Clinical outcomes involving patients that develop septic arthritis with methicillin sensitive staphylococcus aureus versus methicillin resistant staphylococcus aureus

Combs, Kristen; Cox, Kyle

doi:10.1016/j.jor.2017.11.007

Cited by 15 publications

(18 citation statements)

References 14 publications

(8 reference statements)

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“…Prior literature also has not supported a clear association between age and MRSA vs MSSA infection across multiple infection types, including pneumonia and infective endocarditis [ 21–23 ]. Notably, a prior review of the literature comparing MRSA septic arthritis with MSSA septic arthritis did show that MRSA patients tended to be older than those with MSSA in several studies [ 24 ]. However, this review spanned several different countries.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors, Screening, and Treatment Challenges in Staphylococcus aureus Native Septic Arthritis

Gobao

Alfishawy

Smith

et al. 2020

Open Forum Infectious Diseases

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Background Staphylococcus aureus is the most common cause of native septic arthritis. Few studies have characterized this disease during the US opioid epidemic. The role of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening in this disease has not been elucidated. We sought to identify risk factors and outcomes for S. aureus native septic arthritis and to evaluate MRSA screening in this disease. Methods A retrospective cohort study of native septic arthritis patients (2012–2016) was performed. Demographics, risk factors, and outcomes were compared between Staphylococcus aureus and other native septic arthritis infections. Sensitivity, specificity, and predictive values of MRSA screening were assessed. Results Two hundred fifteen cases of native septic arthritis were included. S. aureus was cultured in 64% (138/215). MRSA was cultured in 23% (50/215). S. aureus was associated with injection drug use (odds ratio [OR], 4.33; 95% CI, 1.74–10.81; P = .002) and switching antibiotics (OR, 3.92; 95% CI, 1.01–21.38; P = .032). For every 10-year increase in age, the odds of S. aureus decreased (OR, 0.72; 95% CI, 0.60–0.87; P = .001). For 1-unit increases in Charlson comorbidity index score, the odds of S. aureus decreased (OR, 0.82; 95% CI, 0.73–0.91; P = .0004). MRSA screening during admission demonstrated a sensitivity of 0.59, specificity of 0.96, positive predictive value of 0.85, and negative predictive value of 0.84 for MRSA native septic arthritis. Conclusions The opioid epidemic may be contributing to a demographic shift in native septic arthritis to younger, healthier individuals. S. aureus native septic arthritis has unique risks, including injection drug use. MRSA screening may be useful to rule in MRSA native septic arthritis.

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Section: Discussionmentioning

confidence: 99%

Risk Factors, Screening, and Treatment Challenges in Staphylococcus aureus Native Septic Arthritis

Gobao

Alfishawy

Smith

et al. 2020

Open Forum Infectious Diseases

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“…Overall, SA is the most common pathogen that causes septic arthritis. 25 MRSA suppurative arthritis in children has been associated with an increased number of surgical interventions, longer duration of febrile days, extended courses of antibiotics, and increased sequelae. 7,8,12,17, 26 In a pediatric study based on 158 cases originating from a high income country, the authors highlighted the increasing trend of MRSA infections.…”

Section: Discussionmentioning

confidence: 99%

Suppurative arthritis of hip in a walking child: Effect of patient’s age, delay in surgical drainage, and organism virulence

Agarwal

2020

J Orthop Surg (Hong Kong)

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Introduction: We undertook a retrospective study to stratify the effect of patient’s age, delay in surgical drainage, and Staphylococcus aureus (SA) virulence on expected clinicoradiological outcomes following suppurative arthritis of hip joint in a walking child. Materials and methods: The study was conducted in 18 children over 2 years of age who suffered from joint fluid culture-positive SA arthritis of hip joint and treated with open arthrotomy. Outcomes were defined on the following criteria: age of child (≥5 years or <5 years), duration of symptoms elapsed before surgical intervention (≥5 days or <5 days), and virulence of SA (methicillin-resistant Staphylococcus aureus (MRSA)/methicillin-sensitive Staphylococcus aureus)). The final clinical results were graded according to Moon’s clinical criteria and radiologically by types described by Choi et al. Results: The mean patient age was 6.22 years at the time of index procedure. The average delay in surgery was 17.06 days. Follow-up averaged 15.28 months. Five patients had associated with osteomyelitis femur in preoperative radiographs. MRSA culture was grown in 8 hips (44.4%) of 18 hips. Unsatisfactory clinical results according to Moon’s criteria were obtained in 55.6% patients with 38.9% being MRSA infected. Unsatisfactory Choi’s radiological results were present in 33.3% patients, 27.8% under MRSA category. Our study did not find age to be a significant factor either in clinical or radiological outcome. The clinical results were unsatisfactory in 81.8% patients with surgical delays when compared to early surgery ( p < 0.05). Conclusions: The clinicoradiological outcome in suppurative hip arthritis of walking children was unsatisfactory when there was delay in treatment beyond 5 days, and the causative organism was virulent (MRSA). The presence of preoperative joint incongruency or osteomyelitis of proximal femur was another risk factor.

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“…10 Particularly, the C-SA (32.3%) and C-SA+S-SA (33.0%) haematocrit values are supported by research identifying < 34% haematocrit in MRSA-related SA. 14,17…”

Section: Discussionmentioning

confidence: 99%

Synovial fluid cell counts and its role in the diagnosis of paediatric septic arthritis

Obana

Murgai

Schur

et al. 2019

Journal of Children's Orthopaedics

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PurposeClinical presentation of paediatric septic arthritis (SA) can be similar to other joint pathologies. Despite potential for infection in all major joints, most diagnostic criteria are based on values from the hip. This study identifies the best joint aspirate values in diagnosing SA in all joints.MethodsIn all, 166 patients who underwent 172 joint aspirations at the authors’ institution between 01 September 2004 and 01 September 2014 were retrospectively identified. Recorded measures included age, sex, duration of symptoms, fever history, weight-bearing status, aspiration results, serum results and antibiotic administration. Patients were placed in the following four categories: ‘culture confirmed SA’ (C-SA), ‘suspected SA’ (S-SA), ‘Other’ and ‘Other-rheumatologic’ (Other-R), a subcategory of ‘Other’.ResultsMost common sites of aspiration were the knee (55%) and hip (29%). Diagnostic grouping was as follows: C-SA = 44, S-SA = 45, Other = 83 (Other-R = 21). Fever and non-weight-bearing prior to admission were useful predictors of SA, though in C-SA patients, 21% did not have a fever and 23% could weight bear at the time of admission. Aspirate white blood cell (WBC) count was significantly greater in both C-SA (92 000 cells/hpf) and S-SA (54 000) than in Other (10 000) and Other-R (18 000) patients. The percentage of polymorphonuclear (%PMN) was also significantly greater in C-SA (81.1%) and S-SA (80.9%) than in Other (57.9%) and Other-R (63.3%).ConclusionJoint aspirate values, especially %PMN, are valuable in diagnosing SA. Additionally, antibiotics pre-aspiration did not affect %PMN, facilitating subsequent diagnosis of infection. Lastly, while aspirate WBC count was a valuable indicator of SA, this finding is not as definitive as previous research suggests.Level of EvidenceIV Case Series

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Clinical outcomes involving patients that develop septic arthritis with methicillin sensitive staphylococcus aureus versus methicillin resistant staphylococcus aureus

Cited by 15 publications

References 14 publications

Risk Factors, Screening, and Treatment Challenges in Staphylococcus aureus Native Septic Arthritis

Risk Factors, Screening, and Treatment Challenges in Staphylococcus aureus Native Septic Arthritis

Suppurative arthritis of hip in a walking child: Effect of patient’s age, delay in surgical drainage, and organism virulence

Synovial fluid cell counts and its role in the diagnosis of paediatric septic arthritis

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