Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis

Abstract

Background and Objectives: Septic arthritis is a medical emergency associated with high morbidity and mortality. The incidence rate of septic arthritis among dialysis patients is higher than the general population, and dialysis patients with bacteremia frequently experience adverse outcomes. The aim of this study was to identify the clinical features and risk factors for longer hospital length of stay (LOS), positive blood culture, and in-hospital mortality in dialysis patients with septic arthritis. Materials and Methods: The medical records of 52 septic arthritis dialysis patients admitted to our hospital from 1 January 2009 to 31 December 2020 were analyzed. The primary outcomes were bacteremia and in-hospital mortality. Variables were compared, and risk factors were evaluated using linear and logistic regression models. Results: Twelve (23.1%) patients had positive blood cultures. A tunneled cuffed catheter for dialysis access was used in eight (15.4%) patients, and its usage rate was significantly higher in patients with positive blood culture than in those with negative blood culture (41.7 vs. 7.5%, p = 0.011). Fever was present in 15 (28.8%) patients, and was significantly more frequent in patients with positive blood culture (58.3 vs. 20%, p = 0.025). The most frequently involved site was the hip (n = 21, 40.4%). The most common causative pathogen was Gram-positive cocci, with MRSA (n = 7, 58.3%) being dominant. The mean LOS was 29.9 ± 25.1 days. The tunneled cuffed catheter was a significant predictor of longer LOS (Coef = 0.49; Cl 0.25–0.74; p < 0.001). The predictors of positive blood culture were fever (OR = 4.91; Cl 1.10–21.83; p = 0.037) and tunneled cuffed catheter (OR = 7.60; Cl 1.31–44.02; p = 0.024). The predictor of mortality was tunneled cuffed catheter (OR = 14.33; Cl 1.12–183.18; p = 0.041). Conclusions: In the dialysis population, patients with tunneled cuffed catheter for dialysis access had a significantly longer hospital LOS. Tunneled cuffed catheter and fever were independent predictors of positive blood culture, and tunneled cuffed catheter was the predictor of in-hospital mortality. The recognition of the associated factors allows for risk stratification and determination of the optimal treatment plan in dialysis patients with septic arthritis.

Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed

“…Among 52 patients with septic arthritis in Taiwan, the presence of tunneled cuffed catheter was more common in those with positive blood cultures (41.7 vs 7.5%, p = 0.011) which was also a predictor of longer hospital stay (OR = 7.60; Cl 1.31–44.02; p = 0.024) and higher mortality (OR = 14.33; Cl 1.12–183.18; p = 0.041). 40 This helps clinicians identify patients with tunneled cuffed catheter infection that are more likely to have worse outcomes and need close monitoring as well as aggressive source control and pharmacologic management. It is important to foster an environment of collaboration and communication, and this is one of the reasons why having a vascular surgeon or vascular access specialist onboard with the HD AMS team is crucial.…”

Survival and Risk Factor Analysis in Patients with Septic Arthritis: A Retrospective Study of 192 Cases

“…Signi cant prognostic factors identi ed in the literature include increasing age (p < .001), female sex (p = .046), higher CCI scores (p < .001), and lacking private insurance [28]. Yeh et al's study on 52 dialysis patients with SA revealed tunneled cuffed catheter and fever as predictors of positive blood culture, with tunneled cuffed catheter being a predictor of in-hospital mortality [29]. A study examining SA in emergency departments in the United States revealed that the female sex, urban residence, treatment at a metropolitan teaching hospital, and the presence of medical comorbidities including diabetes mellitus, hyperlipidemia, hypertension, chronic obstructive pulmonary disease, coronary heart disease, gout, osteoarthritis, renal failure, and heart failure were associated with an elevated probability of hospitalization [30].…”

Clinical Characteristics and In-Hospital Outcomes in Patients with Iliopsoas Abscess: A Multicenter Study

“…The severity of the existing physical condition and clinical status (e.g., advanced age, congestive heart failure) may affect the prognosis in patients with IPA. The development of septic shock significantly increases the risk of mortality, which is attributed to several factors, including multiple organ dysfunction, immune system response, and treatment challenges [13,29]. For patients at a higher risk of mortality, a more aggressive therapeutic approach and more frequent monitoring should be considered in addition to empiric antibiotic treatment.…”

“…One study conducted by Hsieh et al revealed that gas-forming IPA frequently requires aggressive drainage and, consequently, contributes to longer LOS [3]. Several studies have demonstrated that an elevated serum creatinine level or dialysis status was associated with poor prognosis [2,3,16,26,27,29,30]. Chronic kidney disease results in impairment of the immune system and aggravates the disease [31][32][33].…”