Youssef P P, York J R
Department of Rheumatology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
Aust N Z J Med. 1994 Jun;24(3):307-11. doi: 10.1111/j.1445-5994.1994.tb02178.x.
To review the diagnostic features, treatment and outcomes of all cases of septic arthritis presenting to a major Australian rheumatology unit, between 1982 and 1991. These were compared with the previous decade's experience.
The medical records of all cases of septic arthritis presenting to the Combined Centre for Rheumatic Diseases, The Rachel Forster Hospital between 1982 and 1991 were reviewed and compared with the experience of the previous decade (1971-1981).
Twenty-seven episodes of septic arthritis were diagnosed in 27 patients. There were 18 females and nine males. The average age was 62 (21-83) with three patients less than 30. Their rheumatological diagnoses were: rheumatoid arthritis (RA) in 15, osteoarthritis in five, gout in two, and one each of mixed connective disease, sarcoid, tenosynovitis of the forearm, seronegative spondyloarthropathy, and non specific polyarthritis. Eleven patients were on oral corticosteroids. Four patients had intra-articular injections within two months of the onset of the septic episode. Sixteen out of 19 aspirates on the wards were positive. The organisms identified were Staphylococcus aureus in ten (one multiply resistant S. aureus (MRSA), Streptococcus four, Mycobacterium three (one atypical), two Pseudomonas and one each of Citrobacter, Enterobacter, Gram negative bacillus. Five patients did not have a causative organism identified. The site of involvement and the causative organisms were similar in both decades. All patients received intravenous antibiotics for at least two weeks and oral antibiotics for at least another four weeks. Twenty-two per cent had regular aspirations on the wards and 26% had surgical drainage performed. Only 59% of all joints returned to good function. Fifty per cent of infected arthroplasties required arthrodesis and only a third of these returned to acceptable function.
Septic arthritis in subjects with previous rheumatic disease continues to have a poor prognosis, especially in cases of infected arthroplasties. There has been no change in the types of causative organisms or sites of involvement over the last two decades.
回顾1982年至1991年间澳大利亚一家大型风湿病治疗中心收治的所有脓毒性关节炎病例的诊断特征、治疗方法及治疗结果，并与前十年的经验进行比较。
回顾了1982年至1991年间在瑞秋·福斯特医院风湿性疾病联合中心就诊的所有脓毒性关节炎病例的病历，并与前十年（1971 - 1981年）的经验进行比较。
27例患者被诊断为脓毒性关节炎发作27次。其中女性18例，男性9例。平均年龄为62岁（21 - 83岁），3例患者年龄小于30岁。他们的风湿性诊断为：类风湿关节炎（RA）15例，骨关节炎5例，痛风2例，混合性结缔组织病、结节病、前臂腱鞘炎、血清阴性脊柱关节病和非特异性多关节炎各1例。11例患者正在服用口服糖皮质激素。4例患者在脓毒性发作开始后两个月内接受了关节内注射。病房内19次关节穿刺中有16次呈阳性。鉴定出的病原体为：金黄色葡萄球菌10例（1例多重耐药金黄色葡萄球菌（MRSA）），链球菌4例，分枝杆菌3例（1例非典型），铜绿假单胞菌2例，柠檬酸杆菌、肠杆菌各1例，革兰氏阴性杆菌1例。5例患者未鉴定出病原体。两个十年间受累部位和病原体相似。所有患者均接受了至少两周的静脉抗生素治疗和至少另外四周的口服抗生素治疗。22%的患者在病房接受了定期穿刺，26%的患者进行了手术引流。所有关节中只有59%恢复到良好功能。50%的感染人工关节需要进行关节融合术，其中只有三分之一恢复到可接受的功能。
既往有风湿性疾病的患者发生脓毒性关节炎的预后仍然较差，尤其是在感染人工关节的病例中。在过去二十年中，病原体类型和受累部位没有变化。
