George Jerry, Chandy V J, Premnath John, Hariharan T D, Oommen Anil Thomas, Balaji V, Poonnoose Pradeep M
Department of Orthopaedics, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India.
Indian J Med Microbiol. 2019 Jan-Mar;37(1):29-33. doi: 10.4103/ijmm.IJMM_19_134.
The aim of this study is to characterise the clinical and microbiological profile of adult patients treated at our orthopaedic unit with septic arthritic between 2006 and 2017.
A total of 70 patients who were admitted with a diagnosis of septic arthritis between 2006 and 2017 were included in the study. The patients' clinical and epidemiological characteristics were surveyed; microbiological profile and the complications relating to the patients' treatment were identified.
Septic arthritis was more common among males (83%). About 75% of the patients presented with a history of fever. The knee was the most commonly affected joint (71%), followed by the hip. While C-reactive protein was found to be consistently >75, total blood white blood cell (WBC) counts were found not to be reflective of the presence of infection with a mean WBC count of only 13,561/cu.mm, and Gram stain examination had a poor sensitivity of 47%. Among the co-morbidities, the most prevalent association was with diabetes mellitus. The infectious agent most frequently isolated was Staphylococcus aureus(42.85%). The antibiotic sensitivity pattern has evolved since the early years, with resistant strains becoming increasingly prevalent. Unusually, high incidence of streptococci was noted (30%), contrary to the published literature. One-third of the patients had multi-resistant organisms. Septic arthritis left 70% of the patients with a significant residual disability at 6 months follow-up and had 4.25% mortality.
Changing sensitivity patterns of microbes in septic arthritis point to a need for reconsidering empirical antibiotic therapy. Joint damage following infection can lead to significant disability.
本研究旨在描述2006年至2017年间在我们骨科接受治疗的成年化脓性关节炎患者的临床和微生物学特征。
本研究纳入了2006年至2017年间共70例诊断为化脓性关节炎的患者。调查了患者的临床和流行病学特征；确定了微生物学特征以及与患者治疗相关的并发症。
化脓性关节炎在男性中更为常见（83%）。约75%的患者有发热病史。膝关节是最常受累的关节（71%），其次是髋关节。虽然发现C反应蛋白持续>75，但发现全血白细胞（WBC）计数不能反映感染情况，平均WBC计数仅为13,561/立方毫米，革兰氏染色检查的敏感性较差，为47%。在合并症中，最常见的关联是糖尿病。最常分离出的病原体是金黄色葡萄球菌（42.85%）。自早年以来，抗生素敏感性模式发生了变化，耐药菌株越来越普遍。与已发表的文献相反，异常的是，链球菌的发病率很高（30%）。三分之一的患者有多重耐药菌。在6个月的随访中，化脓性关节炎使70%的患者有明显的残余残疾，死亡率为4.25%。
化脓性关节炎中微生物敏感性模式的变化表明需要重新考虑经验性抗生素治疗。感染后的关节损伤可导致严重残疾。
