Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991
Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991
复制标题
DOI：
10.1136/ard.58.4.214
复制
发表时间：
1999-04-01
影响因子：
27.4
通讯作者：
Doherty, M
中科院分区：
文献类型：
--
作者：
Weston, VC;Jones, AC;Doherty, M
目的-确定大量确诊为脓毒性关节炎的英国伦敦医院患者的临床特征，并确定与不良结局相关的特征。研究设计-回顾性病例记录调查。设置-一个单一的英国卫生区。患者-纳入1982年1月1日至1991年12月31日期间在诺丁汉住院的所有确诊为脓毒性关节炎的患者。结果测量死亡，骨髓炎和记录的功能immortals.Results-The频谱的致病微生物仍然类似于在以前的研究中看到的革兰氏阳性菌金黄色葡萄球菌和链球菌负责74%的情况下，淋球菌感染，虽然不太常见。82%的病例关节抽吸物和/或血液培养阳性，50%的病例革兰氏染色显示致病微生物。35%的病例中存在明显的既存关节疾病。死亡率仍然很高，为11.5%，发病率显著增加，为31.6%。多变量分析表明，死亡的重要预测因素是：混乱的介绍，年龄>65岁，多关节脓毒症或手肘关节，和发病率是：年龄大于或等于65岁，糖尿病，开放手术引流，革兰氏阳性菌感染以外的金黄色葡萄球菌。结论脓毒性关节炎继续与相当程度的发病率和死亡率。这些结果证实了在开始抗微生物治疗前获取滑液和血液用于培养的重要性。手术干预的结果明显较差，这与之前的一些建议一致，但应根据本研究的回顾性性质谨慎解释。
Aims-To determine the clinical features of a large number of unselected UK hospital patients with confirmed septic arthritis and to determine those features associated with a poor outcome.Study design-Retrospective, case-note survey.Setting-A single English Health District. Patients-All patients admitted to hospital in Nottingham during the period 1 January 1982 to 31 December 1991 with confirmed septic arthritis were included. Outcome measures-Death, osteomyelitis and recorded functional impairment.Results-The spectrum of causative organisms remains similar to that seen in previous studies with the Gram positive organisms Staphylococcus aureus and Streptococci responsible for 74% of cases, gonococcal infections though were less common. Culture of joint aspirates and or blood were positive in 82% of cases, with the Gram stain demonstrating the causative organism in 50% of cases. Pre-existing joint disease was evident in 35% of cases. The mortality remains high at 11.5% with a significant additional morbidity of 31.6%. Multivariate analysis suggests that important predictors of death are: confusion at presentation, age >65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity are: age greater than or equal to 65 years, diabetes mellitus, open surgical drainage, and Gram positive infections other than S aureus.Conclusions-Septic arthritis continues to be associated with a considerable degree of morbidity and mortality. These results confirm the importance of obtaining synovial fluid and blood for culture before starting antimicrobial treatment. The apparent poorer outcome found with surgical intervention is in line with some previous suggestions but should be interpreted with caution in light of the retrospective nature of this study.