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Background Septic arthritis of the temporomandibular joint (SATMJ) is acute or chronic bacterial or fungal infection involving temporomandibular joint (TMJ) space. It is a disease with high mortality in whole body joints, and about three-fourths of survivors have residual malfunctioning of the affected joint. Objective The aim of this review was to search systematically, evaluate and then summarize scientific literature about etiology, signs and symptoms, diagnosis, treatment and prognosis of the SATMJ in adults. Methods After registration at PROSPERO this systematic review was conducted and reported according to the PRISMA checklist. The following databases were systematically searched: MEDLINE, EBSCO, The Cochrane Central Register of Controlled Trials (Central), SCIndex, Scopus, Google Scholar and Registry of clinical studies with human participants. Results In total 37 studies with 91 patients were included in the review. Dominant signs and symptoms of SATMJ were pain and trismus, while fever was infrequent. The most frequent isolates from the TMJ were Staphylococcus aureus and Streptococci; however, less than 20% of patients had data about susceptibility of the isolates to antibiotics. Combination of third generation cephalosporin and metronidazole was the most frequently prescribed empirically, and antibiotics especially active against S. aureus (glycopeptides and anti-staphylococcal beta-lactams) were under-prescribed. Administration of antibiotics was prolonged (median over 30 days), although two weeks are sufficient treatment for SATMJ if right choice of antibiotics was made. There was high rate of repeated surgical interventions (53.5%), which were linked to higher risk of long-term functional defects. Conclusions The SATMJ is serious infection that requires early empiric administration of antibiotics with good coverage of Gram-positive bacteria, and subsequent correction of antibiotic therapy according to susceptibility of isolates. Appropriate antibiotic therapy decreases risk of long-term functional disorders.

Aims Staphylococcus aureus is a major cause of septic arthritis, and in vitro studies suggest α haemolysin (Hla) is responsible for chondrocyte death. We used an in vivo murine joint model to compare inoculation with wild type S. aureus 8325-4 with a Hla-deficient strain DU1090 on chondrocyte viability, tissue histology, and joint biomechanics. The aim was to compare the actions of S. aureus Hla alone with those of the animal’s immune response to infection. Methods Adult male C57Bl/6 mice (n = 75) were randomized into three groups to receive 1.0 to 1.4 × 107 colony-forming units (CFUs)/ml of 8325-4, DU1090, or saline into the right stifle joint. Chondrocyte death was assessed by confocal microscopy. Histological changes to inoculated joints were graded for inflammatory responses along with gait, weight changes, and limb swelling. Results Chondrocyte death was greater with 8325-4 (96.2% (SD 5.5%); p < 0.001) than DU1090 (28.9% (SD 16.0%); p = 0.009) and both were higher than controls (3.8% (SD 1.2%)). Histology revealed cartilage/bone damage with 8325-4 or DU1090 compared to controls (p = 0.010). Both infected groups lost weight (p = 0.006 for both) and experienced limb swelling (p = 0.043 and p = 0.018, respectively). Joints inoculated with bacteria showed significant alterations in gait cycle with a decreased stance phase, increased swing phase, and a corresponding decrease in swing speed. Conclusion Murine joints inoculated with Hla-producing 8325-4 experienced significantly more chondrocyte death than those with DU1090, which lack the toxin. This was despite similar immune responses, indicating that Hla was the major cause of chondrocyte death. Hla-deficient DU1090 also elevated chondrocyte death compared to controls, suggesting a smaller additional deleterious role of the immune system on cartilage. Cite this article: Bone Joint Res 2022;11(9):669–678.

A case report is presented of a 50-year-old woman who was seen in Accident and Emergency because of pain in the lumbar area. She was subsequently diagnosed with septic arthritis of the left hip due to being Neisseria gonorrhoeae positive for beta-lactamase. She responded to treatment with ceftriaxone, but later required a total hip replacement.

A high prevalence of gonococcal infections has been reported from remote parts of Western Australia, but the occurrence of disseminated infection leading to arthritis has not been studied.To investigate the frequency, risk factors and long-term outcome of gonococcal arthritis (GA) in Western Australia (WA).A population-based data linkage study of patients with a hospital-based diagnosis of GA in WA between 1990 and 2014. Demographics, standardised incidence rates per million and comorbidity accrued before (lookback 186 months, interquartile range (IQR) 86-267) and after the index hospital contact for GA (follow up 100 months, IQR 60-209) are presented as frequency (%), median (IQR) or rates /1000 months.In total, 98 patients were diagnosed with GA. The annual incidence of GA increased from 1.35 to 2.10 per million between 1990 and 2014, but the rate of GA complicating all gonococcal infections was stable around 0.25%. Female patients with GA (54%; n = 53/98) were younger (24 vs 38 years) and more frequently identified as indigenous (88% vs 49%) than male patients (46%; n = 45/98; P = 0.002). Female patients had higher rates of prior infections (15.5 vs 8.1 per 1000 months; P = 0.002) and diabetes mellitus (15.9% vs 2.5%; P = 0.03) and a longer hospital stay (10 vs 8 days; P = 0.02). GA recurrence rate during follow up was low (2%), but a broad range of comorbidities developed contributing to a 14% crude death rate.GA stably complicates 0.25% of gonococcal infections in WA with young indigenous females and middle-aged non-indigenous males most affected. Prior infectious disease and diabetes mellitus are potential risk factors for GA in females. GA recurs rarely, but its development reflects a high risk of morbidity and mortality over the following 10 years.

Background Septic arthritis (SA) is a dangerous condition that requires emergency treatment. Managed by culture-specific antibiotics, irrigation, and debridement (I&D), some patients require repeat surgical treatment. The objectives were to determine the risk factors for SA and risk factors for repeat arthroscopic I&D in SA patients. We hypothesized that variables which directly or indirectly contributed to a larger infection burden would be associated with the development of SA and the need for repeat arthroscopic I&D. Methods All patients ≥ 18 years old presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2018 and January 2020 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma and metalwork in the affected joint, periprosthetic joint infection, previous joint arthroplasty surgery, soft tissue infection, missing data, transferred to another centre, diagnosis not concerning the joint, and p Results Multivariable analysis showed multiple risk factors for SA, namely rheumatoid arthritis (RA) (OR: 3.4; 95% CI: 1.2–10.0; p = 0.023); skin infection (OR: 3.3; 95% CI: 1.2–9.0; p = 0.017), liver disease (OR: 9.9; 95% CI: 2.2–43.9; p = 0.003), knee joint involvement (OR: 3.5; 95% CI: 1.3–9.4; p = 0.014), and use of immunosuppressive medication (OR: 3.5; 95% CI: 1.2–10.6; p = 0.027). Risk factors for multiple washouts included synovial WBC levels > 10.5 × 109 cells/L (OR: 3.0; 95% CI: 2.3–38.8; p = 0.009) and RA (OR: 3.5; 95% CI: 1.9–66.3; p = 0.017). Conclusions These findings suggest that prophylactic actions against septic arthritis should be targeted at patients with liver disease, RA, or skin infection. Repeat arthroscopic I&D of septic joints may be needed, especially in patients with synovial WBC levels > 10.5 × 109 cells/L and RA. Key Points• The risk factors for septic arthritis determined in this study are rheumatoid arthritis, skin infection, liver disease, knee joint involvement, and immunosuppressant usage.• Some septic arthritis patients need multiple rounds of arthroscopic irrigation and debridement. The risk factors for this are a synovial WBC count > 10.5 × 109 cells/L and rheumatoid arthritis.

OBJECTIVE To investigate the chondroprotective effects of autologous platelet-rich plasma (PRP), ampicillin-sulbactam (AmpS), or PRP combined with AmpS (PRP+AmpS) in an in vitro chondrocyte explant model of bovine Staphylococcus aureus–induced septic arthritis. SAMPLE Autologous PRP and cartilage explants obtained from 6 healthy, adult, nonlactating Jersey-crossbred cows. ProcedureS Autologous PRP was prepared prior to euthanasia using an optimized double centrifugation protocol. Cartilage explants collected from grossly normal stifle joints were incubated in synovial fluid (SF) alone, S aureus–inoculated SF (SA), or SA supplemented with PRP (25% culture medium volume), AmpS (2 mg/mL), or both PRP (25% culture medium volume) and AmpS (2 mg/mL; PRP+AmpS) for 24 hours. The metabolic activity, percentage of dead cells, and glycosaminoglycan content of cartilage explants were measured with a resazurin-based assay, live-dead cell staining, and dimethylmethylene blue assay, respectively. Treatment effects were assessed relative to the findings for cartilage explants incubated in SF alone. RESULTS Application of PRP, AmpS, and PRP+AmpS treatments significantly reduced S aureus–induced chondrocyte death (ie, increased metabolic activity and cell viability staining) in cartilage explants, compared with untreated controls. There were no significant differences in chondrocyte death among explants treated with PRP, AmpS, or PRP+AmpS. CLINICAL RELEVANCE In this in vitro explant model of S aureus–induced septic arthritis, PRP, AmpS, and PRP+AmpS treatments mitigated chondrocyte death. Additional work to confirm the efficacy of PRP with bacteria commonly associated with clinical septic arthritis in cattle as well as in vivo evaluation is warranted.

Septic arthritis (SA) is a medical emergency. The most common etiological agents are bacteria, which activate the local immune response coordinated by cytokines; however, little is known about the cytokine profile in human SA.To determine the association of local and systemic cytokine profiles with the severity and prognosis of patients with SA.Patients with clinical and laboratory diagnosed SA were enrolled as well as a control group. Serum and synovial fluid (SF) samples were obtained for determining cytokines and glucose levels; SF samples were used for histological analysis. Osteochondral damage and general health status and quality of life (SF-36) were evaluated during recruitment day. WOMAC osteoarthritis index score and SF-36 questionnaire were used a year after recruitment day as a follow up.A systemic and local proinflammatory cytokine profile was found in patients compared to the control group (p0.05). IL-6 was 28 and 525 times higher than controls in sera and SF, respectively (p0.0001). Systemic IL-6 correlated negatively with general mental health score (p = 0.0184) and was associated with a higher osteoarthritis index after one year follow-up in the patients (p = 0.0352). HMGB1 in SF was found higher in patients with SA (p0.0001), and it was associated with osteochondral damage (p = 0.0042). TNF-α in SF correlated negatively with SF-36 questionnaire one year after patients' recruitment in role limitation score (p = 0.0318), body pain score (p = 0.0315), and general mental health score (p = 0.0197).Serum and SF cytokine signatures are associated with disease severity and prognosis in patients with SA.

The purpose of this study was to determine the incidence of osseous lesions and the recurrence rate after arthroscopic surgery in shoulder septic arthritis patients and evaluate the influencing factors.We retrospectively reviewed 44 patients who underwent arthroscopic surgery for septic arthritis of the shoulder between January 2012 and September 2019. The average age of the patients was 65.57 ± 14.2 years, and 56.8% were female patients. The minimum follow-up period was 12 months (average, 32.8 ± 14.2 months; range, 12-72 months). We assessed variables including sex, age, underlying diseases, duration from symptom onset to magnetic resonance imaging (MRI), duration from symptom onset to surgery, radiologic results (radiography and MRI), history of injection therapy, and postoperative infection. The incidence of osseous lesions and the recurrence rate were calculated according to independent variables. In addition, multivariate logistic regression was performed to identify the risk factors for osseous lesions and recurrent infection after adjustment for other variables.Twenty-one patients had an osseous lesion on MRI, and 12 patients had evidence of bone erosion on radiographs. In univariate analyses, significant (P.05) risk factors for the presence of osseous lesions were female sex, lower C-reactive protein level, and longer duration from symptom onset to MRI. The overall infection recurrence rate was 22.7% (10 of 44 patients). Culture results and the duration from symptom onset to surgery were significant risk factors for recurrent infection (P.05). As the duration from symptom onset to MRI increased by 1 day, the probability of osseous lesions increased 1.31-fold (95% confidence interval, 1.08- to 1.59-fold; P = .007), and this probability was significantly higher after correction for other risk factors.To reduce the severity of septic shoulder infection, timely diagnosis and treatment are essential. Even if osseous lesions are present, good results can be obtained if meticulous débridement is performed through arthroscopic surgery. However, functional and radiologic long-term follow-up studies are needed in patients with osseous lesions.

The purpose of this study is to conduct a systematic literature review of the published literature on previously reported cases of nontuberculous septic arthritis, to compare the effect of total and partial synovectomy on the outcome. Furthermore, we reported a case series of NTM septic arthritis that were treated in our institution. The hypothesis is that a complete synovectomy is associated with better outcome. Ideally, results would support future research as well as inform a clearer understanding of NTM septic arthritis management.

Purpose The clinical utility of echocardiography in the setting of a positive blood culture in paediatric patients presenting with osteomyelitis (OM) and/or septic arthritis (SA). Methods Retrospective review between 2013 and 2019: Patients < 18 years with OM, SA or combined infection (OM+SA) were included. Patients were excluded for immunodeficiency, loss of follow-up or penetrating infection. Charts with positive blood cultures were reviewed for echocardiography on that admission. Demographic variables were compared utilizing the Student's t-test and Fisher's exact test. A multivariable linear regression model was constructed to examine the association between echocardiography and length of stay, controlling for age, sex, fever, white blood cell (WBC) on admission, antibiotic administration and surgery performed. Results Of 157 patients with OM, SA or combined infection, 44 had a positive blood culture. In all, 26 had an echocardiogram, and none showed endocarditis. Echocardiography was independently associated with a 6.2-day length of stay increase. WBC count and surgical intervention demonstrated a trend toward significance in length of stay, with each WBC unit increase associated with a 0.53-day increase. Surgical intervention was associated with an average 6.3-day length of stay decrease. Conclusion No patient had a positive echocardiogram, and no changes in management were initiated. However, an echocardiogram increased stay by 6.2 days. In addition to costs associated with increased stay, patients were billed between $1460 and $1700 per echocardiogram. The utility of echocardiograms in the setting of bacteremia associated with musculoskeletal infections in the paediatric population should be re-examined, and guidelines should be updated to reflect the cost-benefit analysis. Level of Evidence III

Primary meningococcal septic arthritis (PMSA) is an extremely rare local infection by Neisseria meningitidis in the absence of meningitis or meningococcaemia syndrome. A 30-year-old healthy, immunocompetent man presented with arthralgia, fever, chest rash, and significant swelling of the right knee. On admission, a disseminated maculopapular and purpuric rash, oligoarthritis, neutrophilia, and elevated acute phase reactants were documented. Following arthrocentesis of the right knee, isolation of N. meningitidis and the presence of calcium oxalate crystals in the synovial fluid were reported. The diagnosis of PMSA was made. Histological analysis of the skin lesion showed leucocytoclastic vasculitis. He was treated with intravenous ceftriaxone plus open surgical drainage and ambulatory cefixime with adequate response. After 1 month, he presented resolution of the pathological process. We performed an extensive review of the literature, finding that the key elements supporting the diagnosis of PMSA are prodromal upper respiratory tract symptoms and skin involvement prior to or synchronous with the arthritis. Also, the most frequently involved joint is the knee. This report is the first case of a patient presenting with PMSA associated with calcium oxalate crystals in the synovial fluid. Herein, we discuss the most frequent clinical manifestations, the unusual histological features, the recommended treatment, and the reported prognosis of this rare entity.

Bacterial arthritis is an inflammation of the joints caused by an infectious etiology, usually bacterial, but there are also fungi, mycobacteria, viruses, or other rare pathogens. Both healthy and predisposed people can be infected. Nongonococcal infectious arthritis, usually a monoarticular disease, affects multiple joints in about 10% of patients and is a new form of septic arthritis. Without treatment, it can progress rapidly and cause irreversible damage to the joints. The overall incidence of bacterial arthritis is 2 to 6 per 100,000, depending on the presence of risk factors. Bacterial arthritis is more common in children than in adults. The incidence of septic arthritis peaks between the ages of 2 and 3 and is predominantly male (2: 1). Most septic joints develop as a result of hematogenous dissemination of the vascular synovium due to bacterial episodes. Osteoarthritis, rheumatoid arthritis, and corticosteroid therapy are the most common predisposing conditions. Typical symptoms of acute septic arthritis without gonorrhea include recent fever, malaise, and local findings of pain, warmth, swelling, and restricted mobility of the affected joint. Accurate history and assessment of risk factors can provide important clues for diagnosis. Careful assessment of risk factors can significantly change the likelihood of a provider developing septic arthritis prior to testing. Laboratory findings, diagnostic imaging, and synovial fluid assessment are all useful for diagnosis. Management components include early detection and treatment with joint aspiration, antibiotics, and orthopedic advice for possible surgical management. Widespread antibiotics are often needed due to the potential for rapid joint destruction. A combination of cefepime or anti-Pseudomonas aeruginosa beta-lactams and vancomycin is recommended to cover both Gram-negative and MRSA bacteria.

Substance use disorders (SUDs) and high incidence of infectious diseases are both critical public health issues. Among patients who use a venous access device (VAD) in home care settings, SUDs may play a role in increasing their risk of having a concurrent infectious disease. This study examined the association of SUD with infectious diseases among adult home healthcare patients with a VAD. We identified adult patients with an existing VAD who were admitted to a home healthcare agency August 1, 2017-July 31, 2018 from the electronic health records of a large Medicare-certified agency. Four serious infectious diseases (endocarditis, epidural abscess, septic arthritis, and osteomyelitis) and SUD related to injectable drugs were identified using relevant ICD-10 codes. Multiple logistic regression was performed to examine the association. Of 416 patients with a VAD, 12% (n = 50) had at least one diagnosis of a serious infectious disease. The percentage of patients who had a serious infectious disease was 40% among those with SUDs, compared with only 11% among those without SUDs. After adjusting for age and sex, the odds of having a serious infectious disease was 3.52 times greater for those with SUDs compared with those without (odds ratio [95% confidence interval], 4.52 [1.48-13.79], n = .008). Our findings suggest that home healthcare patients with a VAD and a documented SUD diagnosis may have an increased risk of having a concurrent serious infectious disease. Therefore, patients with an SUD and a VAD would need more attention from home healthcare providers to prevent a serious infectious disease. Further research is suggested on modalities of care for individuals with an SUD and VAD to reduce the incidence of infectious diseases so that care can be delivered safely and efficiently in a home healthcare setting.

Background: Septic arthritis is a serious emergency causing remarkable morbidity and mortality worldwide. Expeditious diagnosis and effective treatment are necessary to achieve better clinical outcomes and avoid devastating joint consequences. Objective: we focused to detect the most common etiological agent and associated resistance to commonly used antibiotics in Nariman Hospital in Alexandria, Egypt. Molecular detection of mecA gene which causes resistance in methicillin-resistant Staphylococcus aureus and results in treatment failure was studied among our isolates. Methodology: One hundred and fifty joint fluid aspirates were included in the study. Identification of the isolates was done by conventional microbiological methods and BACTEC MGIT 960 TM system. Antibiotic susceptibility tests were done to detect resistance in our isolates. Molecular amplification of mecA gene was done in isolated methicillin-resistant Staphylococcus aureus (MRSA). Results: It was noted that most the of specimens were collected from males. Culture results showed monomicrobial bacterial growth in 90.2% of samples tested. Staphylococcus aureus was the major organism isolated. 88.9% of methicillin-resistant Staphylococcus aureus (MRSA) were positive for mecA gene. Conclusion: As far as we know, this is the first research in Alexandria investigating the most common etiological agent and associated resistance resulting in treatment failure in the leading orthopedic hospital in Alexandria.

Purpose This study aims to assess previously determined predictive criteria for presence of adjacent infection in septic arthritis within a Southeastern United States (US) pediatric population. Results The sensitivity, specificity, positive predictive value, and negative predictive value of the Rosenfeld criteria were: 91.7%, 22.7%, 39.3%, and 83.3%, respectively. The patients with periarticular infection were more likely to have positive blood cultures than those with isolated septic arthritis. There was no difference in likelihood of secondary surgical intervention. Conclusions Previously defined criteria to predict adjacent infection in pediatric septic arthritis did not demonstrate external validity in a Southeastern US pediatric population.

Leprosy, commonly known as Hansen's disease, is a chronic infectious illness caused by the bacteria Myobacterium leprae. The presence of the musculoskeletal system is the third most common symptom. Acute onset of arthritis is documented secondary to Hansen’s disease. Septic arthritis is a joint infection that causes excruciating pain, it typically manifests as a single hot, swollen, and extremely painful joint. The main aim of physical therapy is to recover from functional impairment as a result of Hansen's disease and to tailor lifestyle changes to help the patient regain functional independence. In this case study, updated physiotherapy rehabilitation of septic arthritis following borderline Tuberculoid Hansen's disease has been demonstrated to be important in restoring range of motion (ROM), muscular strength, and pain alleviation. A male with 46 year of age presented to the orthopedic department with the symptoms of pain and swelling of the knee of the right side since 1 month without any history of fall or twisting injury. He was advised for the investigations of x-ray and MRI and arthrocentesis of right knee was done during which pus was found and aspirated. He was diagnosed with septic arthritis of right knee joint. Patient was operated with diagnostic arthroscopy of right knee where debridement was done. Patient then was referred to physiotherapy department with the complaints of pain and stiffness over right knee joint, with restricted range of motion. He was known case of Hansen’s disease. He was started with physiotherapy rehabilitation protocol for 6 weeks where cryotherapy, TENS, passive ROM, active assisted and active ROM exercises were given. Focus was also made on improving strength. In this case study physiotherapy rehabilitation protocol used had significantly reduce the pain, increased ROM, muscle strength and endurance which considerably help the patient in restoring his functional independence at home and work place.

Background/aim: Bacterial meningitis is inflammation of the lining of the brain due to bacterial invasion of the CNS, especially in the cerebrospinal fluid in the subarachnoid and ventricles. Transmission of S. suis to humans occurs through direct contact with pigs and their processed products and consuming raw pork products. This case report reports a case of meningitis S. Suis with symptoms of decreased consciousness, bilateral sensorineural deafness and arthritis. Case: with a gradual loss of consciousness accompanied by headache and fever. The patient works in a pig slaughterhouse, and often consumes processed pork. The patient has decreased consciousness, fever, stiff neck, headache and septic arthritis. The patient found S.Suis type I in the blood, joint fluid culture (+), and CSF culture (+). The patient was treated with ceftriaxone according to CSF sensitivity culture test, dexamethasone and antipyretic/ analgesic as adjuvants. Patient recovered with improved genu arthritis and bilateral sensorineural hearing loss. Conclusion: Transmission of S. suis to humans occurs through direct contact with pork and its raw processed products. Clinical manifestations such as headache, fever, nausea and vomiting accompanied by signs of meningeal stimulation. The most prominent and frequently reported symptom is hearing loss. Definitive diagnosis is highly dependent on clinical examination, CSF culture and blood culture. Antibiotic therapy for 14 days, corticosteroids are the treatment of choice in bacterial meningitis. A frequently reported complication with sensorineural loss. Death is frequently reported in cases with systemic infection. Keywords: Bacterial meningitis, Streptococcus Suis, sensorineural hearing loss, arthritis septic, infected pigs and pork products.

Non-tuberculous Mycobacterium (NTM) infections following knee surgery are rarely reported in the literature. One month after arthroscopic lysis of adhesions from anterior cruciate ligament (ACL) reconstruction, a 67-year-old male patient presented with symptoms suggesting septic arthritis. Empiric antibiotics were initiated. Intraoperative cultures were positive for Mycobacterium abscessus. Organism-specific antimicrobial therapy with azithromycin, amikacin, and imipenem were started. Four months later the patient was switched to oral outpatient treatment with azithromycin, clofazimine and bedaquiline. Mycobacterium infections following ACL reconstruction are exceedingly rare in the United States. Successful management of Mycobacterium abscessus infection is exceptionally challenging for both orthopedists and infection disease specialists.

A 7‐year‐old female ostrich (Struthio camelus) presented with lameness, left intertarsal joint swelling and a healing wound on the caudomedial aspect of the joint. Synovial culture revealed Corynebacterium species and radiographs were consistent with progressive septic arthritis. Multiple treatments were attempted including through‐and‐through joint lavage, intra‐articular antibiotics, caudomedial arthrotomy, and regional limb perfusion in conjunction with systemic antibiotics and analgesia. Euthanasia was ultimately performed due to prolonged recumbency and poor prognosis. This report describes novel therapies and a surgical approach utilized for treatment of intertarsal septic arthritis in an ostrich and exemplifies the poor prognosis described in other species presenting with non‐responsive septic arthritis of critical joints., A female ostrich (Struthio camelus) presented with left intertarsal septic arthritis that was culture positive for Corynebacterium. This report describes novel therapies and a surgical approach utilized for attempted treatment of intertarsal septic arthritis in an ostrich and exemplifies the poor prognosis described in other species presenting with non‐responsive septic arthritis of critical joints.

OBJECTIVE To describe the incidence and long-term outcome of non-gonococcal septic arthritis (SA) in Western Australia (WA). METHODS Newman criteria were applied to define culture-positive SA and suspected SA cases in the state-wide West Australian Rheumatic Diseases Epidemiological Registry with longitudinally linked health data for patients >16 years with a first diagnostic code of pyogenic arthritis (711.xx [ICD-9-CM] and M00.xx [ICD-10-AM]) between 1990-2010. Annual incidence rates/100 000 (AIR) and standardized (against WA population) mortality rates/1000 person-years (SMR) and outcomes during 10.1 years follow-up are reported. RESULTS Among 2633 SA patients (68.6% male, age 47.4 years), 1146 (43.5%) had culture-positive SA. The overall AIR for culture-positive (1.6-6.3) and total SA cases (4.3-12.9) increased between 1990 and 2010 as did age at onset (39.5-54 years) and proportion of females (23-35.6%). Knees (33.6.%) were most frequently affected and 37.1% of cultures showed microorganisms other than Gram-positive cocci. Thirty-day rates for readmission and mortality were 25.4% and 3.2.%. During follow-up rates for serious infections (56.4%), osteoarthrosis (5.2%) and osteomyelitis (2.7%) were higher in culture-positive SA. SMR was increased for all SA patients but especially in those 17-40 years of age with culture-positive SA (24.2; 95% CI 2.3-261). CONCLUSIONS The incidence of SA in WA has risen steeply over 20 years. SA now occurs at higher age, affects females more often with over a third of cases caused by Gram-negative microorganisms. Not only culture-positive, but also suspected SA led to increased bone/joint complications, in-hospital and late mortality.

Introduction: The geriatric population are the fastest growing segment around the world. The prevalence of multiple comorbidities in geriatric patients requiring special perioperative care. Perioperative management must be done properly, considering that surgical complications on geriatric can cause multiple comorbidities. There are many complications that often occur in geriatrics, one of which is infection. Case report: A 77-year-old man complained about pain on his right knee 1 – 2 weeks after doing TKR procedure. The pain accompanied with fever, swollen, and redness. Physical examination showed elevated blood pressure (140/90), Fever (37,4oC), obesity grade I (BMI 27.4 kg/m2), swollen and redness on his right knee, pain on palpation with VAS 5, edema (+). Barthel index ADL showed mild dependency, FRAIL score 3, qSOFA score 0. Laboratory result showed elevated leukocyte 14.900/µl. Conclusion: Geriatric patients are very vulnerable to the risks of surgery, one of which is septic arthritis. So that a good perioperative evaluation can reduce complications, comorbidities and decreased functional status

Septic arthritis is a serious condition that can lead to rapid destruction of joint if it is not rapidly diagnosed and treated appropriately. The reported annual incidence is 10 in 100 000 although this increases to 70 in 100 000 in those with risk factors for developing septic arthritis mainly rheumatoid arthritis and immune-compromised patients. The aim of this study is to examine the sensitivity and specificity, and thus the clinical usefulness, of gram stain results. This was a single centre, retrospective case series. All joint aspirates over a three year period from May 2015 to April 2018 were reviewed. The gram stain and final culture results noted. 830 samples were included from both native and replaced joints. Native joints accounted for a total of 701 cases (84%) of the aspirates, whilst those obtained from prosthetic joints 129 (16%). In 74 (9%) cases there was a discrepancy between the gram stain and culture results. The sensitivity of the gram stain in this case series is 22% and the specificity of the test is 99.6%. The clinician should have a low threshold for overlooking a negative gram stain result and place greater emphases on the clinical findings in conjunction with biochemical markers.

A female patient aged 6 years, a suspected case of sickle cell trait (SCT) having symptoms of Rheumatoid arthritis (RA), while evaluating joint complaints in adult sickle cell disease (SCD) patients, a number of sickle cell-based entities come to mind such as avascular necrosis, osteomyelitis, bone infarcts, and septic arthritis. RA is a chronic systemic inflammatory disease, many reports highlighted the occurrence of RA in SCD presenting as diagnostic challenges for cases with chronic inflammatory arthritis, SCT also have appeared to persist in some populations at a perplexingly high rate given the degree of early mortality of homozygosity of SCD, our case report showed that not only SCD but if a patient has SCT they can develop RA as complication. Our case report concludes that during the evaluation of a SCT patient who presents with chronic synovitis, one should strongly consider the possibility of coexistence of RA and SCT.

Background Septic arthritis (SA) due to Staphylococcus aureus is a major cause of lameness in poultry with improper response to antimicrobial therapy. Objectives The study evaluates the effect of prophylactic administration of vitamin C on SA induced by methicillin resistant S. aureus in chickens. Methods One hundred and twenty chickens were randomly assigned into four groups: I. Negative control (NC), II. Positive control (PC) with SA induced at the age of 35 days by intra articular injection of S. aureus. III. Vehicle control (VC) and IV. Arthritic vitamin C‐treated (VitC) group (15 g/100 L of drinking water from day 25 to the end of the experiment). Samplings were performed on day 44 (sampling 1) and day 54 (sampling 2) of age. Results Arthritic birds showed an obvious decrease in body weight with severe clinical arthritis and lameness which were not significantly affected by vitamin C administration at both samplings. Moreover, marked increase in serum malondialdehyde (MDA) concentration of the PC group was observed in sampling 1. Administration of vitamin C successfully reduced MDA concentration at both samplings. In sampling 2, birds in the VitC group showed significantly higher total antioxidant capacity (TAC) than NC birds (p, Prophylactic administration of vitamin C especially for relatively longer period can ameliorate oxidative stress and histopathological changes due to staphylococcal arthritis in chickens.

Antibiotics have been injected intra-articularly by equine veterinarians for decades, either prophylactically when other drugs are administered for osteoarthritis or therapeutically to treat septic arthritis. This route of administration has also more recently gained attention in human orthopaedic clinical practice, particularly as an alternative to systemic antibiotic administration to treat infections following prosthetic arthroplasty. While the rationale for injecting antibiotics intra-articularly has been largely focused on achieving high local drug concentrations, there has been relatively little focus on pharmacokinetic parameters of antibiotics administered by this route, or on the potential for local toxicity. The increasing incidence of antibiotic resistance in veterinary and human medicine prompts reconsideration of off-label antibiotic usage and evaluation of evidence-based dosing strategies. The purpose of this review was to summarise the current literature describing intra-articular antibiotic usage, including specific studies where pharmacokinetics, potential safety and toxicity have been evaluated. This review will advance practitioners' understanding of the use of intra-articularly administered antibiotics, including the overall pros and cons of the approach.

Background: Significant articular depression, separation of both condyles, diaphyseal comminution and dissociation, and loss of soft-tissue envelope integrity are all associated with high-energy proximal tibia fractures (Schatzker VI). Over the past 50 years, there has been a lot of research on plating problems in these complicated fractures. For the care of these complex injuries, Ilizarov devised a new method (ring fixator). Aim of the Study: To examine the outcomes of patients who received a ring fixator for the treatment of high-energy proximal tibia fractures (Schatzker VI). Materials and Methods: Fourteen patients (mean age 36) were treated with the Ilizarov fixator and transfixion wires for high-energy fractures of the proximal tibia (Schatzker VI). Nine of the patients had open fractures, and five of them had significant soft tissue damage. They were all tracked for an average of 19.4 months. The result was analyzed using the criteria set by Honkonen & Jarvinen (1992). Results: Thirteen fractures healed in an average of 14.6 weeks, with one taking six months. Twelve patients recovered complete extension, while eight others regained more than 110 degrees of flexion. All of the patients knees were stable, except one who had a minor varus deformity. Nine patients walked normally, while four had a little limp. Except for one, all of the knees exhibited an articular step-off of less than 4 mm and normal axial alignment. Six knees were found to be outstanding, five to be decent, and three to be fair. There were no instances of postoperative skin infection or septic arthritis, however, three patients did have a pin tract infection that was effectively managed. Conclusion: The technique is suitable for the treatment of complex proximal tibia fractures when there is substantial comminution at the fracture site as well as soft tissue damage (Schatzker VI).

Background Lyme arthritis often presents as acute monoarticular arthritis challenging to distinguish from septic arthritis. Typical management for Lyme arthritis entails antibiotic therapy, while septic arthritis usually warrants operative debridement. During the period when Western Pennsylvania transitioned to a Lyme-endemic region, many children underwent operative intervention who were ultimately diagnosed with Lyme arthritis due to diagnostic ambiguity. We examined the impact of the operative intervention on pediatric Lyme arthritis outcomes. Methods We conducted a retrospective cohort study of patients admitted to a tertiary care children's hospital who were diagnosed with Lyme arthritis from 2008 to 2018 using chart review. Inclusion criteria were positive Lyme serology by Centers for Disease Control and Prevention (CDC) definition, clinical arthritis, and negative bacterial cultures. We recorded clinical presentation, laboratory data, details of hospitalization, costs, and outcomes after therapy to compare the impact of antibiotics alone (nonoperative group) versus antibiotics plus operative debridement (operative group). Results A total of 149 patients met the inclusion criteria. Overall, 47 (32%) patients underwent orthopaedic intervention. Operative management was associated with increased length (3.17 vs. 1.40 d) and cost ($27,850 vs. $10,716) of admission. The clinical resolution was documented in 57/58 patients (98%) in the nonoperative group and 41/42 patients (98%) in the operative group. The median duration to resolution was 21 days for both groups. Conclusions Operative management of pediatric patients with Lyme arthritis is associated with increased resource utilization and costs while being similarly efficacious to nonoperative management. As the US Lyme epidemic expands, improved diagnosis and management of acute undifferentiated arthritis may prevent unneeded operative intervention. Level of evidence Level III-retrospective cohort study.

We report on a retrospective cohort of 50 cases of three-ligament tenodesis for scapholunate instability. Fifteen cases (30% of our cohort) needed salvage surgery (11 proximal row carpectomies, 2 partial and 2 total wrist fusions) at an average of 33 months and are considered “failures”. Of the 35 remaining cases (“success”), 16 (32% of our cohort) were reviewed at average 111 months and had good functional outcomes (QuickDASH 18/100, PRWE 11/100, pain 1/10, satisfaction 9/10). Return to work was 81% and grip strength was 80% of the opposite side. Radiological review found no significant correction in the short-term: scapholunate angle (SLA) from 72° to 69° (p = 0.544), scapholunate distance (SLD) from 3.4 mm to 3.4 mm (p = 0.833) and radiolunate angle (RLA) from 17° to 13° (p = 0.253). A significant deterioration in SLA from 72° to 80° (p = 0.014), not correlated to function, was seen at final follow-up. Radiographic progression to wrist degeneration was seen in 63% of successful cases. In failed cases, we noticed inferior radiographic parameters in the short-term: SLD of 4.6 mm in failed versus 3.4 mm in successful cases (p = 0.038) and RLA of 22° in failed versus 13° in successful cases (p = 0.046). Complication rate was 10% (2 scaphoid necroses, 1 septic arthritis and 2 complex regional pain syndromes). Despite radiological deterioration of SLA and development of degeneration in most cases, three-ligament tenodesis can give satisfactory wrist function in some patients, but we observed a significant number of failures and a high complication rate. Level of evidence IV

We report a prosthetic joint septic arthritis case caused by Gordonia jacobaea in an immunocompromised woman with catheter-related bacteraemia, supporting Gordonia species as opportunistic emerging human pathogens. Microbiological diagnosis was challenging and required molecular methods for accurate identification. The patient responded well to catheter replacement, knee prothesis lavage and antibiotics.

BACKGROUND Kingella kingae is an important cause of septic arthritis in young children, with modern laboratory methods leading to increased detection. Prevalence of this pathogen in New Zealand, where there are high rates of childhood infections due to Staphylococcus aureus and Streptococcus pyogenes, is not known. METHODS We conducted a retrospective review of children

Septic arthritis of the temporomandibular joint (TMJ) is rare with few cases reported in the literature. We present a case of septic arthritis of the left TMJ in an 18-year-old man who was initially referred as a suspected TMJ dislocation. He had a 3-day history of pain, trismus and malocclusion with left preauricular swelling and became clinically septic with a positive blood culture containing Fusobacterium necrophorum. Computed tomography revealed left TMJ effusion. A later scan showed evidence of a temporal space collection and development of an intracranial extension in the left middle cranial fossa. The patient underwent needle arthrocentesis and drainage, followed by six weeks of antibiotic therapy following advice from neurosurgery and microbiology. Further imaging revealed resolution of the collection. Few cases have been reported of this unusual diagnosis, and this case demonstrates the importance of close multidisciplinary input in forming an accurate diagnosis and managing appropriately.

Septic arthritis (SA) is a secondary infective disease due to joints inflammation. It often appears with mono- or oligoarticular acute arthritis that frequently leads to an emergency department (ED) visit with need for prolonged hospitalization. SA is an orthopedic emergency that can threaten both life and limb due to its potential rapid destruction of the joint with fulminant sepsis, causing significant disability within hours to days. Delayed or poor treatment of septic arthritis can lead to irreversible joint damage with consequent disability in addition there to significant mortality rate. Management includes early detection and treatment with antibiotics, joint aspiration, and consultation for orthopedic surgery as potential operative management. This review aims to summarize current evidence regarding evaluation and management of septic arthritis in emergency department, and to highlight the difficulties of diagnosing and managing SA that face the healthcare providers to help overcome those difficulties and to recommend further studies to be done regarding those problems and their solutions.

Chronic long bone osteomyelitis is a challenging condition to handle. Despite not commonly isolated, anaerobes also have this infectious potential. Bacteroides fragilis is a known anaerobic bacterium causing intraabdominal infections with remote vertebral osteomyelitis cases and knee septic arthritis rarely reported in the literature. We aim to report a rare long bone infection due to B. fragilis, a relatively uncommon bacterium in the everyday orthopedic practice. A patient with a gunshot trauma 21 years ago, treated with knee fusion, was admitted due to chronic osteomyelitis. Debridement cultures were positive for Staphylococcus epidermidis and B. fragilis. The patient was empirically treated as no anaerobe sensitivity testing could be provided. Finally, the patient was amputated due to local squamous cell carcinoma. To our knowledge, there are no reports of B. fragilis isolation in cultures obtained from long bone tissues. In this article, we underline the particularity in managing anaerobe long bone osteomyelitis, as it remains a rare entity.

Introduction While MAC native joint septic arthritis is historically considered a rare entity, the number of reported cases have increased in recent decades. However, no comprehensive review of this topic has been conducted. Objectives To conduct a systematic review of cases of MAC native joint septic arthritis reported in the literature and summarize the presentations, baseline characteristics, risk factors, diagnosis, treatment, and treatment outcomes. Methods A systematic review was conducted by performing an extensive literature search through Medline, Google Scholar, and Web of Science, starting from their inception. Screening of articles, assessment of eligibility, and data synthesis from eligible articles were independently performed by two reviewers with input from a third reviewer to achieve consensus. Inclusion criteria to determine eligibility included articles in English, case reports/case series, adult patients who presented with MAC/MA/MI septic arthritis of a native joint. Statistical analyses were performed using Statistical Package for the Social Sciences. Results Thirty-three cases of MAC native joint septic arthritis were reported since 1976. MAC septic arthritis affects immunocompetent and immunocompromised patients, most frequently as a monoarthritis involving the knees and wrist. MAC septic arthritis may present in the context of disseminated MAC infection and primary MAC septic arthritis. The average time to diagnosis from onset of symptoms was 20 months, where the majority of cases were initially misdiagnosed. Although arthrocentesis can be used to make the diagnosis, a synovial biopsy is necessary in many cases to confirm the diagnosis. A combination of surgery and antimycobacterial drug treatment has the highest chance of achieving complete resolution. Conclusion The diagnosis of septic arthritis of native joints due to MAC can be challenging and/or delayed. A high level of suspicion is needed in high-risk patients and also when atypical presentations occur. Therefore, understanding the presentation, risk factors, and pitfalls in diagnosing MAC septic arthritis are essential. MAC septic arthritis literature is scarce, necessitating further research of this rare condition to increase awareness, diagnostic accuracy and determine the optimal treatment strategy to improve patient outcomes.

BACKGROUND Illness complications are condition-specific adverse outcomes. Detecting complications of pediatric illness in administrative data would facilitate widespread quality measurement, however the accuracy of such detection is unclear. METHODS We conducted a cross-sectional study of patients visiting a large pediatric emergency department. We analyzed those RESULTS We analyzed 1534 encounters. PPVs and NPVs for complications were >80% for 8 of 14 conditions: appendicitis, bacterial meningitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, sepsis, and testicular torsion. Lower PPVs for complications were observed for DKA (57%), empyema (53%), encephalitis (78%), ovarian torsion (21%), and septic arthritis (64%). A lower NPV was observed in stroke (68%). The κ between reviewers was 0.88. CONCLUSIONS An automated method to measure complications by using administrative data can detect complications in appendicitis, bacterial meningitis, intussusception, mastoiditis, myocarditis, orbital cellulitis, sepsis, and testicular torsion. For DKA, empyema, encephalitis, ovarian torsion, septic arthritis, and stroke, the tool may be used to screen for complicated cases that may subsequently undergo manual review.

Upper extremity arthritis in children can be treated with joint aspiration, arthroscopy or arthrotomy, followed by antibiotics. The literature seems inconclusive with respect to the optimal drainage technique. Therefore, the objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the upper extremity in children. Two independent investigators systematically searched the electronic MEDLINE, EMBASE and Cochrane databases for original articles that reported outcomes of aspiration, arthroscopy or arthrotomy for septic arthritis of the paediatric shoulder or elbow. Outcome parameters were clinical improvement, need for repetitive surgery or drainage, and complications. Out of 2428 articles, seven studies with a total of 171 patients treated by aspiration or arthrotomy were included in the systematic review. Five studies reported on shoulder septic arthritis, one study on elbow septic arthritis, and one study on both joints. All studies were retrospective, except for one randomized prospective study. No difference was found between type of treatment and radiological or clinical outcomes. Aspiration of the shoulder or elbow joint required an additional procedure in 44% of patients, while arthrotomy required 12% additional procedures. Conclusion: Both aspiration and arthrotomy can achieve good clinical results in children with septic arthritis of the shoulder or elbow joint. However, the scientific quality of the included studies is low. It seems that the first procedure can be aspiration and washout and start of intravenous antibiotics, knowing that aspiration may have a higher risk of additional drainage procedures. Cite this article: EFORT Open Rev 2021;6:651-657. DOI: 10.1302/2058-5241.6.200122

Background The alpha-defensin test known as Synovaure has been very effective in diagnosis of prosthetic joint infections (PJIs). Being able to easily and accurately differentiate septic and inflammatory arthropathies in native joints would improve diagnostic workup and management. We tested the ability of an alpha-defensin test to distinguish septic from inflammatory or crystalline arthropathy in the native knee. Methods 40 native knee joint fluid specimens were tested with cell count, fluid analysis, and culture and alpha-defensin testing. We determined the sensitivity and specificity of the alpha-defensin test using culture-positive fluid as the gold standard for septic arthropathy and positive crystals as the gold standard for crystalline arthropathy. Results The Synovasure PJI test had 100% specificity for septic arthritis coupled with a 28% false-positive rate when applied to native knee aspirations. False-positive rate was 5.3 times higher in patients with crystals found in the joint fluid. Conclusion Alpha-defensin testing, in the form of the Synovasure PJI test, has a high-false-positive rate when used to distinguish septic and inflammatory arthritis in the native knee joint. Future work will need to determine the sensitivity and specificity of the newer native joint panel. Clinicians should be cognizant of the specific alpha-defensin test used when sampling native knee synovial fluid.

Increasing cases of carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections have been observed globally where multi-drug resistance to CR-KP can make the infection difficult to treat. In recent years, the β-lactam/β-lactamase inhibitor, ceftazidime-avibactam (CAZ-AVI), has been developed to treat complicated urinary tract infections and complicated intra-abdominal infections. CAZ-AVI is approved for children over 3-month old but has yet to be investigated for cases of osteomyelitis. Only three case reports exist in literature on the use of CAZ-AVI for CR-KP osteomyelitis in adults. In this report, we present an infant with primary hematogenous osteomyelitis and septic arthritis in the right shoulder following surgical treatment for a heart murmur. Bacterial isolation revealed a strain of CR-KP, which was successfully treated with CAZ-AVI after initial administration of imipenem-based treatments.

OBJECTIVE Species-related differences in the prevalence, manifestation, and outcome of neonatal illness may impact management practices of neonatal intensive care. The study aimed to elucidate similarities between disease manifestations and mortality risks of critically ill (CI) neonatal crias and foals admitted to the same referral center. DESIGN A comparative, retrospective cohort evaluation of two species (camelid and equine). SETTING The study was conducted in a University hospital. ANIMALS Two hundred and forty-six CI neonatal crias (January 1999 to May 2016) and 356 neonatal foals (February 2001 to May 2016) under 4-week-old were admitted to a university hospital. INTERVENTION All data are presented descriptively and compared between groups using univariate and multivariate analyses. MEASUREMENTS AND MAIN RESULTS Female crias (142/246, 57.7%) were significantly overrepresented in comparison to fillies (132/352, 37.5%). Congenital defects and transfer failure of passive immunity were more often observed in neonatal crias, while colic, diarrhea, patent urachus, septic arthritis, and omphalitis were significantly more common in CI foals. Overall survival to discharge (excluding fatal congenital defects) was comparable between crias (174/224; 77.8%) and foals (287/347, 82.1%), while crias (26/48; 54.2%) were more likely than foals (21/60; 35%) to die naturally than undergo euthanasia. Lower respiratory disease and indications for oxygen or IV glucose support increased mortality in the multivariate outcome models of both species. Species-specific adaptations of pediatric diagnostic criteria for sepsis were significantly associated with mortality in the multivariate analysis of patients with complete hematological datasets. However, the diagnosis of systemic inflammatory response syndrome (SIRS) did not retain statistical significance as an independent outcome predictor. CONCLUSIONS Lower respiratory disease and oxygen or glucose dysregulation increased mortality irrespective of species. However, despite species-specific differences in disease prevalence, the success of intensive care management was comparable.

The aim of the present study was to evaluate if the vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. The hypothesis was that local antibiotic prophylaxis by soaking ACL grafts in vancomycin results in significantly less infections than ACL reconstruction without local antibiosis. In group 1, 636 patients who were operated between 1.9.2014 and 31.8.2016 received no local antibiotic treatment with vancomycin. In group 2, 536 patients who were operated between 1.9.2016 and 31.8.2018 received local antibiotic treatment with vancomycin (1 mg/ml). In this group the graft was soaked in the vancomycin solution for 10 min prior to graft passage and fixation. In group 1 (ACL reconstruction without vancomycin application), a postoperative infection was detected in ten patients (infection rate: 1.6%). In group 2 (ACL reconstruction with 1 mg/ml vancomycin), no postoperative infection was detected (infection rate: 0%). The statistical analysis showed a clear significant difference between the two groups (p = 0.002). The re-rupture rate and the rate of arthrofibrosis differed not significantly between the two treatment groups (p = 0.526). The results of the present study show that graft soaking in vancomycin (1 mg/ml) is effective for the prevention of septic arthritis after ACL reconstruction. III.

A 10-year-old Labrador Retriever was referred for persistent lameness due to chronic right shoulder pain, unresponsive to various pain management therapies. Radiographs indicated signs of severe degenerative changes in the joint. Synovial fluid analysis was not diagnostic. Septic arthritis was suspected based on computed tomography and clinical signs. Arthroscopy allowed joint exploration, tissue biopsies, and copious joint lavage. Trichophyton spp. proliferation was identified on antimicrobial culture and histological analysis on samples obtained during arthroscopy. Oral griseofulvin therapy was initiated. Two months later, the referring veterinarian decided to interrupt the treatment after a negative synovial culture despite persistent lameness. Euthanasia was elected upon after pain also appeared on the tarsus; a post-mortem exam was not authorized by the owner. The origin of the infection remains unclear as this patient had no skin lesions and its immunological status was unknown. However, dermatophytosis has been reported in healthy dogs without skin lesions. To the author's knowledge, this is the first report of an osteoarticular infection with a dermatophyte in a dog.

Mekonnen Damessa Mamo,1 Fekede Bekele Daba,1 Mohammed Beshir Jnr,2 Korinan Fanta1 1Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia; 2Department of Pediatrics, Institute of Health, Jimma University, Jimma, Oromia, EthiopiaCorrespondence: Mekonnen Damessa Mamo; Korinan FantaDepartment of Clinical Pharmacy, Institute of Health, Jimma University, P.O.Box: 378, Jimma, Oromia, EthiopiaTel +251924100153; +251911598485Fax +251576617980Email mekonnenmoke4@gmail.com; korinan.taressa@ju.edu.etBackground: Despite the high burden of osteoarticular infections in sub-Saharan Africa, there is a paucity of data regarding the osteoarticular infections management approach and clinical outcomes in the region. Hence, this study aimed to evaluate a management protocol, clinical outcomes, and its determinants among pediatric patients with osteoarticular infections.Methods: A pediatric patient admitted to Jimma University Medical Center (JUMC), Ethiopia, with a diagnosis of osteoarticular infections was enrolled prospectively from April 30 to October 30, 2019. Clinical characteristics, management modality, and in-hospital complications were recorded from admission to discharge. Data were analyzed by using SPSS v.23 and the p-value < 0.05 was considered statistically significant.Results: Among a total of 150 pediatric patients enrolled in this study, osteomyelitis was diagnosed in 111 (74%), while the rest 39 (26%) had septic arthritis. The majority 105 (70%) of the study participants were male with a mean age of 8.79 ± 4.2 years. The culture was performed for only 3.6% of the patients. Almost all (98.7%) of the patients received intravenous (IV) antibiotics, and ceftriaxone was the most common IV antibiotic used as a monotherapy 66 (44.6%) or in combination with metronidazole 47 (31.8%) or gentamicin (12.8%). Almost half (45.3%) of the patients had poor treatment outcomes. Factors associated with poor treatment outcome were comorbidity [AOR=3.3, 95% CI (1.08– 10.16)] and use of combination antibiotics [AOR=2.9, 95% CI (1.16– 7.3)]. Rural residence [AOR=0.39, 95% CI (0.168– 0.92)] and surgical interventions [AOR=0.29, 95% CI (0.006– 0.144)] were associated with good treatment outcomes.Conclusion: Almost half of pediatric patients with osteoarticular infections had poor treatment outcome. Health providers should increase the accessibility of microbiological tests and diagnostic imaging, which can guide treatment decisions and improve outcomes of patients with osteoarticular infections.Keywords: management, infections, osteomyelitis, septic arthritis, children, sub-Saharan Africa

Staphylococcus aureus is an important organism in orthopaedic practice as it is the most common cause of orthopaedic infections including surgical site infections (SSIs), osteomyelitis and septic arthritis. Carriers of S. aureus are predisposed to developing invasive staphylococcal infections. Knowledge of a patient’s carrier status before surgery together with interventions to eliminate the carrier state have been shown to reduce post-operative infections by S. aureus. A cross-sectional study carried out at Kenyatta National Hospital orthopaedic wards from 1 June 2019 to 30 September 2019. To determine the prevalence and factors associated with nasal colonisation by S. aureus among patients who have been admitted to undergo surgery. Consecutive sampling was done until the required sample size was achieved. Nasal swabs were taken from patients at admission for culture. Data concerning comorbid conditions as well as healthcare associated risk factors was collected. The overall prevalence of colonisation by S. aureus at admission was found to be 24.7% whereas the overall prevalence of colonisation by Methicillin Resistant S. aureus (MRSA) was found to be 3.03%. The prevalence of colonisation by S. aureus is high amongst patients being admitted to orthopaedic wards at Kenyatta National Hospital when compared with previous studies and amongst these are those who are colonised by MRSA. The prevalence of MRSA calls for the need of screening programmes to curtail spread within hospital and community settings. Key words: Staphylococcus aureus, prevalence, nasal colonization, associated factors.

BACKGROUND The present study aimed to investigate diagnostic values of C-reactive protein (CRP), white blood cell (WBC), erythrocyte sedimentation rate (ESR), neutrophil to lymphocyte ratio (NLR), and the platelet to lymphocyte ratio as possible indirect inflammatory markers in children with septic arthritis (SA) for diagnosis process. METHODS The medical records of pediatric patients with SA who underwent debridement surgery between February 2005 and November 2018 were obtained from the hospital records. A total of 59 children with SA and 60 age- and gender-matched healthy controls were enrolled in the study. Hemograms parameters including WBC count, neutrophil count, lymphocyte count, hemoglobin, platelet count, CRP, ESR, NLR, and platelet to lymphocyte ratio. Biochemical parameters including alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, glucose, and albumin were investigated and compared between both groups. RESULTS Fifty-nine patients, 30% female (n: 18) and 70% male (n: 41), who had received operations for SA were included in the study. The mean age of the patients was 7.1 (range 6 days to 15 years) years and mean follow up 56.6 (12-140) months. No significant differences were observed in any biochemical parameters between the groups. However, a significant difference was found between the septic arthritis and the control group in all hemogram parameters. CONCLUSIONS Although the sensitivity and specificity of the NLR are lower than CRP, ESR, and WBC which are most commonly used inflammatory parameters in diagnosis process of septic arthritis, NLR may be useful in confirming the diagnosis in the clinical practise, with an optimum diagnostic cut-off value of 4.05.

Acute septic arthritis (ASA) is a common orthopedic infection of children which may produce devastating sequelae and chronic morbidity. Improved understanding of the intra-articular inflammatory response in ASA may identify cytokine targets with diagnostic or therapeutic potential, though no detailed investigations to this end have been performed. Given this, we used a multiplex cytokine assay for assessment of levels of 40 different cytokines in the synovial fluid and blood of children with ASA. Twelve children (8 controls undergoing orthopedic surgery for non-infectious conditions and 4 with ASA) were prospectively enrolled. Blood and synovial fluid were collected intraoperatively from each subject, and the levels of 40 cytokines were determined using a multiplex assay. Cytokines were organized by function and structure into 12 groups for analysis. The Benjamini-Hochberg method was used to control for type 1 errors, with an a priori false discovery rate of 10%. Subjects with ASA were younger than controls (mean age 8.0 vs 13.1 years, p=0.0400). Significant elevations were seen in interleukins (IL) with chemokine properties, IL-6 and those in the common-γ chain group in the blood and synovial fluid of children with ASA compared with controls, while significant elevations in 5 additional cytokine groups were seen in synovial fluid from children with ASA compared with controls, most notably IL-6 (median 8294.3 vs 10.7 pg/mL, p=0.0066). Our pilot study is the first to describe in detail the cytokine response in children with ASA, and highlights the need for additional study.

ZusammenfassungDiese Arbeit gibt einen Überblick über Epidemiologie, Ätiologie, Klinik, Diagnostik und Therapie von Infektionen an Hand und Handgelenk.

INTRODUCTION Septic arthritis (SA) is a devastating infection with a high rate of sequelae. The aim of this retrospective study was to determine the epidemiology, clinically significant sequelae and risk factors for developing these sequelae in children admitted to our hospital with SA. METHODS Patients with bacteriologically and/or radiologically confirmed SA from January 1999 to December 2014 were identified from discharge and laboratory records. Data was collected through a retrospective review of the case notes. RESULTS A total of 75 patients (62.7% male) met the inclusion criteria. The median age at presentation was six years (range two weeks to 15 years), and six patients were neonates. Microbiologic aetiology was determined in 40 (53.3%) patients, with Staphylococcus aureus being the most common organism. 68.0% of the patients underwent arthrotomy, and the average hospital stay was 15.3 days. Sequelae of SA were observed in nine patients on follow-up. Univariate and multivariate statistical analyses showed that young age, pyogenic bacterial isolation and concomitant osteomyelitis were significant risk factors for developing sequelae. CONCLUSION Our study demonstrated that young age, pyogenic bacterial isolation and concomitant osteomyelitis are associated with a high risk of sequelae. Timely microbiologic diagnosis by novel polymerase chain reaction methods and the use of magnetic resonance imaging in high-risk children to identify adjacent infection could possibly prevent lifelong disabling sequelae in SA.

BACKGROUND A high degree of vigilance is warranted for a spinal infection, particularly in a patient who has undergone an invasive procedure such as a spinal injection. The average delay in diagnosing a spinal infection is 2-4 mo. In our patient, the diagnosis of a spinal infection was delayed by 1.5 mo. CASE SUMMARY A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment. Six weeks to prior to surgery he received a spinal injection, which was followed by increasing lumbar radicular pain, weight loss and chills. This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach. The day after surgery, the patient developed left-sided lumbar radicular pain. Blood cultures grew Staphylococcus aureus (S. aureus). Magnetic resonance imaging showed inflammatory aberrations, revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause. Revision surgery took place and S. aureus was isolated from bacteriological samples. The patient received postoperative antibiotic treatment, which completely eradicated the infection. CONCLUSION The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection. A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.