Joan M Nolla1, Jaime Lora-Tamayo2, Carmen Gómez Vaquero3, Javier Narváez3, Oscar Murillo2, Salvador Pedrero4, Javier Cabo4, Javier Ariza2. 1. Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain. Electronic address: jmnolla@ub.edu. 2. Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain. 3. Rheumatology Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain. 4. Orthopedic Surgery Department, IDIBELL-Hospital Universitari de Bellvitge, Barcelona, Spain.
Abstract
OBJECTIVE: To analyze the clinical features, microbiological spectrum, diagnostic procedures and outcomes in native joint pyogenic arthritis among non-intravenous drug users. METHODS: We collected all microbiologically proved cases of infectious arthritis at our hospital between 1992 and 2013. Patients with prosthetic joint infection were excluded, as were patients with non-pyogenic arthritis and intravenous drug users. RESULTS: We identified 268 patients; the mean age was 61 ± 14.7 years and 62% were men. The incidence increased over the period of study. In 188 patients (70%), one or more underlying medical illnesses were found. The mean symptom duration was 8.9 ± 9.5 days. Globally, 311 affected joints were found, 232 (75%) involving peripheral joints and 79 (25%) axial joints. Staphylococci (55%) and Streptococci (29%) were the predominant microorganisms. Blood cultures were positive in 78% (173/223) of the cases. In 81 patients (30%), one or more concomitant infectious processes were found. Antimicrobial therapy was prescribed 4-8 weeks in most cases, and surgical drainage was performed in 65% of patients. Four patients relapsed and 23 (8%) died. CONCLUSIONS: The prevalence of pyogenic native joint arthritis in non-intravenous drug users is increasing, frequently affecting old patients with underlying medical conditions. Although large joints are the most frequently compromised, the involvement of axial joints is a relevant feature that has not been recognized in other series. Staphylococci and Streptococci are the main causative agents. Bacteremia and concomitant infectious processes are frequent complications. Diagnostic delay and mortality continue to be important concerns.
OBJECTIVE: To analyze the clinical features, microbiological spectrum, diagnostic procedures and outcomes in native joint pyogenic arthritis among non-intravenous drug users. METHODS: We collected all microbiologically proved cases of infectious arthritis at our hospital between 1992 and 2013. Patients with prosthetic joint infection were excluded, as were patients with non-pyogenic arthritis and intravenous drug users. RESULTS: We identified 268 patients; the mean age was 61 ± 14.7 years and 62% were men. The incidence increased over the period of study. In 188 patients (70%), one or more underlying medical illnesses were found. The mean symptom duration was 8.9 ± 9.5 days. Globally, 311 affected joints were found, 232 (75%) involving peripheral joints and 79 (25%) axial joints. Staphylococci (55%) and Streptococci (29%) were the predominant microorganisms. Blood cultures were positive in 78% (173/223) of the cases. In 81 patients (30%), one or more concomitant infectious processes were found. Antimicrobial therapy was prescribed 4-8 weeks in most cases, and surgical drainage was performed in 65% of patients. Four patients relapsed and 23 (8%) died. CONCLUSIONS: The prevalence of pyogenic native joint arthritis in non-intravenous drug users is increasing, frequently affecting old patients with underlying medical conditions. Although large joints are the most frequently compromised, the involvement of axial joints is a relevant feature that has not been recognized in other series. Staphylococci and Streptococci are the main causative agents. Bacteremia and concomitant infectious processes are frequent complications. Diagnostic delay and mortality continue to be important concerns.
Authors: Oscar Murillo; Imma Grau; Joan Gomez-Junyent; Celina Cabrera; Alba Ribera; Fe Tubau; Carmen Peña; Javier Ariza; Roman Pallares Journal: Infection Date: 2018-02-02 Impact factor: 3.553
Authors: Jason M Jennings; Douglas A Dennis; Raymond H Kim; Todd M Miner; Charlie C Yang; David C McNabb Journal: Clin Orthop Relat Res Date: 2017-07 Impact factor: 4.176
Authors: Joan M Nolla; Oscar Murillo; Javier Narvaez; Carmen Gómez Vaquero; Jaime Lora-Tamayo; Salvador Pedrero; Javier Cabo; Javier Ariza Journal: Medicine (Baltimore) Date: 2016-06 Impact factor: 1.889
Authors: Bryan Josué Flores-Robles; Mercedes Jiménez Palop; Abel Alejandro Sanabria Sanchinel; Robert Francis Andrus; Ana Royuela Vicente; Marta Isabel Sanz Pérez; María Espinosa Malpartida; Consuelo Ramos Giráldez; Carolina Merino Argumanez; Luis Fernando Villa Alcázar; José Luis Andréu Sánchez; Hildegarda Godoy Tundidor; José Campos Esteban; Jesús Sanz Sanz; Carmen Barbadillo Mateos; Carlos Isasi Zaragoza; Juan Mulero Mendoza Journal: J Clin Rheumatol Date: 2019-01 Impact factor: 3.517