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Volume 50, Number 4, August 2017

Clinical manifestations and bacteriological features of culture-proven Gram-negative bacterial arthritis 

Wei-Ting Lin, Hung-Jen Tang, Chih-Cheng Lai, Chien-Ming Chao


Corresponding author:

Chien-Ming Chao, Corresponding author. Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, 201, Taikang Village, Liou Ying Township, Tainan County, 736 Taiwan, ROC.


Background and purpose: 

To investigate the clinical manifestations and bacteriological features of culture-proven, Gram-negative bacterial arthritis. 



This study was conducted at the Chi Mei Medical Center, a 1300-bed teaching hospital located in southern Taiwan. Patients with synovial fluid cultures positive for Gram-negative bacilli (GNB) during the period January 2009 to May 2014 were identified from the hospital's computerized microbiology database. 



During the study period, a total of 48 patients with culture-confirmed, GNB septic arthritis were identified. In the majority of patients (n = 33, 68.8%), the knee was the most commonly involved joint. The most common causative pathogen was Pseudomonas spp. (n = 16, 33.3%), followed by Escherichia coli (n = 13, 28.1%). Among the 29 clinical isolates of Enterobacteriaceae, eight (27.6%) were resistant to ceftriaxone and six (20.7%) were resistant to cefpirome. Three E. coli isolates and three Klebsiella pneumoniae isolates were extended-spectrum beta-lactamase producers (n = 6, 20.7%). Among the nonfermenting GNB (NFGNB), 21.1% were resistant to ceftazidime, 21.1% were resistant to ciprofloxacin, 26.3% were resistant to piperacillin-tazobactam, and 15.8% were resistant to imipenem. The overall mortality rate was 10.4%, and the significant risk factors for death were concomitant bacteremia [odds ratio (OR): 14.6, 95% confidence interval (CI): 1.9–115.2, p = 0.011] and liver cirrhosis (OR: 20.0, 95% CI: 2.4–169.9, p = 0.006). 



Approximately 25% of cases of septic arthritis were due to GNB and resistance to commonly used antimicrobial agents was common. Liver cirrhosis and concomitant bacteremia were significant risk factors for death. 


Key words:

antibiotic resistance, Gram-negative bacteria, outcome, septic arthritis