Adult native septic arthritis: 10 years in review in order to establish local guidelines on empiric antibiotic therapy.


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Adult native septic arthritis: 10 years in review in order to establish local guidelines on empiric antibiotic therapy.
Titre de la conférence
20th European Congress of Clinical Microbiology and Infectious (ECCMID)
Clerc O., Senn L., Prod'hom G., Greub G., Zanetti G.
Vienna, Austria, April 10-13, 2010
Statut éditorial
Date de publication
Clinical Microbiology and Infection
Objective: Antibiotic stewardship includes development of practice
guidelines incorporating local microbiology and resistance patterns. In
case of septic arthritis (SA), addition of vancomycin to the empiric
therapy and broad-spectrum antibiotherapy in some clinical settings
are subjects of discussion. Our objective was to review the local
epidemiology of native septic arthritis in adults, in order to establish
local guidelines for empiric therapy.
Methods: Retrospective study based on positive synovial fluid cultures
and hospital discharge diagnoses of SA obtained from 1999 to 2008
in patients _16 years. Medical records were reviewed to assess the
diagnosis and complete relevant clinical information.
Results: During this ten-year period, we identified 233 SA on native
joints in 231 patients. 107 episodes (46%) were obtained through positive
synovial fluid cultures, and 126 episodes (54%) through the discharge
diagnosis. 147 SA (63%) were large joint infections (LJI). 35 SA (15%)
occurred in intravenous drug users. Preexisting arthropathy was present
in 51% of cases. 42% of patients with small joint infection (SJI) were diabetic,
vs. 23% with LJI (p = 0.003). When available, synovial fluid direct
examination was positive in 35% of cases. Etiologic agents are reported
in the table. Five of the 11 MRSA SA (45%) occurred in known carriers.
SJI were more frequently polymicrobial (24% vs. 1%, p<0.001).
For LJI, an empiric treatment with amoxicillin/clavulanate (A/C) would
have been appropriate in 85% of cases. MRSA (8 cases) and tuberculous
(7 cases) arthritis would have been the most frequently untreated
pathogens. Addition of vancomycin to A/C in MRSA carriers would
rise the adequacy to 87%. In contrast, A/C would cover only 75% of
SJI (82% if restricted to non-diabetic patients). MRSA (3 cases) and
P. aeruginosa (9 cases, 7 monomicrobial) would be the main untreated
pathogens. An anti-pseudomonal penicillin would have been appropriate
in 94% of cases of SJI (P = 0.002 vs. A/C, p = 0.19 if diabetic patients
not included).
Conclusions: Treatment with A/C seems adequate for empiric coverage
of LJI in our setting. Broad-spectrum antibiotherapy was significantly
superior for SJI in diabetic patients, due to different causative bacteria.
In an area of low MRSA incidence, our results do not justify a systematic
empiric therapy for MRSA, which should be considered in a known
Création de la notice
10/03/2011 14:36
Dernière modification de la notice
20/08/2019 15:58
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