Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis

Flores-Robles, B J; Palop, Mercedes Jiménez; Sanchinel, Abel Alejandro Sanabria; Andrus, Robert Francis; Vicente, Ana Royuela; Pérez, Marta Isabel Sanz; Malpartida, María Espinosa; Giráldez, Consuelo Ramos; Argumánez, C. Merino; Alcázar, Luis Fernando Villa; Sánchez, J. L. Andréu; Tundidor, Hildegarda Godoy; Esteban, J. Campos; Sanz, Jesús; Mateos, C. Barbadillo; Zaragoza, C. Isasi; Mendoza, Juan Mulero

doi:10.1097/rhu.0000000000000615

Cited by 25 publications

(31 citation statements)

References 27 publications

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“…A non-operative approach of NJSA management has not been yet prospectively studied. By contrast with Flores-Robles et al who did not observe worst outcomes with medical or surgical management, 29 in our cohort, patients undergoing surgery had higher rate of adverse joint outcome. However, we could not exclude an indication bias, since patients undergoing surgery probably had a more serious condition.…”

Section: Miscellaneouscontrasting

confidence: 99%

Management and outcome of native joint septic arthritis: a nationwide survey in French rheumatology departments, 2016–2017

Richebé

Coiffier²,

Guggenbuhl

et al. 2022

Ann Rheum Dis

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ObjectivesTo describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments.MethodsFor this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded.ResultsOverall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0–14)). Knee was the most frequent site (n=160 (38.9%)), and Staphylococcus sp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; p<0.001), Charlson’s index (OR 1.30, 95% CI 1.06 to 1.58; p=0.012), presence of bacteraemia (OR 4.02, 95% CI 1.35 to 11.99; p=0.008), antibiotic use in the previous 3 months (OR 3.32, 95% CI 1.11 to 9.87; p=0.029) and Staphylococcus aureus NJSA compared with Streptococcus sp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%).ConclusionPrognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.

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Section: Miscellaneouscontrasting

confidence: 99%

Management and outcome of native joint septic arthritis: a nationwide survey in French rheumatology departments, 2016–2017

Richebé

Coiffier²,

Guggenbuhl

et al. 2022

Ann Rheum Dis

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“…In children with uncomplicated septic arthritis, as few as 10 days of antibiotic therapy may be sufficient [ 82 ]. Septic arthritis can be managed with antibiotics combined with joint drainage by arthroscopy, arthrocentesis, or arthrotomy [ 83 , 84 , 85 ]. Joint drainage decompresses the joint, improves blood flow, and removes bacteria, toxins, and proteases [ 84 ].…”

Section: Diagnosis and Treatment Of Septic Arthritismentioning

confidence: 99%

Neutrophils: Beneficial and Harmful Cells in Septic Arthritis

Boff

Crijns

Teixeira

et al. 2018

IJMS

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Septic arthritis is an inflammatory joint disease that is induced by pathogens such as Staphylococcus aureus. Infection of the joint triggers an acute inflammatory response directed by inflammatory mediators including microbial danger signals and cytokines and is accompanied by an influx of leukocytes. The recruitment of these inflammatory cells depends on gradients of chemoattractants including formylated peptides from the infectious agent or dying cells, host-derived leukotrienes, complement proteins and chemokines. Neutrophils are of major importance and play a dual role in the pathogenesis of septic arthritis. On the one hand, these leukocytes are indispensable in the first-line defense to kill invading pathogens in the early stage of disease. However, on the other hand, neutrophils act as mediators of tissue destruction. Since the elimination of inflammatory neutrophils from the site of inflammation is a prerequisite for resolution of the acute inflammatory response, the prolonged stay of these leukocytes at the inflammatory site can lead to irreversible damage to the infected joint, which is known as an important complication in septic arthritis patients. Thus, timely reduction of the recruitment of inflammatory neutrophils to infected joints may be an efficient therapy to reduce tissue damage in septic arthritis.

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“…It is difficult to conclude whether this was due to serial aspiration having a therapeutic effect or, more likely, the presence of antibiotic therapy. Although the efficiency of treatment for septic arthritis may be debated, the length of treatment and thus inpatient hospital stay is not, with all previous research indicating a longer length of stay in medically managed septic arthritis [3,6,8], to which our series is no exception. In our case series, we used serial aspiration for one patient as a mode of palliative symptom control.…”

Section: Discussionmentioning

confidence: 79%

“…However, the medical management of septic arthritis is not a novelty, with good results being seen in treating native hip septic arthritis with serial aspiration in the paediatric population, and this remains a validated treatment option [ 5 ]. Recent research has indicated that in the adult population, the medical management of native joint septic arthritis is not inferior to surgical management [ 3 , 6 ] but has failed to demonstrate any patient outcome or cost advantages. Literature also fails to define a medical management timeline, particularly in regards to the timing of serial aspiration, the number of aspirates to be therapeutic, and objective measurements to assess the effectiveness of treatment.…”

Section: Discussionmentioning

confidence: 99%