Young-Rock Jang1, Taeeun Kim2, Min-Chul Kim3, Heung Sup Sung4, Mi-Na Kim4, Min Jae Kim3, Sung Han Kim3, Sang-Oh Lee3, Sang-Ho Choi3, Jun Hee Woo3, Yang Soo Kim3, Yong Pil Chong3. 1. a Department of Internal Medicine, Division of Infectious Disease, Gil Medical Center, Gachon University College of Medicine , Incheon , Republic of Korea. 2. b Department of Internal Medicine, Division of Infectious Diseases, Nowon Eulji Medical Center, Eulji University School of Medicine , Seoul , Republic of Korea. 3. c Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea. 4. d Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine , Seoul , Republic of Korea.
Abstract
Background: Aggressive surgery such as en bloc joint resection is favored for treating uncommon sternoclavicular (SC) septic arthritis, based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with Staphylococcus aureus SC septic arthritis treated medically or with limited surgery. Methods: All adult patients with this septic arthritis at the Asan Medical Center between September 2009 and December 2016 were reviewed. Limited surgery was defined as simple incision, drainage, and debridement of the infected joint. Results: Of 22 patients enrolled, 11 received medical treatment only, and 11 underwent limited surgery, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes and liver cirrhosis, and none had intravenous drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscesses tended more often to undergo limited surgery than patients without such abscesses (73% vs. 27%, p = .09). The median duration of intravenous antibiotics was 35 days (IQR, 25-46 days). Treatment was successful in all cases. In a median 53-week follow-up (IQR, 8-171 weeks), there was no relapse of arthritis or joint deterioration. Conclusions: Medical treatment alone or with limited surgery could be successful therapeutic strategies for complicated S. aureus SC septic arthritis in selected patients.
Background: Aggressive surgery such as en bloc joint resection is favored for treating uncommon sternoclavicular (SC) septic arthritis, based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with Staphylococcus aureus SC septic arthritis treated medically or with limited surgery. Methods: All adult patients with this septic arthritis at the Asan Medical Center between September 2009 and December 2016 were reviewed. Limited surgery was defined as simple incision, drainage, and debridement of the infected joint. Results: Of 22 patients enrolled, 11 received medical treatment only, and 11 underwent limited surgery, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes and liver cirrhosis, and none had intravenous drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscesses tended more often to undergo limited surgery than patients without such abscesses (73% vs. 27%, p = .09). The median duration of intravenous antibiotics was 35 days (IQR, 25-46 days). Treatment was successful in all cases. In a median 53-week follow-up (IQR, 8-171 weeks), there was no relapse of arthritis or joint deterioration. Conclusions: Medical treatment alone or with limited surgery could be successful therapeutic strategies for complicated S. aureus SC septic arthritis in selected patients.
Authors: Shriya B Reddy; Jack Mizelle; Helene M Sterbling; Brenda Lin; Virginia R Litle; Kei Suzuki Journal: J Thorac Dis Date: 2020-10 Impact factor: 2.895