Madruga Dias J, Costa M M, Pereira da Silva J A, Viana de Queiroz M
Rheumatology Department, Santa Maria Hospital, Centro Hospitalar de Lisboa Norte, Avenida Professor Egas Moniz, 1649-035, Lisbon, Portugal,
Infection. 2014 Apr;42(2):385-91. doi: 10.1007/s15010-013-0567-z. Epub 2013 Dec 7.
Septic arthritis can be disabling and life-threatening, requiring prompt diagnosis and treatment. The infectious agent is not always identified in these patients. We revaluate septic arthritis cases discharged from our department, describing the affected population, causative microorganisms and antibiotic therapy used, and characterised differences between patients with and without isolated pathogenic agents.
Sixty-eight septic arthritis patients were included in this study. Diagnosis was based on clinical findings, and/or the presence of joint purulent material, and/or bacterial pathogen isolation from joint fluid/synovial membrane/blood cultures and response to antibiotics. Data analysis was performed using SPSS 20.
Patients had a mean age of 61.1 ± 18.8 years, without sex predominance. 26.5 % had an infection ≤ 15 days before septic arthritis diagnosis. Besides previous infection, 57.4 % had ≥ 1 risk factors for septic arthritis, most commonly pharmacological immunosuppression (20.6 %), diabetes mellitus type 2 (19.1 %) and rheumatoid arthritis (17.6 %). The knee was the most often affected (54.3 %). Only 39.7 % presented fever from clinical onset until hospital admission (mean 13.4 ± 18.9 days). Leucocytosis was present in 45.6 % of patients, elevated erythrocyte sedimentation rate (ESR) in 75 % and elevated C-reactive protein (CRP) in 97.1 %. 5.9 % had articular damage attributable to septic arthritis. An infectious agent was isolated in 41.2 % of patients, with Staphylococcus aureus being the most frequent. 38.7 % of synovial fluid and 23.5 % of synovial membrane cultures were positive. Patients with an identified infectious agent have no significant differences other than more days of hospitalisation (p = 0.003) and in-hospital antibiotic treatment (p = 0.017).
Synovial fluid and synovial membrane cultures more often identified pathogens compared to blood or urine cultures. Patients with and without an identified infectious agent have similar demographic, clinical, laboratory and radiographic characteristics.
化脓性关节炎可能导致残疾甚至危及生命，需要及时诊断和治疗。在这些患者中，感染病原体并不总是能被识别出来。我们重新评估了从我们科室出院的化脓性关节炎病例，描述了受影响人群、致病微生物以及所使用的抗生素治疗情况，并对有和没有分离出致病病原体的患者之间的差异进行了特征分析。
本研究纳入了68例化脓性关节炎患者。诊断基于临床发现，和/或关节脓性物质的存在，和/或从关节液/滑膜/血培养中分离出细菌病原体以及对抗生素的反应。使用SPSS 20进行数据分析。
患者的平均年龄为61.1±18.8岁，无性别优势。26.5%的患者在化脓性关节炎诊断前≤15天有感染史。除既往感染外，57.4%的患者有≥1个化脓性关节炎危险因素，最常见的是药物性免疫抑制（20.6%）、2型糖尿病（19.1%）和类风湿关节炎（17.6%）。膝关节是最常受累的部位（54.3%）。从临床发病到入院只有39.7%的患者出现发热（平均13.4±18.9天）。45.6%的患者有白细胞增多，75%的患者红细胞沉降率（ESR）升高，97.1%的患者C反应蛋白（CRP）升高。5.9%的患者有关节损伤归因于化脓性关节炎。41.2%的患者分离出感染病原体，其中金黄色葡萄球菌最为常见。38.7%的关节液培养和23.5%的滑膜培养呈阳性。有明确感染病原体的患者除住院天数更多（p = 0.003）和住院期间抗生素治疗更多（p = 0.017）外，无显著差异。
与血液或尿液培养相比，关节液和滑膜培养更常能识别出病原体。有和没有明确感染病原体的患者在人口统计学、临床、实验室和影像学特征方面相似。
