Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan 33305, Taiwan.
Department of Nephrology, Kidney Research Center, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan.
Medicina (Kaunas). 2022 Mar 7;58(3):401. doi: 10.3390/medicina58030401.
Background and Objectives: Septic arthritis is a medical emergency associated with high morbidity and mortality. The incidence rate of septic arthritis among dialysis patients is higher than the general population, and dialysis patients with bacteremia frequently experience adverse outcomes. The aim of this study was to identify the clinical features and risk factors for longer hospital length of stay (LOS), positive blood culture, and in-hospital mortality in dialysis patients with septic arthritis. Materials and Methods: The medical records of 52 septic arthritis dialysis patients admitted to our hospital from 1 January 2009 to 31 December 2020 were analyzed. The primary outcomes were bacteremia and in-hospital mortality. Variables were compared, and risk factors were evaluated using linear and logistic regression models. Results: Twelve (23.1%) patients had positive blood cultures. A tunneled cuffed catheter for dialysis access was used in eight (15.4%) patients, and its usage rate was significantly higher in patients with positive blood culture than in those with negative blood culture (41.7 vs. 7.5%, p = 0.011). Fever was present in 15 (28.8%) patients, and was significantly more frequent in patients with positive blood culture (58.3 vs. 20%, p = 0.025). The most frequently involved site was the hip (n = 21, 40.4%). The most common causative pathogen was Gram-positive cocci, with MRSA (n = 7, 58.3%) being dominant. The mean LOS was 29.9 ± 25.1 days. The tunneled cuffed catheter was a significant predictor of longer LOS (Coef = 0.49; Cl 0.25−0.74; p < 0.001). The predictors of positive blood culture were fever (OR = 4.91; Cl 1.10−21.83; p = 0.037) and tunneled cuffed catheter (OR = 7.60; Cl 1.31−44.02; p = 0.024). The predictor of mortality was tunneled cuffed catheter (OR = 14.33; Cl 1.12−183.18; p = 0.041). Conclusions: In the dialysis population, patients with tunneled cuffed catheter for dialysis access had a significantly longer hospital LOS. Tunneled cuffed catheter and fever were independent predictors of positive blood culture, and tunneled cuffed catheter was the predictor of in-hospital mortality. The recognition of the associated factors allows for risk stratification and determination of the optimal treatment plan in dialysis patients with septic arthritis.
脓毒性关节炎是一种与高发病率和死亡率相关的医学急症。透析患者的脓毒性关节炎发病率高于普通人群，伴有菌血症的透析患者常出现不良预后。本研究旨在确定透析患者脓毒性关节炎中导致住院时间延长、血培养阳性和院内死亡的临床特征和危险因素。
分析了 2009 年 1 月 1 日至 2020 年 12 月 31 日期间我院收治的 52 例透析相关性脓毒性关节炎患者的病历。主要结局为菌血症和院内死亡。对变量进行比较，并使用线性和逻辑回归模型评估危险因素。
12 例（23.1%）患者血培养阳性。8 例（15.4%）患者使用带隧道带袖套的导管进行透析，带隧道带袖套的导管在血培养阳性患者中的使用率明显高于血培养阴性患者（41.7%比 7.5%，p=0.011）。15 例（28.8%）患者发热，血培养阳性患者发热更常见（58.3%比 20%，p=0.025）。最常受累的部位是髋关节（n=21，40.4%）。最常见的病原体是革兰阳性球菌，以耐甲氧西林金黄色葡萄球菌（MRSA，n=7，58.3%）为主。平均住院时间为 29.9±25.1 天。带隧道带袖套的导管是导致住院时间延长的显著预测因素（Coef=0.49；Cl 0.25-0.74；p<0.001）。血培养阳性的预测因素为发热（OR=4.91；Cl 1.10-21.83；p=0.037）和带隧道带袖套的导管（OR=7.60；Cl 1.31-44.02；p=0.024）。死亡的预测因素是带隧道带袖套的导管（OR=14.33；Cl 1.12-183.18；p=0.041）。
在透析人群中，使用带隧道带袖套的导管进行透析的患者住院时间明显延长。带隧道带袖套的导管和发热是血培养阳性的独立预测因素，带隧道带袖套的导管是院内死亡的预测因素。认识到相关因素可以对透析相关性脓毒性关节炎患者进行风险分层，并确定最佳治疗方案。
