Teparrukkul Prapit, Nilsakul Jiraphorn, Dunachie Susanna, Limmathurotsakul Direk
Medical department, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Microbiological department, Sunpasitthiprasong Hospital, Ubon Ratchathani, Thailand.
Am J Trop Med Hyg. 2017 Dec;97(6):1695-1701. doi: 10.4269/ajtmh.17-0288. Epub 2017 Sep 28.
Septic arthritis is a medical emergency, and if not treated appropriately, it can be associated with high morbidity and mortality. Melioidosis, a serious infectious disease caused by the Gram-negative bacillus , is highly endemic in South and Southeast Asia and northern Australia. We reviewed the medical charts of adult patients admitted with bacterial septic arthritis at Sunpasitthiprasong Hospital, Ubon Ratchathani, northeast Thailand from January 2012 to December 2014. Bacterial septic arthritis was defined as one or more hot swollen joints with isolation of a pathogenic organism from an affected joint or from blood. A total of 154 patients with septic arthritis were retrospectively evaluated. The most common causes were (48%, = 74), spp. (29%, = 44), and (10%, = 16). Prevalence of diabetes, bacteremia, and pneumonia was higher in septic arthritis than in septic arthritis caused by the other bacteria (all < 0.01). Seventy three percent (54/74) of patients infected with and 69% (55/80) of patients with the other bacteria received effective antimicrobials on the first day of admission ( = 0.60), but in-hospital mortality of the former group was considerably higher (34% versus 14%, = 0.004). In conclusion, septic arthritis is common and associated with high mortality in northeast Thailand. Emergence of arthritis is observed. Difficulty in diagnosing melioidosis and identifying in areas where health care workers are not familiar with the disease is discussed. In melioidosis-endemic regions, parenteral ceftazidime could be considered as empirical antimicrobial therapy for patients with septic arthritis and underlying diseases.
脓毒性关节炎是一种医疗急症，若未得到恰当治疗，可能会导致高发病率和死亡率。类鼻疽是由革兰氏阴性杆菌引起的一种严重传染病，在南亚、东南亚和澳大利亚北部高度流行。我们回顾了2012年1月至2014年12月期间在泰国东北部乌汶叻差他尼府Sunpasitthiprasong医院收治的成年细菌性脓毒性关节炎患者的病历。细菌性脓毒性关节炎定义为一个或多个关节红肿发热，且从患关节或血液中分离出致病生物体。共对154例脓毒性关节炎患者进行了回顾性评估。最常见的病因是（48%， = 74）、 spp.（29%， = 44）和（10%， = 16）。脓毒性关节炎患者中糖尿病、菌血症和肺炎的患病率高于其他细菌引起的脓毒性关节炎（均 < 0.01）。感染的患者中有73%（54/74）以及感染其他细菌的患者中有69%（55/80）在入院第一天接受了有效的抗菌药物治疗（ = 0.60），但前一组的院内死亡率显著更高（34% 对 14%， = 0.004）。总之，在泰国东北部，脓毒性关节炎很常见且与高死亡率相关。观察到了类鼻疽关节炎的出现。讨论了在医护人员不熟悉该疾病的地区诊断类鼻疽和鉴定的困难。在类鼻疽流行地区，对于患有脓毒性关节炎和基础疾病的患者，可考虑将胃肠外使用头孢他啶作为经验性抗菌治疗。
