Sarah B Lieber1,2, Ori Tishler3, Kunwal Nasrullah4, Mary Louise Fowler4, Robert H Shmerling5, Ziv Paz5,3,6. 1. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. liebers@hss.edu. 2. Hospital for Special Surgery, New York, NY, USA. liebers@hss.edu. 3. Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel. 4. Boston University School of Medicine, Boston, MA, USA. 5. Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. 6. Galilee Medical Center, Nahariya, Israel.
Abstract
PURPOSE: Patients with septic arthritis (SA) often undergo echocardiographic evaluation to identify concomitant infective endocarditis (IE). The purpose of this study is to identify distinguishing features of patients with SA and IE by comparing them to patients with SA alone. METHODS: We conducted a retrospective study of all patients 18 and older admitted to a single tertiary hospital between 1998 and 2015 with culture-positive SA. Patients were stratified by echocardiogram status and the presence of vegetations: those who had echocardiographic evaluation with no evidence of infective endocarditis (ECHO + IE-) or with a vegetation present (ECHO + IE+) and those who had no echocardiographic evaluation (ECHO-). Demographic data, clinical characteristics, microbiology data, treatment strategies, and patient outcomes were recorded and compared. RESULTS: We identified 513 patients with SA. Transthoracic echocardiogram and/or transesophageal echocardiogram were performed in 263 patients (51.2%) and demonstrated evidence for IE in 19 patients (3.7%). While most demographic features, comorbidities, and clinical characteristics did not differ significantly between those with and without IE, those with IE had higher rates of sepsis and septic shock. In addition, patients with SA and IE had higher rates of positive blood cultures and Methicillin-sensitive staphylococcus aureus (MSSA) infection when compared to those with SA without IE. Patients with IE had higher rates of intensive care unit admission and increased 30-day mortality. CONCLUSIONS: IE is uncommon among patients with SA. Echocardiography may be overutilized and may be more useful among patients presenting with sepsis, shock, or positive blood cultures, especially when MSSA is isolated.
PURPOSE:Patients with septic arthritis (SA) often undergo echocardiographic evaluation to identify concomitant infective endocarditis (IE). The purpose of this study is to identify distinguishing features of patients with SA and IE by comparing them to patients with SA alone. METHODS: We conducted a retrospective study of all patients 18 and older admitted to a single tertiary hospital between 1998 and 2015 with culture-positive SA. Patients were stratified by echocardiogram status and the presence of vegetations: those who had echocardiographic evaluation with no evidence of infective endocarditis (ECHO + IE-) or with a vegetation present (ECHO + IE+) and those who had no echocardiographic evaluation (ECHO-). Demographic data, clinical characteristics, microbiology data, treatment strategies, and patient outcomes were recorded and compared. RESULTS: We identified 513 patients with SA. Transthoracic echocardiogram and/or transesophageal echocardiogram were performed in 263 patients (51.2%) and demonstrated evidence for IE in 19 patients (3.7%). While most demographic features, comorbidities, and clinical characteristics did not differ significantly between those with and without IE, those with IE had higher rates of sepsis and septic shock. In addition, patients with SA and IE had higher rates of positive blood cultures and Methicillin-sensitive staphylococcus aureus (MSSA) infection when compared to those with SA without IE. Patients with IE had higher rates of intensive care unit admission and increased 30-day mortality. CONCLUSIONS: IE is uncommon among patients with SA. Echocardiography may be overutilized and may be more useful among patients presenting with sepsis, shock, or positive blood cultures, especially when MSSA is isolated.