Site-specific mortality in native joint septic arthritis: a national population study

Abstract

Objective This national cohort study investigated the incidence, site-specific mortality and prognostic factors of native septic arthritis (SA). Methods Tapping Taiwan’s National Health Insurance Research Database, we identified inpatients with newly diagnosed SA between 1998 and 2012. They were categorized by site of infection and followed to calculate 30-day, 90-day and 1-year mortality. Predictors of mortality were calculated using Cox models. Results A total of 31 491 patients were identified as having SA, the most common site of infection being the knee (50.1%), followed by the hip (14.4%), other sites (26.8%), the shoulder (5.5%) and multiple sites (1.2%). Knee joint involvement was the most common site for all subgroups. Incidence increased from 9.8/105 in 1998 to 13.3/105 in 2012. The 30-day, 90-day and 1-year mortality rates were 4.3, 8.6 and 16.4% respectively. Predictors for mortality were hip infection, shoulder infection, multiple-site infection, being male, age ≥65 years old and comorbidities. We derived a mortality scoring model over age/SA site/comorbidity, and age ≥65 years old had the greatest risk contribution to mortality. No matter whether 1-month, 3-month or 1-year mortality was being considered, patients with the higher risk scores had the higher mortality rates (P < 0.0001). Conclusion SA is an emerging infectious disease with a rising incidence, long duration of hospital stay and high mortality rate. The most common affected joint was knee for all subgroups. Patients aged ≥65 years old had a high SA incidence and the greatest risk contribution.

Native joint infections in Iceland 2003–2017: an increase in postarthroscopic infections

“…Delayed or inadequate treatment can result in permanent loss of joint function as well as life-threatening septicaemia. Even with treatment, overall mortality rates related to SA can be significant in adults, ranging from 3% to 23% with 30-day mortality rates of 2%-10% [1][2][3][4][5][6][7][8] and a poor functional outcome in 24% of cases. 9 The incidence of SA is increasing according to some studies.…”

Non‐gonococcal septic arthritis of native joints in Western Australia. A longitudinal population‐based study of frequency, risk factors and outcome

“…30 Knees were the most frequently affected joint, and the relative high frequency of hand (wrist/small joints) SA is in line with some recent studies reporting 22%-31% frequencies of SA in the hands. 6,11 In culturepositive SA, Gram stain-positive cocci were found in 62% as in other studies 6,21,22 but with Gram-negative bacteria observed in about a third of cases, these should certainly be considered when initiating empirical antibiotic treatment. 29 While in-hospital mortality in this study was at the lower range (2%-10%) reported, 6,11,31 aspirations (13.7%) and replacement (2.1%) and new onset of inflammatory joint disease were similar across groups and on the lower end of reported SA sequelae.…”

“…12 Despite variable case definitions (eg, inclusion of prosthetic joint infections), this increasing trend is seen across most studies. 11,12,21,22 behind this rise in SA cases are less clear. A contribution from increasing numbers of diagnostic and therapeutic joint procedures has been described, 9 while other studies suggest a role for aging populations with underlying organ-based comorbidities.…”

“…26,27 Pre-existing joint disease was present in 15% of patients, with a recent joint procedure contributing to around 6% of cases, which is considerably lower than the 13.4% iatrogenic rate in Iceland. 9 The clinical presentation of SA was unremarkable 9,21,22,28,29 as male preponderance is nearly universal in studies of SA while the comparatively low age at diagnosis (49 years) likely results from excluding patients with prosthetic joint infection. 30 Knees were the most frequently affected joint, and the relative high frequency of hand (wrist/small joints) SA is in line with some recent studies reporting 22%-31% frequencies of SA in the hands.…”

Association of childhood physical and sexual abuse with arthritis in adulthood: Findings from a population-based study

“…Arthritis and other rheumatic conditions can lead to chronic pain, deformity, poor physical functioning, mental health problems, and decreased quality of life over time ( Barbour et al, 2013 , Barbour et al, 2017 , Centers for Disease Control and Prevention, 2017 , Khanna et al, 2011 , Price et al, 2020 ). If not treated, arthritis can also increase the risk of mortality ( England et al, 2018 , Huang et al, 2020 , Kiadaliri et al, 2017 ). Thus, understanding factors associated with arthritis is an important first step towards an effective and efficient allocation of resources in managing arthritis.…”