SciELO - Scientific Electronic Library Online

vol.8 número3 índice de autoresíndice de assuntospesquisa de artigos
Home Pagelista alfabética de periódicos  

Serviços Personalizados



Links relacionados

  • Em processo de indexaçãoCitado por Google
  • Em processo de indexaçãoSimilares em Google


SA Orthopaedic Journal

versão On-line ISSN 2309-8309
versão impressa ISSN 1681-150X

SA orthop. j. vol.8 no.3 Centurion Jan. 2009




Adult septic arthritis in a tertiary setting: A retrospective analysis



JM NelI; A VisserII; HF VisserI; K GollerIII; R GollerI; CH SnyckersIV

IMBChB(Pret); Senior Registrar, Department Orthopaedic Surgery, University of Pretoria
IIMBChB(Pret); Senior Registrar, Department Clinical Pathology, University of Pretoria; National Health Laboratory Services, Tshwane Academic Division
IIIBPhysT(Pret); Kira Goller Physiotherapy, Newlands, Pretoria
IVMBChB(Pret), Dip(PEC)SA, MMed(Ort)(Pret), FC(Ort)SA; Consultant, Department Orthopaedic Surgery, University of Pretoria





PURPOSE OF THE STUDY: Septic arthritis (SA) constitutes an orthopaedic emergency as it can rapidly lead to progressive and irreversible joint destruction with loss of function. We aim to identify our microbiological spectrum and sensitivity profiles, and compare it to our empirical antimicrobial choice in the management of septic arthritis in the adult population.
DESCRIPTION OF METHODS: A retrospective analysis was performed on patients admitted from June 2005 to March 2009. The study population consisted of all patients over the age of 14 years admitted for either arthrotomies or joint aspirations, yielding positive cultures of either joint fluid or pus swabs taken intra-operatively. A data analysis was also done on serum CRP and WCC on all the patients.
SUMMARY OF RESULTS: Gram-positive organisms were cultured in only 53% of isolates, and Staphylococcus aureus accounted for only 25% of all isolates. Of all the Gram-positive organisms, 38% were multi-drug resistant, only sensitive to vancomycin. Gram-negative organisms constituted 36% of isolates, showing resistance in 55%. The remainder of isolates consisted of anaerobic organisms.
CONCLUSION: Gram-negative and resistant strains are becoming more important as an aetiological agent in adult septic arthritis. The current use of cloxacillin as empiric antibiotic therapy only covers 32% of all isolates in our setting. Based on these findings, use of co-amoxyclav as empiric antibiotic will increase the cover to 46%. The emergence of resistant strains remains a challenge, as evidenced by this study. Patients not responding to initial empiric therapy should be considered for early use of extended spectrum antimicrobials.



“Full text available only in PDF format”



1. Gupta G, Sturrock R, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford) 2001;40:24-30.         [ Links ]

2. Margaretten M, et al. Does this patient have septic arthritis? JAMA 2007;297:1478.         [ Links ]

3. Reveille J. The changing spectrum of rheumatic diseases in human immunodeficiency infection. Semin Arthritis Rheum 2000;30:147.         [ Links ]

4. Newman J. Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis 1976;35:198-205.         [ Links ]

5. Weston V, et al. Clinical features and outcome of septic arthritis in a single UK health district 1982-1991. Ann Rheum Dis 1999;58:214-9.         [ Links ]

6. Sharp J, et al. Infectious arthritis. Arch Intern Med 1979;139:1125-30.         [ Links ]

7. Dubost J, et al. No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis 2002;61:267-9.         [ Links ]

8. Ryan M, et al. Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period. Br J Rheumatol 1997;36:370-3.         [ Links ]

9. Goldenberg D, Cohen A. Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 1976;60:369-77.         [ Links ]

10. Brook I, Frazier E. Anaerobic osteomyelitis and arthritis in a military hospital: a 10-year experience. Am J Med 1993;94:21-8.         [ Links ]

11. Ispahami P, et al. Septic arthritis due to Streptococcus pneumoniae in Nottingham, United Kingdom, 1985-1998. Clin Infect Dis 1999;29:1450-4.         [ Links ]

12. Kaandorp C, et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997;56:470-5.         [ Links ]

13. Kaandorp C, et al. The outcome of bacterial arthritis: a prospective community-based study. Ann Rheum Dis 1997;62:327-31.         [ Links ]

14. Gupta M, Sturrock R, Field M. Prospective comparative study of patients with culture proven and high suspicion of adults onset septic arthritis. Ann Rheum Dis 2003;62:327-31.         [ Links ]

15. Meijers K, et al. Non-gonococcal infectious arthritis: a retrospective study. J Infect 1987;14:13-20.         [ Links ]

16. Arfaj A. A prospective study of the incidence and characteristics of septic arthritis in a teaching hospital in Riyadh, Saudi Arabia. Clin Rheumatol 2008;27:1403.         [ Links ]

17. Almeida A, Roberts I. Bone involvement in sickle cell disease. BJH 2005;129:482-90.         [ Links ]

18. Gavet F, Tournadre A, Soubrier M. Septic arthritis in patients aged 80 and older: a comparison with younger adults. J Am Geriatr Soc 2005;53:1210.         [ Links ]

19. Mathews C, et al. Management of septic arthritis: a systematic review. Postgrad Med J 2008;84:265-70.         [ Links ]

20. Vestra M, et al. Acute septic arthritis: remember gonorrhea. Rheumatol Int 2008;29:81-5.         [ Links ]

21. Creighton S, Revell B, Barrow A. Concordance between nucleic acid amplification technique and culture for the diagnosis of gonorrhoea. Int J STD AIDS 2009;20(5):358-9.         [ Links ]

22. Shmerling R, et al. Synovial fluid tests. What should be ordered? JAMA 1990;264:1009.         [ Links ]

23. Jeng G, Wang C, Liu S. Measurement of synovial tumor necrosis factor-alpha in diagnosing emergency patients with bacterial arthritis. Am J Emerg Med 1997;15:626.         [ Links ]

24. Morgan D, et al. An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 1996;117:423.         [ Links ]

25. Lyon R, Evanich J. Culture-negative Septic Arthritis in Children. J Paed Ortho 1999;19(5):655.         [ Links ]

26. Kortekangas P, Aro H, Lehtonen O. Synovial fluid culture and blood culture in acute arthritis. A multi-case report in 90 patients. Scand J Rheumatol 1995;24:44.         [ Links ]

27. Coutlakis P. In: Roberts WN, Wise CM eds. Another look at synovial fluid leukocytosis and infection. J Clin Rheumatol 2002;8:67-71.         [ Links ]

28. Soderquist B. Bacterial or crystal-associated arthritis? Discriminating ability of serum inflammatory markers. Scand J Infect Dis 1988;30:591-6.         [ Links ]

29. Dohmen P. Antibiotic resistance in common pathogens reinforces the need to minimise surgical site infections. J Hosp Infect 2008;70(S2):15-20.         [ Links ]

30. Nijhof M, et al. Evaluation of infections of the locomotor system with indium-111-labeled human IgG scintigraphy. J Nucl Med 1997;38:1300-5.         [ Links ]

31. Karchevsky M, et al. MRI findings of septic arthritis and associated osteomyelitis in adults. Am J Roentgenol 2004;182:119-22.         [ Links ]

32. Weston V, Coakley G. Guideline for the management of the hot swollen joint in adults with a particular focus on septic arthritis. JAC 2006;58:492-3.         [ Links ]

33. Arnold S, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: Emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orth 2006;26(6):703-8.         [ Links ]

34. Ross J, et al. Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis 2003;36:319.         [ Links ]

35. Khatib R, et al. Impact of initial antibiotic choice and delayed appropriate treatment on the outcome of Staphylococcus aureus bacteremia. Eur J Clin Microbiol Infect Dis 2006;25:181-5.         [ Links ]

36. Stevens D. The role of vancomycin in the treatment paradigm. CID 2006;42(Suppl 1):S51-57.         [ Links ]

37. Stryjewski M, et al. Use of vancomycin or first-generation cephalosporins for the treatment of hemodialysis-dependent patients with methicillin-susceptible Staphylococcus aureus bacteremia. CID 2007;44(15 Jan):190-6.         [ Links ]



Dr CH Snyckers
Tel: 072 805 1972



The content of this article is the sole work of the author. No benefits of any form have been derived from any commercial party related directly or indirectly to the subject of this article.

Creative Commons License Todo o conteúdo deste periódico, exceto onde está identificado, está licenciado sob uma Licença Creative Commons