Hunter Joshua G, Gross Jonathan M, Dahl Jason D, Amsdell Simon L, Gorczyca John T
Department of Orthopaedic Surgery and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Avenue, Box 665, Rochester, NY 14642. E-mail address for J.T. Gorczyca:
J Bone Joint Surg Am. 2015 Apr 1;97(7):558-64. doi: 10.2106/JBJS.N.00593.
Acute septic arthritis in a native joint may require more than one surgical debridement to eradicate the infection. Our objectives were to determine the prevalence of failure of a single surgical debridement for acute septic arthritis, to identify risk factors for failure of a single debridement, and to develop a prognostic probability algorithm to predict failure of a single surgical debridement for acute septic arthritis in adults.
We collected initial laboratory and medical comorbidity data of 128 adults (132 native joints) with acute septic arthritis who underwent at least one surgical debridement at our institution between 2000 and 2011. Univariate and logistic regression analyses were used to identify potential risk factors for failure of a single surgical debridement. Stepwise variable selection was used to develop a prediction model and identify probabilities of failure of a single surgical debridement.
Of the 128 patients (132 affected joints) who underwent surgical debridement for acute septic arthritis, forty-nine (38%) of the patients (fifty joints) experienced failure of a single debridement and required at least two debridements (range, two to four debridements). Staphylococcus aureus was the most common bacterial isolate (in sixty, or 45%, of the 132 joints). Logistic regression analysis identified five independent clinical predictors for failure of a single surgical debridement: a history of inflammatory arthropathy (odds ratio [OR], 7.3; 95% confidence interval [CI], 2.4 to 22.6; p < 0.001), the involvement of a large joint (knee, shoulder, or hip) (OR, 7.0; 95% CI, 1.2 to 37.5; p = 0.02), a synovial-fluid nucleated cell count of >85.0 x 10(9) cells/L (OR, 4.7; 95% CI, 1.8 to 17.7; p = 0.002), S. aureus as the bacterial isolate (OR, 4.6; 95% CI, 1.8 to 11.9; p = 0.002), and a history of diabetes (OR, 2.6; 95% CI, 1.1 to 6.2; p = 0.04).
Most (62%) of the septic joints were managed effectively with a single surgical debridement. Adults with a history of inflammatory arthropathy, involvement of a large joint, a synovial-fluid nucleated cell count of >85.0 x 10(9) cells/L, an infection with S. aureus, or a history of diabetes had a higher risk of failure of a single surgical debridement for acute septic arthritis and requiring additional surgical debridement(s).
原发性关节急性化脓性关节炎可能需要不止一次外科清创术来根除感染。我们的目标是确定急性化脓性关节炎单次外科清创术失败的发生率，识别单次清创术失败的风险因素，并开发一种预测概率算法，以预测成人急性化脓性关节炎单次外科清创术的失败情况。
我们收集了2000年至2011年间在本机构接受至少一次外科清创术的128例成人（132个原发性关节）急性化脓性关节炎患者的初始实验室和内科合并症数据。采用单因素和逻辑回归分析来识别单次外科清创术失败的潜在风险因素。采用逐步变量选择法来开发预测模型，并确定单次外科清创术失败的概率。
在128例接受急性化脓性关节炎外科清创术的患者（132个受累关节）中，49例（38%）患者（50个关节）单次清创术失败，需要至少两次清创术（范围为两次至四次清创术）。金黄色葡萄球菌是最常见的分离细菌（在132个关节中的60个，即45%）。逻辑回归分析确定了单次外科清创术失败的五个独立临床预测因素：炎性关节病病史（比值比[OR]，7.3；95%置信区间[CI]，2.4至22.6；p<0.001）、大关节（膝、肩或髋）受累（OR，7.0；95%CI，1.2至37.5；p = 0.02）、滑液有核细胞计数>85.0×10⁹个/L（OR，4.7；95%CI，1.8至17.7；p = 0.002）、分离出金黄色葡萄球菌（OR，4.6；95%CI，1.8至11.9；p = 0.002）以及糖尿病病史（OR，2.6；95%CI，1.1至6.2；p = 0.04）。
大多数（62%）化脓性关节通过单次外科清创术得到有效治疗。有炎性关节病病史、大关节受累、滑液有核细胞计数>85.0×10⁹个/L、感染金黄色葡萄球菌或有糖尿病病史的成人，急性化脓性关节炎单次外科清创术失败并需要额外进行外科清创术的风险更高。
