Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital

Abstract

ObjectiveTo describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment.MethodsA retrospective case series was studied with patients treated between 2004 and 2014. The patients’ clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated.ResultsTwenty-seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors.ConclusionsSeptic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. S. aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.

Detecção de Cutibacterium acnes em amostras de tecidos de cirurgias limpas primárias do ombro – Parte I

“…Regarding the only case with bacterial growth, we emphasize that it was not consistent with a shoulder infection since no clinical, laboratory or radiographic criteria were met; as such, the diagnosis of specimen contamination is evident. 19 The greatest importance of the present study is to alert for the low effectiveness of the methods currently used in Brazil for bacterial identification, even in the largest laboratories.…”

“…Com relação ao único caso em que ocorreu crescimento bacteriano, salientamos que ele não apresentou quadro compatível com infecção no ombro, uma vez que não preencheu nenhum critério clínico, laboratorial ou radiográfico, ficando evidente o diagnóstico de contaminação da amostra. 19 Consideramos que a grande importância do presente estudo é a de alertar a baixa eficácia dos métodos atualmente utilizados no Brasil para identificação bacteriana, mesmo nos maiores laboratórios.…”

“…Regarding the only case with bacterial growth, we emphasize that it was not consistent with a shoulder infection since no clinical, laboratory or radiographic criteria were met; as such, the diagnosis of specimen contamination is evident. 19 …”

“…Com relação ao único caso em que ocorreu crescimento bacteriano, salientamos que ele não apresentou quadro compatível com infecção no ombro, uma vez que não preencheu nenhum critério clínico, laboratorial ou radiográfico, ficando evidente o diagnóstico de contaminação da amostra. 19 …”

Bilateral septic arthritis of the shoulder: case report and literature review

“…Septic arthritis may be related to rheumatic diseases (rheumatoid arthritis, osteoarthritis, and other inflammatory arthritis), previous surgical procedures, diabetes, ulcers of the lower limbs, alcohol or intravenous drug abuse, injections of corticosteroids in the joints, and possibly HIV infection 21,22 . There was an association between septic arthritis and immunocompromise, the presence of comorbidities, and also previous joint disease 3,8,10,17,[23][24][25][26] . The most common form is by hematogenous dissemination.…”