Department of Orthopaedic Surgery, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, 605006, India.
Department of Orthopaedic Surgery, Jawaharlal Institute of Post Graduate Medical Education and Research, Pondicherry, 605006, India.
Chin J Traumatol. 2021 Mar;24(2):94-99. doi: 10.1016/j.cjtee.2020.11.005. Epub 2020 Nov 17.
There were 10%-30% of patients with adult-onset septic arthritis (SA) exhibiting sterile synovial fluid (SF), and the uncertainty in the determining diagnosis of these patients posed a challenge in management. The purpose of this study was to investigate the differences between confirmed (Newman A) and suspected (Newman B & C) SA in adults.
This was a descriptive study with a cross-sectional study design conducted at a tertiary referral centre from July 2016 to February 2019. Patients aged over 18 years presented to the emergency department with clinical features suggestive of SA and were scheduled to undergo arthrotomy and joint lavage by the treating surgeon were included in the study. Patients with prosthetic joint infections and open joint injuries were excluded. Patients' demographic data, clinical features and laboratory parameters were collected. The clinical and laboratory profile (blood and SF) of the adult patients presenting with features suggestive of SA based on Newman criteria was statistically analyzed by SPSS version 20 software and Microsoft Excel. The categorical variables were expressed as proportions while the continuous variables were expressed as mean (SD) or median (IQR) depending upon the normality of distribution. The difference between the two groups for categorical variables was assessed using the Chi-square test and the difference for continuous variables was assessed using the unpaired t-test and the Mann-Whitney test depending upon normality. A p value < 0.05 was considered significant.
Thirty-six patients were divided into confirmed (n = 19) or suspected (n = 17) SA for assessment based on SF culture. The median (IQR) age of the patients was 50 years (37-60 years). There was no significant difference in demographic, clinical and laboratory parameters between the concerned groups. Eight patients presented with fever. Among the confirmed SA cases, 8 were negative for C-reactive protein and 6 had synovial white blood cell count <50,000. Staphylococcus species were isolated in 8 cases. The most common risk factors for SA were chronic kidney disease (25.0%), diabetes mellitus (25.0%), pharmacologic immunosuppression (16.7%), recent joint surgery (11.1%) and distant site infection (11.1%).
SA is an orthopaedic emergency that needs prompt and aggressive treatment to prevent catastrophic complications. Confirmed and suspected cases of SA exhibit similar demography, clinical features and laboratory parameters at presentation which may mislead the treating surgeon. Management should be based on sound clinical judgment in the event of failure to culture microorganisms.
有 10%-30%的成人发病期脓毒性关节炎（SA）患者的滑液呈无菌性，这些患者的诊断不确定给治疗带来了挑战。本研究的目的是探讨成人确诊（Newman A）和疑似（Newman B 和 C）SA 之间的差异。
这是一项描述性研究，采用横断面研究设计，于 2016 年 7 月至 2019 年 2 月在一家三级转诊中心进行。纳入研究的患者为年龄在 18 岁以上，因临床特征提示有 SA 而到急诊科就诊，并计划由主治外科医生进行关节切开术和关节灌洗。排除患有假体关节感染和开放性关节损伤的患者。收集患者的人口统计学数据、临床特征和实验室参数。采用 SPSS 20 软件和 Microsoft Excel 对符合 Newman 标准的有 SA 临床特征的成年患者的临床和实验室特征（血液和 SF）进行统计学分析。分类变量用比例表示，连续变量用均值（SD）或中位数（IQR）表示，取决于分布的正态性。使用卡方检验评估两组间分类变量的差异，使用配对 t 检验和 Mann-Whitney 检验评估连续变量的差异，取决于正态性。p 值<0.05 为差异有统计学意义。
根据 SF 培养结果，36 例患者被分为确诊（n=19）或疑似（n=17）SA。患者的中位（IQR）年龄为 50 岁（37-60 岁）。两组患者的人口统计学、临床和实验室参数均无显著差异。8 例患者出现发热。在确诊的 SA 病例中，8 例 C 反应蛋白阴性，6 例滑膜白细胞计数<50,000。8 例分离出葡萄球菌。SA 的最常见危险因素为慢性肾脏病（25.0%）、糖尿病（25.0%）、药物免疫抑制（16.7%）、近期关节手术（11.1%）和远处部位感染（11.1%）。
SA 是一种骨科急症，需要及时、积极治疗，以预防灾难性并发症。确诊和疑似 SA 患者在就诊时表现出相似的人口统计学、临床特征和实验室参数，这可能会误导主治外科医生。如果未能培养出微生物，应根据临床判断进行治疗。
