Pyogenic Arthritis of the Fingers and the Wrist: Can We Shorten Antimicrobial Treatment Duration?

Abstract

Background.Pyogenic arthritis of the small joints of the hand and wrist is a known but poorly described entity. The objective of this work was to characterize the clinical presentation, antimicrobial treatment, and surgical interventions of native small joint arthritis (SJA) treated in our tertiary center.Methods.According to predefined variables, medical records of adult patients with SJA treated in a Swiss university hospital between 2005 and 2013 were retrospectively analyzed.Results.The median age of 97 patients (101 joints) was 52 years (interquartile range [IQR], 38–68 years); 52% had no comorbidity. Small joint arthritis of the second and third fingers accounted for 53% of infections, with metacarpal-phalangeal and proximal interphalangeal joints most commonly involved. Of 86 (89%) episodes with an exogenous source, 63 (65%) followed a trauma. The most commonly isolated microorganism was Staphylococcus aureus (38%), followed by β-hemolytic streptococci (13%) and Pasteurella spp (11%). Eighty-seven episodes (89 joints) in patients with follow-up examinations were included in treatment and outcome analyses. Up to 2 surgical interventions were required to cure infection in 74 (83%) joints. Median antimicrobial treatment duration was 14 days (IQR, 12–28 days), with amoxicillin/clavulanate administered in 74 (85%) episodes. At follow up, cure of infection was noted in all episodes and good functional outcome in 79% of episodes.Conclusions.Small joint arthritis shows considerable differences from clinical patterns reported for larger joints. In our series, the outcome was good with no more than 2 surgical interventions and median treatment duration of 14 days in 79% of episodes.

Primarily Treated Patients versus Referred Patients in the Treatment of Native Septic Arthritis of Digits: A Retrospective Comparative Study

“…In septic arthritis of the native nger joints, S. aureus was the most frequent isolated microorganism, followed by Streptococcal species; further, MRSA was detected in lesser number of cases than was MSSA [1,7,10,19,20]. Thus, conventional narrow-spectrum antibiotics such as penams and the rst-generation cephalosporins are recommended in primary cases.…”

“…Surgeons can choose either primary extensive resection or sequential gradual resection as long as the debridement extends beyond the necrotic tissues. Besides, the duration of antibiotics use could be shortened according to recent studies [10,22]. Thus, future studies, including large cohorts (to match age and treatment delay) and focusing on the extent of surgical debridement and shorter duration of antibiotics use are warranted.…”

“…One surgeon (the rst author) who was level 3 (specialist-experienced) according to Tang's levels of surgical expertise performed all surgeries [9]. The de nite diagnosis of septic arthritis of the digits was made after the surgery as having at least one of the following criteria: (1) growth of microorganisms from samples obtained during the operation, (2) intraoperative pus in the joint, and (3) leucocytes in the microscopic analysis of samples obtained during operation (leucocytes ≥10 in any of the 5 high power (×40) elds) [2,10,11]. We excluded patients who did not meet any of the criteria of septic arthritis (n=11), patients diagnosed with tuberculous arthritis (n=2), patients diagnosed with rheumatoid arthritis (n=4), and patients with metal implants (n=2).…”

Hand Infections

“…Appropriate antibiotic treatment is indispensable and should be adjusted after close monitoring and culture results. A study of 97 patients by Meier and colleagues 40 in 2017 found that the median antimicrobial treatment duration was 14 days. Surgical drainage should be done with care to avoid contamination of surrounding structures or injury to nearby structures, and patients should be advised that some degree of joint stiffness often is inevitable, especially in patients who presented after a few days of infection or whose proximal interphalangeal joints are affected.…”

Man With Finger Pain and Swelling

“…1 It occurs less frequently than large joint septic arthritis and is less likely to cause laboratory-result abnormalities and abnormal vital signs. 2 Water bath ultrasonography allows immediate, high-quality evaluation of the smaller joints of the body, which can quickly identify signs of septic arthritis not appreciable on physical examination. 3,4 Author affiliations: From the Department of Emergency Medicine, University of Kansas Health System, Kansas City, KS.…”