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. 2016 Jun 1:16:239.
doi: 10.1186/s12879-016-1540-0.

Morbimortality in adult patients with septic arthritis: a three-year hospital-based study

Julien Ferrand  1 , Youssef El Samad  2 , Benoit Brunschweiler  3 , Franck Grados  1 , Nassima Dehamchia-Rehailia  1 , Alice Séjourne  1 , Jean-Luc Schmit  2 , Antoine Gabrion  3 , Patrice Fardellone  1 , Julien Paccou  4
Affiliations

Morbimortality in adult patients with septic arthritis: a three-year hospital-based study

Julien Ferrand et al. BMC Infect Dis. .

Abstract

Background: The objective of this ambispective study was to determine outcomes and associated factors for adult patients with confirmed septic arthritis (SA).

Methods: All adult patients admitted to Amiens University Hospital between November 2010 and December 2013 with confirmed SA were included in the study. Patients with prosthetic joint infections were excluded. A statistical analysis was performed in order to identify risk factors associated with a poor outcome (including mortality directly attributable to SA).

Results: A total of 109 patients (mean ± SD age: 60.1 ± 20.1; 74 male/35 females) were diagnosed with SA during the study period. The most commonly involved sites were the small joints (n = 34, 31.2 %) and the knee (n = 25, 22.9 %). The most frequent concomitant conditions were cardiovascular disease (n = 45, 41.3 %) and rheumatic disease (n = 39, 35.8 %). One hundred patients (91.7 %) had a positive microbiological culture test, with Staphylococcus aureus as the most commonly detected pathogen (n = 59, 54.1 %). Mortality directly attributable to SA was relatively infrequent (n = 6, 5.6 %) and occurred soon after the onset of SA (median [range]: 24 days [1-42]). Major risk factors associated with death directly attributable to SA were older age (p = 0.023), high C-reactive protein levels (p = 0.002), diabetes mellitus (p = 0.028), rheumatoid arthritis and other inflammatory rheumatic diseases (p = 0.021), confusion on admission (p = 0.012), bacteraemia (p = 0.015), a low creatinine clearance rate (p = 0.009) and the presence of leg ulcers/eschars (p = 0.003). The median duration of follow-up (in patients who survived for more than 6 months) was 17 months [6-43]. The proportion of poor functional outcomes was high (31.8 %). Major risk factors associated with a poor functional outcome were older age (0.049), hip joint involvement (p = 0.003), the presence of leg ulcers/eschars (p = 0.012), longer time to presentation (0.034) and a low creatinine clearance rate (p = 0.013).

Conclusions: In a university hospital setting, SA is still associated with high morbidity and mortality rates.

Keywords: C-reactive protein; Clinical characteristics; Mortality; Poor functional outcome; Risk factors; Septic arthritis.

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Figures

Fig. 1
Fig. 1
Study flow chart
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