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. 2022 Jan;81(1):132-139.
doi: 10.1136/annrheumdis-2021-220820. Epub 2021 Sep 17.

Native joint infections in Iceland 2003-2017: an increase in postarthroscopic infections

Signý Lea Gunnlaugsdóttir  1 , Helga Erlendsdóttir  2 , Kristján Orri Helgason  2 , Árni Jón Geirsson  3 , Valtýr Thors  4 , Sigurður Guðmundsson  5   6 , Magnús Gottfreðsson  7   6
Affiliations

Native joint infections in Iceland 2003-2017: an increase in postarthroscopic infections

Signý Lea Gunnlaugsdóttir et al. Ann Rheum Dis. 2022 Jan.

Abstract

Objectives: Nationwide study on the epidemiology, clinical characteristics and outcomes among patients with native joint infection (NJI) in Iceland, 2003-2017.

Methods: All positive synovial fluid culture results in Iceland were identified and medical records reviewed.

Results: A total of 299 NJI (40 children and 259 adults) were diagnosed in Iceland in 2003-2017, with a stable incidence of 6.3 cases/100 000/year, but marked gender difference among adults (33% women vs 67% men, p<0.001). The knee joint was most commonly affected, and Staphylococcus aureus was the most common isolate in both adults and children, followed by various streptococcal species in adults and Kingella kingae in children. NJI was iatrogenic in 34% of adults (88/259) but comprised 45% among 18-65 years and a stable incidence. Incidence of infections following arthroscopic procedures in adults increased significantly compared with the previous decade (9/100 000/year in 1990-2002 vs 25/100 000/year in 2003-2017, p<0.01) with no significant increase seen in risk per procedure. The proportion of postarthroscopic NJI was 0.17% overall but 0.24% for knee arthroscopy. Patients with postarthroscopic infection were more likely to undergo subsequent arthroplasty when compared with other patients with NJI (p=0.008).

Conclusions: The incidence of NJI in Iceland has remained stable. The proportion of iatrogenic infections is high, especially among young adults, with an increase seen in postarthroscopic infections when compared with the previous decade. Although rare, NJI following arthroscopy can be a devastating complication, with significant morbidity and these results, therefore, emphasise the need for firm indications when arthroscopic treatment is considered.

Keywords: arthritis; epidemiology; health services research; infectious; orthopedic procedures.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart showing identification of culture confirmed NJI in Iceland, 2003–2017. NJI, native joint infection.
Figure 2
Figure 2
(A) Overall annual incidence of culture confirmed NJI in Iceland, 2003–2017. The dashed line shows running 2-year average. (B) Age-specific and gender-specific incidence of culture confirmed NJI in Iceland, 2003–2017. NJI, native joint infection.
See this image and copyright information in PMC

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