Background Native joint septic arthritis (NJSA) is poorly studied. We describe the epidemiology, treatment, and outcomes of large joint NJSA (LNJSA) and small joint NJSA (SNJSA) in adults at Middlemore Hospital, Auckland, New Zealand. Methods This was a coding-based retrospective study of patients ≥16 years old admitted between 2009 and 2014. Prosthetic joint infections were excluded. Results Five hundred forty-three NJSA episodes were included (302 LNJSA, 250 SNJSA). Only 40% had positive synovial fluid culture. Compared to SNJSA, LNJSA has higher incidence (13 vs 8/100 000 person-years [PY]), occurs in older, more comorbid patients, and is associated with greater rates of treatment failure (23% vs 12%) and mortality, despite longer antibiotic treatment. Total incidence is higher than previously reported (21/100 000 PY), with marked interethnic variation. Incidence rises with age (LNJSA only) and socioeconomic deprivation (LNJSA and SNJSA). Tobacco smokers and males are overrepresented. The most commonly involved joints were knee (21%) and hand interphalangeal (20%). Staphylococcus aureus was the most common pathogen (53%). Mean antibiotic duration was 25 days for SNJSA and 40 days for LNJSA, and the mean number of surgical procedures was 1.5 and 1.6, respectively. Treatment failure was independently associated with LNJSA, age, intra-articular nonarthroplasty prosthesis, and number of surgical procedures. Conclusions This is the largest contemporary series of adult NJSA. SNJSA has better outcomes than LNJSA and may be able to be safely treated with shorter antimicrobial courses. Incidence is high, with significant ethnic and socioeconomic variation. Microbiological NJSA case ascertainment underestimates case numbers as it frequently excludes SNJSA.
Despite the significant variation in the types of diseases, procedures and indicators of surgical care of the included studies, consistent findings are that disparities in different aspects of surgical care exist between Māori and NZE in NZ. This review highlights the need to better quantify the important issue of health equity for Māori in surgery given the lack of studies over the majority of surgical specialties.
BackgroundFight bite-related septic arthritis (FBSA) occurs when a joint is infected following a human bite injury. We aimed to describe the clinical features, treatment, and outcomes of FBSA and compare these with native joint septic arthritis of other causes.MethodsCases were obtained from a previously described retrospective cohort of adult native joint septic arthritis admitted to Middlemore Hospital, Auckland, New Zealand from January 1, 2009 and December 31, 2014. FBSA cases were compared with small-joint non-fight bite septic arthritis (SJNFBSA), and all NFBSA. P-values of ≤0.05 were considered significant.ResultsSixty-seven FBSA and 476 NFBSA cases (including 183 SJNFBSA) were identified. Compared with SJNFBSA and all NFBSA, FBSA was associated with younger age (median 26 years vs. 49 and 52, respectively) and tobacco use, but lower rates of diabetes, osteoarthritis and renal failure. Osteomyelitis was more common and metastatic infection less common in FBSA (all P ≤ 0.05). FBSA was more likely to be polymicrobial (76% vs. 30% and 20%), and to be caused by oral flora, oral streptococci, HACEK organisms, and anaerobes. SJNFBSA was less likely to be caused by S. aureus than FBSA. FBSA was more commonly managed operatively than SJNFBSA and all NFBSA (93% vs. 79% and 81%) and received shorter antibiotic courses (median 2 weeks vs. 4 and 5 weeks), more commonly orally (84% oral vs. 6% and 32%). Hospital length of stay for FBSA was shorter (median 4.5 days vs. 6 and 9 days). Compared with all NFBSA, treatment failure was less common (7% vs. 19%, P = 0.0242) and there was a trend toward lower mortality (0% vs. 5%, P = 0.0604).ConclusionFBSA represents a distinct subset of septic arthritis with differing morbidity and better outcomes than NFBSA. FBSA may be able to be safely managed with shorter, oral antibiotic regimens if adequate operative management is undertaken. Further studies are required to validate these findings.Disclosures All authors: No reported disclosures.
BackgroundNative joint septic arthritis (NJSA) is commonly caused by Gram-positive organisms. Gram-negative NJSA is uncommon, and discussion is usually limited to gonococcal arthritis despite NJSA due to enterobacteriaceae being more prevalent. We aimed to describe the clinical features, treatment, and outcomes of enterobacteriaceae NJSA (ENJSA).MethodsCases were obtained from a previously described retrospective cohort of adult NJSA admitted to Middlemore Hospital, Auckland, and New Zealand between January 1, 2009 and December 31, 2014. ENJSA episodes were compared with non-Enterobacteriaceae NJSA (NENJSA).ResultsFrom 543 NJSA episodes identified, ENJSA were the most frequent Gram-negative group (7%, 36/543) followed by HACEK (25/543), nonfermenters (10/543), Pasteurella (9/543), and Neisseria (5/543). The median age of ENJSA cases was 50 years and 72% were male. Immune compromise was more prevalent in ENJSA (19%, 7/36) than NENJSA (8%, 42/507), P = 0.0341. The most common causative organism for ENJSA was E. coli (10/36), followed by Enterobacter cloacae (8/36) and Klebsiella pneumoniae (6/36). Polymicrobial infection was more common in ENJSA (64%, 23/36) than NENJSA (20%, 99/507), P ≤ 0.0001. All ENJSA cases were monoarticular, and 72% (26/36) affected large joints. Small joint infection was less common in ENJSA (28%, 10/36) than NENJSA (47%, 240/507), P = 0.0247. Osteomyelitis was more common in ENJSA (53%, 19/36) than NENJSA (23%, 116/507), P = 0.0002. Carbapenems and ciprofloxacin were the most commonly utilised antimicrobials for ENJSA. Clinical outcomes were worse for ENJSA, with higher rates of treatment failure (53%, 19/36) than NENJSA (15%, 76/507), P = 0.0001 (although this association did not persist on multivariate analysis of the whole cohort) and longer mean length of stay (23.2 vs. 12.8 days P = 0.0001).ConclusionEnterobacteriaceae are an important and poorly described cause of NJSA, associated with immune compromise, large joint infection, polymicrobial infection, treatment failure, and increased hospital length of stay. The optimal management strategy to improve ENJSA outcomes is unknown, but may include more aggressive surgical and longer medical therapy. Further studies of ENJSA are warranted.Disclosures All authors: No reported disclosures.
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