1 Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171

[pmid15374369-9] Lagaay AM, van Asperen IA, Hijmans W (1992) The prevalence of morbidity in the oldest old, aged 85 and over: a population-based survey in Leiden, The Netherlands. Arch Gerontol Geriatr 15 (2):115-31. PMID: 15374369

[pmid6887177-10] Lurie DP, Musil G (1983) Staphylococcal septic arthritis presenting as acute flare of pseudogout: clinical, pathological and arthroscopic findings with a review of the literature. J Rheumatol 10 (3):503-6. PMID: 6887177

[pmid6989540-11] Rubinow A, Spark EC, Canoso JJ (1980) Septic arthritis in a Charcot joint. Clin Orthop Relat Res (147):203-6. PMID: 6989540

[pmid9449882-12] Goldenberg DL (1998) Septic arthritis. Lancet 351 (9097):197-202. DOI:10.1016/S0140-6736(97)09522-6 PMID: 9449882

[pmid19665261-13] Frazee BW, Fee C, Lambert L (2009) How common is MRSA in adult septic arthritis? Ann Emerg Med 54 (5):695-700. DOI:10.1016/j.annemergmed.2009.06.511 PMID: 19665261

[pmid18525361-14] Mathews CJ, Coakley G (2008) Septic arthritis: current diagnostic and therapeutic algorithm. Curr Opin Rheumatol 20 (4):457-62. DOI:10.1097/BOR.0b013e3283036975 PMID: 18525361

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