Eder L, Zisman D, Rozenbaum M, Rosner I
Internal Medicine A, Department of Rheumatology, Bnai-Zion Medical Center, Haifa, Israel.
Rheumatology (Oxford). 2005 Dec;44(12):1559-63. doi: 10.1093/rheumatology/kei092. Epub 2005 Sep 7.
To assess the clinical features and determine the pathogens responsible for septic arthritis in patients admitted to two community hospitals in the Haifa district in northern Israel over a 17-yr period.
A retrospective study of the hospital records of patients with septic arthritis admitted to Carmel Medical Center and Bnai Zion Medical Center in Haifa between 1987 and 2003.
Of 150 cases identified by discharge summary diagnostic codes, only 110 patients met criteria for the case definition of septic arthritis, and these form the basis of this report. Their mean age was 37.2 yr. Of the patients, 10.4% were recent immigrants, most of them from the former Soviet Union and from Ethiopia. Primary joint disease was reported in 21.8% of the cases, osteoarthritis being most prevalent (8.1%). Of the infected joints, 8.1% were prosthetic. Staphylococcus aureus was the most common pathogen isolated, making up 40% of all positive cultures. Streptococcal and Gram-negative bacilli were both identified in 14%. Eight patients had tuberculous arthritis (9%). Another pathogen, unusual in developed countries, was Brucella species, which was identified in 11% of the cases. Two-thirds of the patients underwent surgical joint drainage while the rest were treated solely with antibiotics.
The present study highlights the importance of characterizing the profile of species causing septic arthritis in specific regions, taking into account ethnic, genetic and environmental factors. In our survey population, tuberculous arthritis is a growing problem, mainly due to recent immigration waves, and brucella is an endemic and common pathogen. It is important to keep a high level of suspicion for these latter two bacteria, as they require special and unique care.
评估以色列北部海法地区两家社区医院17年间收治的脓毒性关节炎患者的临床特征，并确定其病原体。
对1987年至2003年间在海法的卡梅尔医疗中心和贝纳伊锡安医疗中心收治的脓毒性关节炎患者的医院记录进行回顾性研究。
根据出院小结诊断编码确定的150例病例中，只有110例符合脓毒性关节炎病例定义标准，这些病例构成了本报告的基础。他们的平均年龄为37.2岁。患者中10.4%为新移民，其中大多数来自前苏联和埃塞俄比亚。21.8%的病例报告有原发性关节疾病，其中骨关节炎最为常见（8.1%）。感染的关节中，8.1%为人工关节。金黄色葡萄球菌是最常见的分离病原体，占所有阳性培养物的40%。链球菌和革兰氏阴性杆菌的检出率均为14%。8例患者患有结核性关节炎（9%）。另一种在发达国家不常见的病原体是布鲁氏菌属，在11%的病例中被检出。三分之二的患者接受了手术关节引流，其余患者仅接受抗生素治疗。
本研究强调了在特定地区考虑种族、遗传和环境因素来确定引起脓毒性关节炎的物种特征的重要性。在我们的调查人群中，结核性关节炎是一个日益严重的问题，主要归因于近期的移民潮，而布鲁氏菌是一种地方流行且常见的病原体。对后两种细菌保持高度怀疑很重要，因为它们需要特殊和独特的治疗。
