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Volume 42, Number 3, June 2009

Characteristics and outcomes of community-onset septic arthritis in adults


Yu-Chung Chuang, Jiun-Ling Wang, Yee-Chun Chen, Shan-Chwen Chang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

Received: May 1, 2008    Revised: June 8, 2008    Accepted: July 15, 2008   

 

Corresponding author:

Dr. Shan-Chwen Chang, Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Rd., Taipei 100, Taiwan. E-mail: Dr. Shan-Chwen Chang This e-mail address is being protected from spam bots, you need JavaScript enabled to view it
 



 

Background and purpose: 

Failure to recognize and to appropriately treat septic arthritis results in substantial morbidity rates. This study compared the demographic characteristics, risk factors, and outcomes of patients with community-onset septic arthritis due to Gram-positive and Gram-negative bacteria.

 



 

Methods:

The medical charts of 51 adults with culture-proven community-onset septic arthritis treated at a tertiary medical center in northern Taiwan from January 1, 2004 through December 31, 2007 were retrospectively reviewed. The demographic data and clinical features were analyzed.
 



 

Results:

There were 39 patients with septic arthritis caused by Gram-positive cocci (76.4%) and 12 with septic arthritis caused by Gram-negative bacteria (23.6%). The most common pathogen was Staphylococcus aureus (n = 30; 58.9%). The most frequently involved joint was the knee (n = 33; 63.5%). By multivariate logistic regression analysis, age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; p = 0.024) and range of motion limitation (OR, 8.23; 95% CI, 1.14-59.49; p = 0.037) were independent predictive factors for septic arthritis caused by Gram-positive cocci. Diabetes mellitus with end-organ damage (OR, 0.03; 95% CI, 0.00-0.39; p = 0.007) and malignancy (OR, 0.04; 95% CI, 0.00-0.66; p = 0.025) were negative predictive factors for septic arthritis caused by Gram-positive cocci. There were no significant differences in outcomes for patients with Gram-positive and Gram-negative septic arthritis.
 



 

Conclusion:

In adult patients with community-onset septic arthritis, older age and limited range of motion predict for Gram-positive cocci as the causative pathogen, while underlying diabetes mellitus with end-organ damage and malignancy predict for Gram-negative bacteria as the causative pathogen.



 

Key words:

 Arthritis, infectious; Diabetes mellitus; Gram-negative bacteria; Gram-positive cocci; Neoplasms

 



 

J Microbiol Immunol Infect. 2009;42:258-264.