Wu Kevin A, Kugelman David N, Seidelman Jessica L, Seyler Thorsten M
Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC 27701, USA.
Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA.
Antibiotics (Basel). 2024 Jun 27;13(7):596. doi: 10.3390/antibiotics13070596.
Native joint septic arthritis (NJSA) is a severe and rapidly progressing joint infection, predominantly bacterial but also potentially fungal or viral, characterized by synovial membrane inflammation and joint damage, necessitating urgent and multidisciplinary management to prevent permanent joint damage and systemic sepsis. Common in large joints like knees, hips, shoulders, and elbows, NJSA's incidence is elevated in individuals with conditions like rheumatoid arthritis, diabetes, immunosuppression, joint replacement history, or intravenous drug use. This review provides a comprehensive overview of NJSA, encompassing its diagnosis, treatment, antibiotic therapy duration, and surgical interventions, as well as the comparison between arthroscopic and open debridement approaches. Additionally, it explores the unique challenges of managing NJSA in patients who have undergone graft anterior cruciate ligament (ACL) reconstruction. The epidemiology, risk factors, pathogenesis, microbiology, clinical manifestations, diagnosis, differential diagnosis, antibiotic treatment, surgical intervention, prevention, and prophylaxis of NJSA are discussed, highlighting the need for prompt diagnosis, aggressive treatment, and ongoing research to enhance patient outcomes.
原发性关节化脓性关节炎(NJSA)是一种严重且进展迅速的关节感染,主要由细菌引起,但也可能是真菌或病毒感染,其特征为滑膜炎症和关节损伤,需要紧急的多学科管理以防止永久性关节损伤和全身脓毒症。NJSA常见于膝关节、髋关节、肩关节和肘关节等大关节,在类风湿关节炎、糖尿病、免疫抑制、有关节置换史或静脉吸毒等情况下,其发病率会升高。本综述全面概述了NJSA,包括其诊断、治疗、抗生素治疗疗程、手术干预,以及关节镜清创术和开放清创术方法的比较。此外,还探讨了在接受前交叉韧带(ACL)重建移植的患者中管理NJSA的独特挑战。讨论了NJSA的流行病学、危险因素、发病机制、微生物学、临床表现、诊断、鉴别诊断、抗生素治疗、手术干预、预防和预防措施,强调了及时诊断、积极治疗以及持续研究以改善患者预后的必要性。