Department of Trauma and Orthopaedics, St Vincents Hospital, Dublin 4, Republic of Ireland.
Aging Clin Exp Res. 2010 Jun;22(3):270-3. doi: 10.1007/BF03324807. Epub 2009 Nov 25.
An epidemiological analysis of cases of spontaneous community acquired septic arthritis in an elderly population at a university teaching hospital.
Confirmed cases of spontaneous septic arthritis in the over-65 population were studied. Patients with prosthetic joint infections were excluded from the study. Analysed data included initial presenting complaint and clinical examination, hematological and microbiological tests together with ultimate patient outcome.
There were 7 confirmed cases of spontaneous septic arthritis in the over 65 population in the past 6 months (2 hips, 5 knees). The mean age was 72.14 (range 65-82) with a mean length of stay of 49 days. Those with septic arthritis of the knee presented with swelling, pain and immobility. Hip cases presented with pain and immobility. All patients were systemically well at the time of presentation, with no other foci of infection detected after septic screening. All patients had confirmed aspirate and arthroscopic/arthrotomy infection. Staphylococcus aureus was isolated from 6 joint aspirations and Pseudomonas Aeruginosa from one patient. Complications of treatment included acute renal failure, cardio/respiratory failure, disseminated infection, and death (1 case).
Septic arthritis must be considered as a differential diagnosis in all patients with joint pain, swelling and immobility. This diagnosis is not confined to the pediatric population. A background of degenerative disease and occult presentation in the elderly may delay diagnosis. Sepsis must be considered in the elderly with joint pathology, and treatment must be initiated in a prompt and aggressive manner, to prevent sequelae.
对大学教学医院老年人群中自发性社区获得性化脓性关节炎病例进行的流行病学分析。
研究了 65 岁以上人群中确诊的自发性化脓性关节炎病例。排除了人工关节感染的患者。分析的数据包括初始表现症状和临床检查、血液学和微生物学检查以及最终患者的结果。
在过去 6 个月中，65 岁以上人群中有 7 例确诊为自发性化脓性关节炎（2 髋，5 膝）。平均年龄为 72.14 岁（范围 65-82 岁），平均住院时间为 49 天。膝关节化脓性关节炎患者表现为肿胀、疼痛和活动受限。髋关节病例表现为疼痛和活动受限。所有患者在就诊时全身状况良好，经过感染筛查后未发现其他感染灶。所有患者均经确认性关节抽吸和关节镜/关节切开术感染。从 6 例关节抽吸液中分离出金黄色葡萄球菌，从 1 例患者中分离出铜绿假单胞菌。治疗并发症包括急性肾功能衰竭、心肺功能衰竭、播散性感染和死亡（1 例）。
对于所有关节疼痛、肿胀和活动受限的患者，都应考虑化脓性关节炎作为鉴别诊断。该诊断不仅限于儿科人群。老年患者退行性疾病和隐匿性表现可能会延迟诊断。对于关节病变的老年患者应考虑脓毒症，并必须迅速积极地开始治疗，以防止出现后遗症。
