300. Armed to the Teeth: Human Bite-Associated Septic Arthritis

Abstract

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.

Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections—A Five-Year Retrospective Study

“…These types of injuries frequently determine septic arthritis of the hand because of the nature of the pathogens present in the oral flora of animals and humans and the mechanics of the bite, which often results in penetrating injuries that introduce polymicrobial pathogens directly into the joint space [ 5 , 28 , 29 , 30 ].…”

An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review

“…WBC≥50,000/ml in a synovial fluid provides diagnostic significance for septic arthritis; however, only 5% of individuals with septic arthritis had WBC <50,000/ml in their synovial fluid (Coutlakis et al, 2002). Gram stains are positive in 40% to 70% of septic arthritis patients (Ross, 2017), although, in a study by McBride et al,543 samples of septic arthritis in adults, only 40% had a positive synovial fluid culture (McBride et al, 2020). In another conducted by Daynes et al,55% of 183 adult patients with native septic arthritis had positive synovial fluid cultures, while 54% of 65 patients with native septic arthritis had positive blood cultures; 91% of the blood culture results were identical to the joint fluid culture results.…”

“…The incidence of the large joint is higher than small joints for septic arthritis and raised with age; the most commonly involved large joint was the knee and hand interphalangeal in the small joints (Mathews et al, 2010;Ilharreborde, 2015;Momodu and Savaliya, 2022). Staphylococcus aureus is the most common pathogen causing septic arthritis (Kennedy et al, 2015;Jung et al, 2018;McBride et al, 2020).…”

“…Treatment failure was independently linked with joint size, age, intra-articular non-arthroplasty prosthesis, and surgical procedures performed. Small-joint septic arthritis has a better prognosis than large-joint septic arthritis and may be treated safely with shorter antibiotic courses (McBride et al, 2020). Injection drug use is a growing cause of septic knee admissions and is related to greater rates of death, recurrent arthroscopic or open irrigation, and debridement (Oh et al, 2018).…”

Bone and joint infection: past, present, and future

“…The incidence of the large joint is higher than small joints for septic arthritis and raised with age; the most commonly involved large joint was the knee and hand interphalangeal in the small joints (Mathews et al, 2010;Ilharreborde, 2015;Momodu and Savaliya, 2022). Staphylococcus aureus is the most common pathogen causing septic arthritis (Kennedy et al, 2015;Jung et al, 2018;McBride et al, 2020).…”