Morbimortality in adult patients with septic arthritis: a three-year hospital-based study

Julien Ferrand , Youssef El Samad (1) , Benoit Brunschweiler , Franck Grados (1, 2) , Nassima Dehamchia-Rehailia , Alice Sejourne (1, 2) , Jean-Luc Schmit (1, 3) , Antoine Gabrion (1, 4) , Patrice Fardellone (1, 2) , Julien Paccou (5)

1 CHU Amiens-Picardie
2 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications vasculaires - UR UPJV 7517
3 AGIR - Agents infectieux, résistance et chimiothérapie - UR UPJV 4294
4 SSPC - Simplification des soins chez les patients complexes - UR UPJV 7518
5 MABLab (ex-pmoi) - Marrow Adiposity & Bone Lab - Adiposité Médullaire et Os - ULR 4490

Background: The objective of this ambispective study was to determine outcomes and associated factors for adult patients with confirmed septic arthritis (SA). Methods: All adult patients admitted to Amiens University Hospital between November 2010 and December 2013 with confirmed SA were included in the study. Patients with prosthetic joint infections were excluded. A statistical analysis was performed in order to identify risk factors associated with a poor outcome (including mortality directly attributable to SA). Results: A total of 109 patients (mean +/- SD age: 60.1 +/- 20.1; 74 male/35 females) were diagnosed with SA during the study period. The most commonly involved sites were the small joints (n = 34, 31.2 %) and the knee (n = 25, 22. 9 %). The most frequent concomitant conditions were cardiovascular disease (n = 45, 41.3 %) and rheumatic disease (n = 39, 35.8 %). One hundred patients (91.7 %) had a positive microbiological culture test, with Staphylococcus aureus as the most commonly detected pathogen (n = 59, 54.1 %). Mortality directly attributable to SA was relatively infrequent (n = 6, 5.6 %) and occurred soon after the onset of SA (median [range]: 24 days [1-42]). Major risk factors associated with death directly attributable to SA were older age (p = 0.023), high C-reactive protein levels (p = 0.002), diabetes mellitus (p = 0.028), rheumatoid arthritis and other inflammatory rheumatic diseases (p = 0.021), confusion on admission (p = 0.012), bacteraemia (p = 0.015), a low creatinine clearance rate (p = 0.009) and the presence of leg ulcers/eschars (p = 0.003). The median duration of follow-up (in patients who survived for more than 6 months) was 17 months [6-43]. The proportion of poor functional outcomes was high (31.8 %). Major risk factors associated with a poor functional outcome were older age (0.049), hip joint involvement (p = 0.003), the presence of leg ulcers/eschars (p = 0.012), longer time to presentation (0.034) and a low creatinine clearance rate (p = 0.013). Conclusions: In a university hospital setting, SA is still associated with high morbidity and mortality rates.

Domaines: Sciences du Vivant [q-bio]

Julien Ferrand, Youssef El Samad, Benoit Brunschweiler, Franck Grados, Nassima Dehamchia-Rehailia, et al.. Morbimortality in adult patients with septic arthritis: a three-year hospital-based study. BMC Infectious Diseases, 2016, 16, ⟨10.1186/s12879-016-1540-0⟩. ⟨hal-03564086⟩