Bacterial septic arthritis in adults

Identifying septic arthritis superimposed on crystalline arthropathy: Is synovial cell count the answer?

Background

Septic arthritis (SA) is an orthopedic urgency with significant morbidity and potential mortality. Differentiating SA and crystalline arthritis (CA) is difficult as concurrent disease may exist. This study sought to identify the prevalence of and define diagnostic laboratory markers for SA in the setting of CA.

Methods

A retrospective review was conducted of adult patients presenting to a single medical center between January 2012 and March 2023 with monosodium urate (MU) or calcium pyrophosphate (CPP) in synovial knee joint fluid of a native knee. Categorical variables were assessed using chi-square and Fisher exact tests. Receiver operating characteristic curves were computed, and diagnostic accuracy was determined from associated area under the ROC curve (AUC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated and optimal diagnostic thresholds determined by Youden index.

Results

225 knee aspirations were analyzed, 56.4 % CPP and 43.6 % MSU. There were 12 cases of superimposed SA (5.3 %), 11 culture confirmed and 1 suspected. Immunosuppression was associated with a higher incidence of SA (41.7 % versus 14.6 %, p = 0.0271). SA had a significantly higher mean synovial WBC (135,796 vs 22,510; p = 0.0007). There was no difference in percentage of PMNs between the septic and aseptic groups (90.6 % vs 69.7 %; p = 3.327). Of the 12 cases of concomitant SA, 10 (83.3 %) had a synovial WBC ≥50,000/mm3, compared to 21 (9.9 %) of the aseptic aspirations (p < 0.0001). Nine (75 %) aspirations in the septic group had ≥90 % PMNs, compared to 78 (36.6 %) in the aseptic group (p = 0.0123). The optimal diagnostic threshold for synovial WBC was 50,000/mm3 (91.7 % sensitivity, 90.1 % specificity, AUC = 0.960). The optimal synovial percentage of PMNs was 64 % (100 % sensitivity, 6.7 % specificity, AUC = 0.731).

Conclusion

In the setting of CA, synovial WBC may provide a useful diagnostic marker for SA with an optimal threshold of 50,000 cells/mm3.

Validation of septic arthritis diagnosis and disease characteristics in West Sweden

BACKGROUND

This study aimed to validate the septic arthritis diagnosis using International Classification of Diseases (ICD)-10 codes against the Newman criteria. Additionally, the study presents disease characteristics and compares subgroups.

METHODS

475 patients with an ICD-10 code for septic arthritis were identified at a university (n = 265) and a county (n = 167) hospital in West Sweden between 2016 and 2019. Medical records were analysed for adherence to the Newman criteria. Clinical data and culture results were compared between the university hospital and the county hospital, as well as between subgroups categorised by the pathogenetic route of infection, including direct inoculation and haematogenous spread infection.

RESULTS

91% of the patients fulfilled the Newman criteria (52% positive for synovial culture or PCR, 24% positive culture from blood or elsewhere, and 24% with radiological evidence or turbid synovial fluid). The patient population was predominantly male (62%), with a median age of 69 years, and the knee was the most commonly affected joint (39%). Staphylococcus aureus emerged as the predominant pathogen across all patient groups. 80% had a haematogenous spread septic arthritis, while 20% resulted from direct inoculation. In the haematogenous spread groups, patients were older, with fewer males, but higher CRP levels compared to those in the direct inoculation group.

CONCLUSION

ICD-10 codes for septic arthritis have a positive predictive value of 91% in relation to the Newman criteria in Swedish hospital care, making the utilisation of ICD-10 codes a reliable data source for future epidemiological studies.

Risk Factors for Failure to Eradicate Infection after Single Arthroscopic Debridement in Septic Arthritis of a Native Knee Joint

PURPOSE

To identify the risk factors and effect of empirical glycopeptide on the failure of single arthroscopic debridement for septic knee arthritis in a native knee joint.

MATERIALS AND METHODS

Patients who underwent arthroscopic debridement for septic knee arthritis from March 2005 to December 2022 at one institution were included in this study. Demographic data, comorbidities, preoperative factors including history of previous surgery, history of injection, laboratory data including preoperative C-reactive protein (CRP) and white blood cell (WBC) count, isolated pathogens from synovial fluid culture, and Gachter stage were analyzed. Statistical analyses using univariate and logistic regression were performed.

RESULTS

Out of 132 patients, 17 patients (12.9%) had more than one additional arthroscopic debridement. History of diabetes mellitus (DM) (p<0.001), previous injection (p=0.041), isolated Staphylococcus aureus in synovial fluid (p=0.010), and high Gachter stage (p=0.002) were identified as risk factors, whereas age, history of previous knee surgery at the affected knee, CRP level, preoperative WBC, and preoperative neutrophil count of synovial fluid had no significant relation. Logistic regression analysis showed significant increase of risk in patients with DM [odds ratio (OR) 12.002, 95% confidence interval (CI) 3.243-44.418, p<0.001], previous injection history (OR 4.812, 95% CI 1.367-16.939, p=0.017), and isolation of Staphylococcus aureus in synovial fluid (OR 4.804, 95% CI 1.282-18.001, p=0.031) as independent risk factors for failure of infection eradication after single arthroscopic debridement.

CONCLUSION

Comorbidity of DM, history of previous injection, isolated Staphylococcus aureus in synovial fluid, and high Gachter stage were associated with a higher risk of failure to eradicate infection with a single arthroscopic procedure. Empirical glycopeptide administration also showed no significant benefit in reducing the risk of additional surgical procedures for infection control, suggesting against the routine administration of glycopeptide.

[Septic musculoskeletal complications under immunomodulating treatment]

Infections are an important cause of morbidity and mortality in patients with inflammatory rheumatic diseases. Among these, musculoskeletal infections represent a relevant proportion as patients with rheumatoid arthritis face an increased risk of developing septic arthritis and prosthesis infections. The causes are multifactorial. In addition to immunosuppressive treatment, risk factors of infection in rheumatoid arthritis (RA) patients include repeated intra-articular joint punctures, an increased rate of joint replacement surgery, damaged joint structure and comorbidities. The use of glucocorticoids and tumor necrosis factor alpha (TNF-alpha) inhibitors, especially in the first 6 months of treatment, increase the risk of septic arthritis and periprosthetic joint infections. In addition, an increased disease activity could also be identified as a risk factor. Under immunosuppressive therapy rare pathogens such as Candida and mycobacteria can cause the infection and should be considered when there is a lack of clinical response to antibiotic treatment.

Staphylococcus aureus thermonuclease NucA is a key virulence factor in septic arthritis

Septic arthritis, primarily caused by Staphylococcus aureus, poses a significant risk of both mortality and morbidity due to its aggressive nature. The nuc1-encoded thermonuclease NucA of S. aureus degrades extracellular DNA/RNA, allowing the pathogen to escape neutrophil extracellular traps (NETs) and maintain the infection unabated. Here we show that in the mouse model for hematogenous septic arthritis, the Δnuc1 mutant is much less pathogenic and the severity of clinical septic arthritis is markedly reduced, including decreased weight loss, lower kidney bacterial load, reduced bone erosion, and much less IL-6 production. In vitro, S. aureus genomic DNA induces a robust TNF-α response in macrophage-like RAW 264.7 cells abrogated when the DNA is degraded by NucA. Moreover, the wild type induces high levels of TNF-α, IL-10, and IL-6 in neutrophils and osteoblast-like SAOS-2 cells, respectively. NucA exacerbates septic arthritis by increasing extracellular and intracellular survival of bacteria.

Computed Tomography Scan Detection of Intra-Articular Air in the Ankle Joint: A Cadaveric Study

INTRODUCTION

The diagnosis of traumatic arthrotomy is often accomplished using the saline load test. The introduction of large volumes of saline into the joint is uncomfortable for the patient and has been reported to have low sensitivity and specificity. Computed tomography (CT) scan has been previously validated as a fast and reliable method of detecting free air in the knee joint. The primary objective of this study was to evaluate the use of CT scan for the detection of intra-articular free air in the ankle joint.

METHODS

Eighteen fresh-frozen cadaver distal lower extremities were thawed, and then CT scans were obtained at their baseline harvested state. The tibiotalar joint was injected with 0.05cc free air, and then repeat CT scans of each specimen were obtained. Specimens with instrumentation, intra-articular air, or ambiguous free air prior to intervention were excluded from the study. Scans were performed from the mid leg through the entire foot at institution standard radiation dose (120 kV, 170 mA) and a slice thickness of 0.6 mm. Images were anonymized, randomized, and sent to 4 reviewers (2 orthopedic surgeons, 1 musculoskeletal radiologist, and 1 radiology resident) for evaluation of free air. Sensitivity and specificity of CT to detect free air were calculated, and Fleiss's Kappa coefficient was used to determine interobserver reliability.

RESULTS

The sensitivity and specificity of CT to detect free air in cadaver ankles was 100%. Twenty-two CT scans (11 natural state and 11 with simulated air arthrotomies) were correctly identified for the presence or absence of intra-articular free air by all reviewers with kappa coefficient 1.0 (complete agreement).

CONCLUSIONS

Computed tomography is a fast, reproducible method for detecting small volumes of free air in the ankle and may offer clinical benefit in evaluation of traumatic arthrotomy of the ankle.

Prospective evaluation of real-world performance and clinical impact of the Biofire FilmArray joint infection panel

Limitations of culture-based diagnostic approaches in pathogen detection in joint infections (JI) can be overcome by amplification-based, molecular assays. Recently, a syndromic panel PCR (spPCR) assay (Biofire JI panel; BJA) was approved for pathogen identification from synovial fluid (SF). Here, the performance and the clinical impact of the BJA were assessed in comparison to standard of care diagnostics in a prospective cohort of patients presenting with symptoms consistent with JI. One hundred sixty-five synovial fluids underwent analysis using the BJA. The results were compared with culture-based diagnostics. Discrepant results were re-analyzed using species-specific PCRs or 16S-rDNA sequencing. Clinical data from patients were collected to evaluate the impact on patient management. Twenty-seven of 165 (16.3%) synovial fluid cultures grew bacterial pathogens. In 24/27 cases, the BJA results were concordant. In one case, the cultured pathogen was missed, but three additional pathogens were identified. In 11 culture-negative cases, BJA identified a pathogen. Mean turnaround time in culture-positive samples was 14:11 h and 35:17 h in BJA and culture, respectively. In 11 cases, antibiotic therapy was optimized, based on BJA results. This study demonstrates high sensitivity and specificity (96.3% and 97.8%, respectively) of BJA, as well as a shorter turnaround time than culture-based techniques (21 h faster). Based on analysis of clinical data, antibiotic therapy was optimized due to BJA results in 11 cases. Care must be taken, as important pathogens in prosthetic JI are not included in the panel, restricting its value here.IMPORTANCEPathogen detection is critical for targeted management of joint infections; however, cultural detection of pathogens can be challenging. The Biofire Joint Infection Assay (BJA) is a syndromic panel PCR test that allows culture-independent detection of 31 pathogens. The diagnostic performance and clinical impact were evaluated in a cohort of 160 patients with native and prosthetic joint infections. BJA detected concordant pathogens in 24 of 27 culture-positive cases and enabled the detection of additional pathogens in 11 patients. The time to result was significantly shorter than with standard culture-based diagnostics (14 vs 35 h), and BJA allowed optimization of therapy in 11 patients. The data show that BJA is a relevant addition to the diagnostic options for joint infections. Limitations result from incomplete detection of relevant pathogens, especially in prosthetic joint infections. The use of BJA in daily practice must therefore be accompanied by diagnostic stewardship measures.

Risk factors for readmission and mortality after irrigation & debridement for septic arthritis in persons who inject drugs

Background and objective

Persons who inject drugs (PWID) are associated with increased risk of repeat irrigation & debridement (I&D) in the setting of native joint septic arthritis. Despite these associations, there is a lack of data regarding postoperative outcomes for PWID with septic arthritis. The primary aim of this study was to determine if PWID were associated with increased rates of readmission and mortality after I&D for septic arthritis.

Materials and methods

Patients from two level one trauma centers with native joint septic arthritis from 2015 to 2019 were retrospectively identified. Patients were included if they had a clinical presentation consistent with septic arthritis. Independent sample T-tests and Fisher's Exact testing were used to compare outcomes by PWID and repeat I&D status. Primary outcomes included 30 and 90-day readmission, 30 and 90-day readmission related to septic arthritis, and 30 and 90-day mortality. Binary logistic regression testing was used to control for confounders such as human immunodeficiency virus (HIV), tobacco use disorder, diabetes, and immunocompromised status.

Results

192 patients with septic arthritis were identified (female, n = 70; male, n = 122). 231 joints were included in the analysis. There were 67 cases associated with PWID (29 %). Notably, PWID were associated with increased rates of tobacco use disorder (92 % vs. 24 %, p < 0.001) and increased immunocompromised status (81 % vs. 24 %, p < 0.001). PWID were associated with increased rates of 30-day and 90-day readmission (35 % vs. 12 %, p = 0.008; 61 % vs. 21 %, p = 0.002), and increased 30-day and 90-day mortality rate (22 % vs. 0.03 %, p < 0.001; 35 % vs 0.09 %, p = 0.001). However, these associations did not remain significant after controlling for confounders. Repeat I&D was significantly associated with increased 90-day readmission rates (OR 6.32, p < 0.001), which remained significant when controlling for confounders.

Conclusions

This multicenter study demonstrated a strong association between repeat I&D and 90-day readmission rate in the setting of native joint septic arthritis. Reassuringly, repeat I&D was not associated with increased rates of postoperative mortality. PWID were associated with increased 30 and 90-day readmission and mortality rates, but these were no longer significant after controlling for confounders.

Causal relationship between gut microbiota and pyogenic arthritis: a two-sample Mendelian randomization study

Introduction. Accumulating evidence indicates a significant association between gut microbiota and the risk of developing pyogenic arthritis (PA). However, their causal relationship has yet to be elucidated.Hypothesis. The gut microbiota is causally associated with the risk of PA.Aim. The Mendelian randomization (MR) methodology was employed to assess the potential causal effects of gut microbiota on the susceptibility to PA.Methodology. A two-sample MR study was performed using the summary statistics of gut microbiota from the largest available genome-wide association study meta-analysis (n=13,266) conducted by the MiBioGen consortium. The summary statistics of PA were obtained from the R11 release data provided by the FinnGen consortium (2,441 cases and 2,87,796 controls). Inverse-variance weighted (IVW) model, weighted median estimator model, weighted model-based method and MR-Egger regression (MER) model were used to examine the causal association between gut microbiota and PA. To assess the heterogeneity and pleiotropic effects of the identified instrumental variables (IVs), we utilized several analytical methods, including the leave-one-out sensitivity analysis, the MR Pleiotropy Residual Sum and Outlier test and Cochran's Q test.Results. Utilizing the IVW method, we identified six bacterial traits that were negatively correlated with PA: Eubacterium eligens group [OR: 0.6057; 95 % confidence interval (CI): 0.4525 to 0.8107; P=0.0007], Barnesiella (OR: 0.7456; 95 % CI: 0.5760 to 0.9651; P=0.0258), Coprococcus2 (OR: 0.7257; 95 % CI: 0.5352 to 0.9840; P=0.0391), Ruminococcaceae UCG005 (OR: 0.7562; 95 % CI: 0.5920 to 0.9660; P=0.0252), E. oxidoreducens group (OR: 0.7311; 95 % CI: 0.5547 to 0.9637; P=0.0262) and Lachnospiraceae FCS020 group (OR: 0.7825; 95 % CI: 0.6135 to 0.9981; P=0.0482), respectively. On the contrary, four bacterial traits were positively correlated with PA: Adlercreutzia (OR 1.3210, 95 % CI 1.0181-1.7141, P=0.0362), Holdemania (OR 1.2239, 95 % CI 1.0013-1.4960, P=0.0485), Anaerostipes (OR 1.3614, 95 % CI 1.0189-1.8191, P=0.0369) and Butyricimonas (OR 1.2627, 95 % CI 1.0016-1.5921, P=0.0484), respectively. No significant heterogeneity among IVs or evidence of horizontal pleiotropy was detected.Conclusion. Our research demonstrates a potential causal link between various gut microbiota and the risk of PA. Further research is imperative to elucidate the mechanisms by which gut microbiota influence the pathogenesis of PA.

Septic Arthritis Modeling Using Sonographic Fusion with Attention and Selective Transformation: a Preliminary Study

Conventionally diagnosing septic arthritis relies on detecting the causal pathogens in samples of synovial fluid, synovium, or blood. However, isolating these pathogens through cultures takes several days, thus delaying both diagnosis and treatment. Establishing a quantitative classification model from ultrasound images for rapid septic arthritis diagnosis is mandatory. For the study, a database composed of 342 images of non-septic arthritis and 168 images of septic arthritis produced by grayscale (GS) and power Doppler (PD) ultrasound was constructed. In the proposed architecture of fusion with attention and selective transformation (FAST), both groups of images were combined in a vision transformer (ViT) with the convolutional block attention module, which incorporates spatial, modality, and channel features. Fivefold cross-validation was applied to evaluate the generalized ability. The FAST architecture achieved the accuracy, sensitivity, specificity, and area under the curve (AUC) of 86.33%, 80.66%, 90.25%, and 0.92, respectively. These performances were higher than using conventional ViT (82.14%) and significantly better than using one modality alone (GS 73.88%, PD 72.02%), with the p-value being less than 0.01. Through the integration of multi-modality and the extraction of multiple channel features, the established model provided promising accuracy and AUC in septic arthritis classification. The end-to-end learning of ultrasound features can provide both rapid and objective assessment suggestions for future clinic use.

Staphylococcus Aureus Tames Nociceptive Neurons to Suppress Synovial Macrophage Responses for Sustained Infection in Septic Arthritis

The interaction between the nervous system and immune system during chronic bacterial infection remains unclear. Here, it is reported that Staphylococcus aureus (S. aureus) infection induces calcitonin gene-related peptide (CGRP) secretion from intra-articular transient receptor potential cation channel subfamily V member 1 positive (TRPV1+) nociceptive nerves through its pore-forming toxin (PFT) α-hemolysin. The released CGRP then inhibits the production of chemotactic cytokines by CX3CR1+ tissue-resident synovial lining macrophages via receptor activity modifying protein 1 (RAMP1) receptors at the onset of septic arthritis. During the subsequent chronic course of infection, the continuous release of CGRP triggered by pain has a lasting effect on the antimicrobial capabilities of macrophages, thereby promoting bacterial survival and joint damage. This evidence suggests a critical role for neuroimmune regulation in S. aureus-induced chronic septic arthritis. CGRP receptor antagonism may reduce joint destruction, thus providing a new option for treating bone and joint infections.

Sonography of Arthritis: Inflammatory, Infectious, Depositional

Ultrasound (US) is a valuable tool in the evaluation of arthritis both for diagnosis and treatment response. Pertinent findings such as joint effusions, synovitis, bursitis, bone erosions, tenosynovitis, and enthesitis can all be readily evaluated sonographically. In this article, we describe specific considerations in the US evaluation of rheumatoid arthritis, psoriatic arthritis, juvenile idiopathic arthritis, crystalline arthritis (gout, calcium pyrophosphate deposition disease, and hydroxyapatite deposition disease), septic arthritis, and osteoarthritis with attention to certain differentiating features. The potential role of US in the diagnosis of specific arthritides is discussed, together with an overview of newer technologies and future directions.

Combination treatment with anti-RANKL and antibiotics for preventing joint destruction in septic arthritis

Septic arthritis, the most severe joint disease, is frequently caused by Staphylococcus aureus (S. aureus). A substantial proportion of patients with septic arthritis experience poor joint outcomes, often necessitating joint replacement surgery. Here, we show that monocyte depletion confers full protection against bone erosion in a septic arthritis mouse model. In the infected synovium, Ly6Chi monocytes exhibited increased expression of osteoclastogenesis-related molecules, including CCR2, c-Fms, and RANK. S. aureus lipoproteins induced elevated levels of RANKL, MCSF, and CCL2 in joints, with synovial fibroblasts identified as the major RANKL producer. Anti-RANKL treatment prevented bone destruction in both local and hematogenous septic arthritis murine models. Importantly, combining anti-RANKL treatment with antibiotics provided robust protection against joint damage. Our results indicate that the infiltration and transformation of monocytes into bone-destructive, osteoclast-like cells are key mechanisms in septic arthritis. Combining anti-RANKL and antibiotic therapy represents a promising therapy against this devastating disease.

Survival and risk factor analysis in patients with septic arthritis: a retrospective study of 192 cases

BACKGROUND

Septic arthritis (SA) presents a complex clinical challenge, often resulting in significant morbidity and mortality. This study aimed to (1) assess overall mortality rates and (2) identify potential factors contributing to increased mortality risk in patients with SA.

METHODS

This retrospective study on SA patients treated at a German university hospital between January 1, 2011, and December 31, 2021. Patients were identified using International Classification of Diseases (ICD)-10 codes for septic arthritis, specifically "M00.-". The study evaluated mortality rates and analyzed comorbidities, pathogens, and other potential risk factors. Kaplan-Meier survival curves and odds ratios (OR) were calculated to assess mortality risk.

RESULTS

In a cohort of 192 patients diagnosed with SA, 64 patients (33.3%) died during a mean follow-up period of 54.4 ± 42 months. The overall mortality rate was 17.5% at one year, 19.9% at two years, and 28.3% at five years. Patients aged 65 years or older, as well as those with arterial hypertension, congestive heart failure, chronic renal disease, chronic liver disease, malignancy, steroid use and immunosuppression showed significantly higher mortality rates (p < 0.05). Chronic renal disease (OR = 2.80), malignancy (OR = 3.40), and chronic heart failure (OR = 2.62) were identified as significant notably risk factors for mortality.

CONCLUSION

This study highlights a notably high mortality rate among vulnerable patients with SA, particularly those with pre-existing comorbidities. Recognizing and addressing these risk factors early could improve patient outcomes. These results unterscore the need for close monitoring of SA patients, particularly those with chronic organ conditions, and timely intervention for sepsis to reduce mortality risk.

In situ dual-targeted drug delivery system for alleviating imaging and pathological damage in septic arthritis

Septic arthritis is a severe disease that damages articular cartilage and triggers a strong inflammatory response. Current treatments mainly depend on systemic antibiotics and lack effective intra-articular therapies, as well as standardized animal models, and precise detection methods. In this study, we present a drug delivery system responsive to the bacterial microenvironment for targeted inflammation control, along with an effective method for monitoring changes in septic arthritis in SD rats. This system consists a core with pH-sensitive metal-organic frameworks ZIF-8 loading anti-inflammatory drugs indomethacin and a shell with hybrid cell membranes from macrophages (MM) and platelets (PM), refer as MP@ZIF-8@IN. This system, which diverges from traditional treatments, enhances drug utilization, prolongs local retention, and allows for spontaneous release at the treatment site, thereby enabling the exclusive intra-articular treatment of septic arthritis. The drug delivery system inhibits the NF-κB pathway, reduces oxidative stress, and regulates macrophage polarization, preventing cartilage destruction. Additionally, in this standardized animal model utilizing the knee joints of SD rats, we have developed musculoskeletal ultrasound and magnetic resonance imaging for time-based monitoring, thus overcoming the limitation of conventional methods, which are unsuitable for soft tissue analysis. Our findings advance therapeutic strategies for septic arthritis and encourage further application of visualization techniques in related fields. STATEMENT OF SIGNIFICANCE: This study presents significant advancements in the treatment and understanding of septic arthritis. Our customized drug delivery system targets bacteria and macrophages, ensuring long-time drug retention and enhanced inflammation control, all while reducing reliance on antibiotics-an important step toward addressing antibiotic resistance. Additionally, we have refined septic arthritis animal models to establish clearer guidelines for intervention timing, grounded in clinical symptoms and imaging data. This addresses a critical gap in current research and offers a practical framework for future therapeutic approaches.

A Fused Membrane-Camouflaged Biomimetic Nanosystem for Dual-Targeted Therapy of Septic Arthritis

Due to the inherent aseptic and enclosed characteristics of joint cavity, septic arthritis (SA) almost inevitably leads to intractable infections and rapidly progressing complex pathological environments. Presently, SA faces not only the deficient effectiveness of the gold-standard systemic antibiotic therapy but also the scarcity of effective localized targeted approaches and standardized animal models. Herein, an ingenious multifunctional nanosystem is designed, which involves the methylation of hyaluronic acid (HA), copolymerization with DEGDA, loading with vancomycin (VAN), and then coating with fused macrophage-platelet membrane (denoted as FM@HA@VAN). Upon intra-articular administration, FM@HA@VAN nanoparticles exhibit sustained retention and selectively targeting to infected sites, leveraging macrophage-mediated inflammation homing and platelet-directed bacteria targeting. The acidic microenvironment triggers responsive release of vancomycin, leading to potent bactericidal effects. Subsequently, the exposed HA@VAN nanoparticles are efficiently internalized by activated macrophages, releasing HA to alleviate oxidative stress and achieve chondroprotection by inhibiting pro-inflammatory cytokines, neutralizing ROS and upregulating macrophage M2 polarization. In vivo model and experiments confirm the efficacy of this dual-targeting antibacterial approach, demonstrating its precision in eradicating bacterial infections and alleviating associated pathological processes, including synovial hyperplasia and cartilage erosion. The dual-targeting therapeutic nanosystem, coordinated with fused-membranes, holds promise for enhancing the treatment efficacy of SA.

Septic Arthritis of the Elbow: A 10-Year Retrospective Clinical and Microbiological Review From a Single Center

Introduction In industrialized nations, the incidence of septic arthritis (SA) varies depending on geographic region, socioeconomic status, and age group. The condition is more frequently observed in male individuals, the elderly, and children. Additionally, its prevalence may have increased due to a rise in orthopaedic procedures, an aging population, and higher rates of immunosuppression. Hence, understanding the evolving clinical and epidemiological patterns of SA is crucial, along with identifying the common microbiological causes and pathogens involved. Material (patients) and methods A retrospective examination of the case series analysis was conducted. Patients underwent treatment at the Poole General Hospital, specializing in acute orthopaedic cases. Data collection lasted six months, from January 2021 to July 2021. During this time, every individual with a suspicion of primary SA of the elbow joint underwent aspiration. Exclusion criteria included any previous elbow joint surgery, a diagnosis of fungal or tuberculous arthritis, and duration of symptoms >6 months. Means and standard deviations were displayed for the continuous variables. Continuous data were summarized using averages and standard deviations, whilst categorical data was provided as absolute numbers with their corresponding percentages. Results A total of 241 patients were included in the study, comprising 200 (83%) male patients and 41 (17%) female patients, with a mean age of 67.47 ± 18.23 years. The most common symptom was pain (81.7%), while fever (>37.8°C) was observed in 3.7% of cases. The mean white blood cell (WBC) count was 11.85 ± 7.2, and C-reactive protein (CRP) levels averaged 103.45 ± 102. Leukocytosis was noted in 48.5% of cases. Comorbidities included hypertension (25.3%), diabetes (12.0%), and immunosuppression (34.0%). Gram stain identified bacteria in 10% of cases, while microbial cultures were positive in 27.1%, with Staphylococcus aureus being the most frequently isolated pathogen (58.8%). Resistance to co-trimoxazole was observed in 61.8% of isolates, with 79.4% being Staphylococcus aureus and 11.7% being methicillin-resistant Staphylococcus aureus (MRSA) (p<0.001). Univariate analysis showed significant associations between rheumatoid arthritis (RA), diabetes, and orthopaedic complications (p<0.01). Patients with clinical complications had a significantly longer hospital stay (17.8 ± 12.4 days vs. 6.43 ± 9.5 days, p<0.01). These findings highlight the importance of regional bacterial trends in guiding antibiotic therapy and patient management. Conclusions The findings emphasize the predominant role of Staphylococcus aureus as the causative pathogen, with notable antibiotic resistance patterns, particularly to co-trimoxazole and erythromycin. Despite timely surgical intervention and antibiotic therapy, complications including orthopaedic sequelae and prolonged hospital stays were more common among patients with RA, diabetes, and other comorbidities.

Knowledge, Attitudes, and Practices of Moroccan Rheumatologists in the Management of Acute Septic Arthritis: Results of a National Cross-Sectional Survey

Objective To assess the level of knowledge of Moroccan rheumatologists regarding the management of acute septic arthritis and analyze their attitudes and clinical practices toward this condition. Methods A descriptive cross-sectional study was conducted among Moroccan rheumatologists through a Google Forms questionnaire distributed via email. The data collected included sociodemographic characteristics of Moroccan rheumatologists, their level of knowledge, as well as their attitudes and clinical practices, assessed on a Likert scale (1 to 5). Results Out of the 440 questionnaires sent, 131 rheumatologists replied, corresponding to a response rate of 131 (33.58%). The average age of participants was 42.9±12.7 years, with a predominance of females (103 (84.8%)) and an average of 13.8 ± 11.3 years of experience in rheumatology. The diagnosis of septic arthritis was systematically considered in the case of acute monoarthritis, even in the absence of fever, by 122 (93.1%) rheumatologists. However, only 68 (51.9%) were aware of the association between a quick Sequential Organ Failure Assessment (qSOFA) score ≥2 and a high risk of mortality. Regarding therapeutic management, 115 (87.8%) rheumatologists preferred a third-generation cephalosporin, often combined with an aminoglycoside (110 (84%)). However, only 18 (13.7%) prescribed short-course antibiotics for small joints, and 13 (9.9%) associated this with joint lavage and/or surgical synovectomy. Furthermore, in cases of unfavorable evolution, only 19 (14.5%) routinely referred the patient to an orthopedic surgeon for surgical lavage. The main challenges identified were delayed diagnosis (90 (68.7%)) and the management of complicated cases (91 (69.5%)). To address these issues, a large majority of rheumatologists recommended the development of standardized protocols (118 (90.1%)), raising awareness among healthcare professionals about early diagnosis (116 (88.5%)), and strengthening collaboration with orthopedic surgeons (111 (84.7%)). Conclusion This study highlights gaps in the management of acute septic arthritis and emphasizes the need for better awareness, standardization of practices, and improved coordination with other specialties to optimize patient care.

Surgical Management of Septic Arthritis of the Wrist: An Analysis of Short- and Long-Term Functional and Clinical Outcomes

Septic arthritis of the wrist is a rare but severe condition requiring urgent diagnosis and treatment to prevent joint destruction and functional impairment. The objective of this study was to investigate prognostic parameters and the long-term functional outcomes. This retrospective and prospective cohort study included 44 patients treated for septic arthritis of the wrist between 2008 and 2024. All patients underwent surgical wrist arthrotomy due to concomitant soft tissue involvement, with a median follow-up of 29 months. Clinical outcomes were assessed through total active range of motion (TROM), grip strength, and patient-reported hand function using the DASH questionnaire. Data analysis examined correlations between comorbidities, surgical interventions and long-term outcomes. Staphylococcus aureus was identified in 61.4% of cases, thus being the most common pathogen. Type 2 diabetes mellitus was identified as a risk factor for requiring a higher number of surgeries to control the infection. Patients requiring more invasive procedures showed worse long-term outcomes, with lower grip strength, a limited active range of motion (TROM) and higher DASH scores. Mortality was associated with higher inflammatory markers and older age at the onset of disease. A total of 36.4% of patients were unable to return to work after treatment, while those who successfully returned to work experienced a median recovery period of seven months. The timely initiation of appropriate surgical therapy is essential in the treatment of septic arthritis of the wrist in order to reduce joint damage and associated loss of hand function, particularly in patients with comorbidities such as diabetes mellitus. Studies should focus on comparing different treatment options and developing more targeted rehabilitation strategies to improve functional outcomes.

Ten years of experience with elbow native joint arthritis: a multicenter retrospective cohort study

Background: Elbow native joint septic arthritis (NJSA) is a rare condition, constituting 6 %-9 % of all native septic arthritis cases. It is associated with elevated mortality and morbidity. This study aims to clarify the characteristics, management, and outcomes of elbow NJSA. Methods: We retrospectively analyzed adults diagnosed with elbow NJSA who underwent surgical intervention at Mayo Clinic facilities from January 2012 to December 2021. Diagnosis relied on clinical presentation, synovial fluid white blood cell (WBC) count, and aspiration or operative cultures. Results: Among 557 patients with NJSA during the study time frame, 19 (3.4 %) were found to have elbow NJSA. The median age of these patients was 64 years. Joint aspirations were conducted in 16 cases (84.2 %). The median synovial fluid WBC count was 43 139 cells mm-3. Crystals were observed in three patients (15.8 %). Synovial fluid and operative tissue samples revealed 12.5 % and 20 % positive Gram stains, mostly indicating Gram-positive cocci clusters. Open arthrotomy (72.2 %) was the predominant surgical approach, and three patients (16.7 %) required reoperation within 90 d. The median antimicrobial therapy duration was 30 d (interquartile range: 22-44 d). Non-tuberculosis mycobacterium (NTM) was detected in two patients, with a treatment duration of 274 and 374 d, respectively. Complications included joint contracture and joint resection. Conclusions: Elbow NJSA is an infrequent condition associated with significant complications, such as the necessity for reoperation. Although the synovial fluid WBC count, crystals, and Gram stain positivity were less helpful for diagnosis in this study, positive Gram stain and culture results from operative tissue specimens demonstrated greater effectiveness in diagnosing elbow NJSA.

Fusobacterium necrophorum septic arthritis of the hip: A case-report and literature review

INTRODUCTION

Fusobacterium necrophorum is a rare but significant cause of septic arthritis, typically following oropharyngeal infections in adolescents. This anaerobic pathogen, commonly associated with Lemierre's syndrome, can lead to joint infections, posing risks for severe morbidity if diagnosis and treatment are delayed. Awareness and timely intervention are essential for preventing long-term joint damage.

CASE REPORT

We report the case of a 19-year-old woman who developed high fever and acute right hip pain one week after a sore throat. Imaging revealed septic arthritis, with F. necrophorum identified in both blood and synovial fluid cultures. She received intravenous piperacillin/tazobactam, followed by outpatient parenteral therapy through an elastomeric pump, achieving full recovery. This case adds to the 42 cases documented in our literature review, reinforcing the need for prompt antimicrobial therapy.

CONCLUSION

Fusobacterium-induced septic arthritis, though uncommon, should be considered in young patients presenting with joint infections post-pharyngitis. Early diagnosis and targeted antimicrobial therapy, particularly with β-lactamase inhibitors, are critical for effective management and preventing joint sequelae.

Advances in the pathology and treatment of osteoarthritis

BACKGROUND

Osteoarthritis (OA), a widespread degenerative joint disease, predominantly affects individuals from middle age onwards, exhibiting non-inflammatory characteristics. OA leads to the gradual deterioration of articular cartilage and subchondral bone, causing pain and reduced mobility. The risk of OA increases with age, making it a critical health concern for seniors. Despite significant research efforts and various therapeutic approaches, the precise causes of OA remain unclear.

AIM OF REVIEW

This paper provides a thorough examination of OA characteristics, pathogenic mechanisms at various levels, and personalized treatment strategies for different OA stages. The review aims to enhance understanding of disease mechanisms and establish a theoretical framework for developing more effective therapeutic interventions.

KEY SCIENTIFIC CONCEPTS OF REVIEW

This review systematically examines OA through multiple perspectives, integrating current knowledge of clinical presentation, pathological mechanisms, and associated signaling pathways. It assesses diagnostic methods and reviews both pharmacological and surgical treatments for OA, as well as emerging tissue engineering approaches to manage the disease. While therapeutic strategies such as exercise, anti-inflammatory drugs, and surgical interventions are employed to manage symptoms and modify joint structure, none have been able to effectively halt OA's advancement or achieve long-lasting symptom relief. Tissue engineering strategies, such as cell-seeded scaffolds, supportive matrices, and growth factor delivery, have emerged as promising approaches for cartilage repair and OA treatment. To combat the debilitating effects of OA, it is crucial to investigate the molecular basis of its pathogenesis and seek out innovative therapeutic targets for more potent preventive and treatment strategies.

Dual neutralization of TGF-β and IL-21 regulates Th17/Treg balance by suppressing inflammatory signalling in the splenic lymphocytes of Staphylococcus aureus infection-induced septic arthritic mice

Septic arthritis (SA) caused by Staphylococcus aureus is a severe inflammatory joint disease, characterized by synovitis accompanied with cartilage destruction and bone erosion. The available antibiotic treatment alone is insufficient to resolve the inflammation that leads to high rates of morbidity and mortality. Among the CD4+ T helper lymphocytes, the Th17 and Tregs are key regulators of immune homeostasis. A high Th17 could lead to autoimmunity, whereas an increase in Tregs indicates immunosuppression. Depending on the external cytokine milieu, naïve CD4+ T cells transform into either Th17 or Treg cell lineage. TGF-β in the presence of IL-21 produces Th17 cells and drives the inflammatory cascade of reactions. We studied the effects of in vivo neutralization of TGF-β and IL-21 in septic arthritic mice to control arthritic inflammation, which has not been studied before. The arthritic index showed maximum severity in the SA group which substantially reduced in the Ab-treated groups. Flow cytometric analyses of peripheral blood collected from mice at 9DPI revealed the highest Th17/Treg ratio in the SA group but least in the combined-antibody-treated group. TGF-β1 and IL-21 cytokine production from serum, spleen, and synovial tissue homogenates was significantly reduced in the dual Ab-treated group than in the untreated SA group. From the Western blot analyses obtained from splenic lymphocytes at 9 DPI, we elucidated the possible underlying mechanism of interplay in downstream signalling involving the interaction between different STAT proteins and SOCS, NF-κB, RANKL, mTOR, iNOS, and COX-2 in regulating inflammation and osteoclastogenesis. On endogenous blockade with TGF-β and IL-21, the Th17/Treg ratio and resultant arthritic inflammation in SA were found to be reduced. Therefore, maintaining the Th17/Treg balance is critical to eradicate infection as well as suppress excessive inflammation and neutralization of TGF-β and IL-21 could provide a novel therapeutic strategy to treat staphylococcal SA.

Osteomyelitis and Septic Arthritis in the Darwin Prospective Melioidosis Study

Background

Melioidosis is a multisystem infectious disease caused by the environmental bacterium Burkholderia pseudomallei. Osteomyelitis (OM) and septic arthritis (SA) are uncommon primary presentations for melioidosis but important secondary foci, often requiring prolonged therapy and multiple surgeries. We characterized the epidemiology, presentation, treatment, and outcomes of patients from 24 years of the Darwin Prospective Melioidosis Study (DPMS).

Methods

DPMS patients from October 1, 1999, until September 30, 2023, were included if they had a primary or secondary diagnosis of OM or SA. Epidemiological, risk factor, clinical, and outcome data were retrieved from the DPMS database. Antibiotic and surgical data were collated from patient records.

Results

From 1129 consecutive patients with culture-confirmed melioidosis, 122 (10.8%) had OM and/or SA, with 115 evaluable. Ninety-four of 1129 (8.3%) had OM, and 62/1129 (5.5%) had SA, with 41/115 (35.7%) of these having both OM and SA. Many combined infections involved contiguous bone and joints or soft tissue. Fifty-nine (51.3%) were male, and only 4.3% were ≤16 years old. Diabetes mellitus was present in 69.6%, and only 12.2% had no identifiable clinical risk factor. There were 8 deaths (7.0%) and 20 (17.4%) recurrent infections. Seventy-one (61.7%) had operative management, with combined infection associated with more procedures and longer length of stay.

Conclusions

The current paradigm of care for osteoarticular melioidosis involves prolonged intravenous antibiotics in conjunction with timely and complete operative management, and in our setting where these are available, outcomes are good. In many melioidosis-endemic regions these resources are limited, and mortality remains high.

Pneumococcal Septic Arthritis among Adults, France, 2010-2018

Streptococcus pneumoniae infection is considered an uncommon cause of arthritis in adults. To determine the clinical and microbiological characteristics of pneumococcal septic arthritis, we retrospectively studied a large series of cases among adult patients during the 2010-2018 conjugate vaccine era in France. We identified 110 patients (56 women, 54 men; mean age 65 years), and cases included 82 native joint infections and 28 prosthetic joint infections. Most commonly affected were the knee (50/110) and hip (25/110). Concomitant pneumococcal infections were found in 37.2% (38/102) and bacteremia in 57.3% (55/96) of patients, and underlying conditions were noted for 81.4% (83/102). Mortality rate was 9.4% (8/85). The proportion of strains not susceptible to penicillin was 29.1% (32/110). Of the 55 serotyped strains, 31 (56.4%) were covered by standard pneumococcal vaccines; however, several nonvaccine serotypes (mainly 23B, 24F, and 15A) had emerged, for which susceptibility to β-lactams was low.

Focal Staphylococcus Aureus Septic Arthritis Elicits Age and TLR2-Dependent Periarticular Bone Loss

Introduction

Septic arthritis, primarily caused by Staphylococcus aureus (S. aureus), is a severe joint infection that leads to joint and bone damage. S. aureus lipoproteins (LPPs) bind to Toll-like Receptor 2 (TLR2), inducing arthritis and localized bone loss. Aging affects TLR2 immune response to pathogens. While intra-articular injections of S. aureus LPPs induces local bone resorption in mice, the influence of aging and TLR2 expression on bone mineral density (BMD) after S. aureus bacteremia remains unclear.

Methods

We analyzed distal femoral BMD in young and old TLR2 knock-out and wild-type mice following intravenous S. aureus infection. BMD was measured in both total and trabecular bone in old and young mice to determine age and TLR2-dependent responses to infection.

Results

In non-infected mice, BMD in both total and trabecular bone was mainly age-related and TLR2-independent. Following S. aureus bacteremia, young wild-type mice with TLR2 expression showed decreased combined cortical and trabecular BMD. This effect was absent in aged mice or TLR2 deficient mice. Focal septic arthritis, induced by S. aureus bacteremia, emerged as the primary cause to bone loss in the femur metaphysis. TLR2 appears to play a crucial role in focal septic arthritis-induced bone loss, as evidenced by in vitro findings demonstrating that staphylococcal LPPs, known TLR2 agonists, increase the Tnfsf11/Tnfrsf11b ratio in mouse pariosteal osteoblasts.

Conclusion

S. aureus bacteremia triggers local bone loss in murine arthritis, depending on both age and TLR2 expression.

Two-stage total joint replacement for hip or knee septic arthritis: post-traumatic etiology and difficult-to-treat infections predict poor outcomes

PURPOSE

Septic arthritis (SA) is a rare but significant clinical challenge in orthopedics that can impact patients' quality of life. This study aims to examine the clinical outcomes of patients undergoing two-stage total joint replacement (TJR) in hip and knee SA and analyze potential predictors of treatment failure.

METHODS

A retrospective analysis was conducted using data from a prospectively collected institutional arthroplasty registry from January 1st, 2012, to January 1st, 2019. Patients with hip or knee SA who underwent a two-stage TJR and had at least two years of follow-up were included. Demographic characteristics, surgical variables, and outcomes were collected and analyzed from clinical and surgical data. Statistical analysis was performed using IBM SPSS Statistics, with statistical significance at p < 0.05.

RESULTS

One hundred and fourteen patients (61 with hip SA, 53 with knee SA) were included in the study. The mean follow-up was 72.8 months. Postoperatively, both clinical and functional outcomes significantly improved, as indicated by the Hip Society Score (HHS) and Knee Society Score (KSS). The overall success rate of the two-stage protocol was 89.5%. Complications that did not require revision occurred in 21% of cases. The most identified pathogen was methicillin-sensitive Staphylococcus aureus (MSSA). Difficult-to-treat (DTT) infections and post-traumatic etiology were identified as predictors of treatment failure in patients undergoing two-stage TJR for hip and knee SA.

CONCLUSIONS

Two-stage TJR in hip and knee SA demonstrated favorable clinical outcomes at mid-term follow-up. The procedure significantly improved functional scores and achieved a high success rate, while DTT infections and post-traumatic etiology were associated with a higher risk of treatment failure.

Three-arm polyrotaxanes with multidirectional molecular motions as the nanocarrier for nitric oxide-enhanced photodynamic therapy against bacterial biofilms in septic arthritis

Bacterial biofilms are one of the major contributors to the refractoriness of septic arthritis. Although nitric oxide (NO)-enhanced photodynamic (PDT) therapy has been involved in biofilm eradication, the anti-biofilm efficacy is usually hindered by the short half-life and limited diffusion distance of active molecules. Herein, we report a three-arm structure using the photosensitive core chlorin e6 to integrate three α-cyclodextrin (α-CD) polyrotaxane chains as the supramolecular nanocarrier of NO-enhanced PDT therapy, in which NO was loaded on the cationic rings (α-CDs). Beneficial from the enhanced permeability of the nanocarrier due to the collective act on biofilms by the molecular motions (slide and rotation of rings) of three chains in different directions, NO capable of inducing biofilm dispersal and reactive oxygen species were efficiently delivered deep inside biofilms under 660 nm laser irradiation, and reactive nitrogen species with stronger bactericidal ability was produced in-situ, further accomplishing bacteria elimination inside biofilms. In-vivo therapeutic performance of this platform was demonstrated in a rat septic arthritis model by eliminating the methicillin-resistant Staphylococcus aureus infection, and potentiating the immune microenvironment regulation and bone loss inhibition, also providing a promising strategy to numerous obstinate clinical infections caused by biofilms.

Rheumatoid arthritis and risk of osteoarticular infection and death following Staphylococcus aureus bacteraemia: a nationwide cohort study

OBJECTIVES

Osteoarticular infection (OAI) is a feared complication of Staphylococcus aureus bacteraemia (SAB) and is associated with poor outcomes. We aimed to explore the risk of OAI and death following SAB in patients with and without rheumatoid arthritis (RA) and to identify risk factors for OAI in patients with RA.

METHODS

Danish nationwide cohort study of all patients with microbiologically verified first-time SAB between 2006-18. We identified RA, SAB, comorbidities, and RA-related characteristics (e.g. orthopaedic implants and antirheumatic treatment) in national registries including the rheumatology registry DANBIO. We estimated the cumulative incidence of OAI and death and adjusted hazard ratios (HRs, multivariate Cox regression).

RESULTS

We identified 18 274 patients with SAB (n = 367 with RA). The 90-day cumulative incidence of OAI was 23.1% (95% CI 18.8; 27.6) for patients with RA and 12.5% (12.1; 13.0) for patients without RA (non-RA) [HR 1.93 (1.54; 2.41)]. For RA patients with orthopaedic implants cumulative incidence was 29.4% (22.9; 36.2) [HR 1.75 (1.08; 2.85)], and for current users of tumor necrosis factor inhibitors (TNFi) it was 41.9% (27.0; 56.1) [HR 2.27 (1.29; 3.98) compared with non-users]. All-cause 90-day mortality following SAB was similar in RA [35.4% (30.6; 40.3)] and non-RA [33.9% (33.2; 34.5), HR 1.04 (0.87; 1.24)].

CONCLUSION

Following SAB, almost one in four patients with RA contracted OAI corresponding to a doubled risk compared with non-RA. In RA, orthopaedic implants and current TNFi use were associated with approximately doubled OAI risk. One in three died within 90 days in both RA and non-RA. These findings encourage vigilance in RA patients with SAB to avoid treatment delay of OAI.

Noncontact Diffuse Reflectance Spectroscopy of Synovial Fluid Samples for Rapid Identification of Infections

Severe joint infections, such as septic arthritis, require rapid diagnostic testing of the synovial fluid aspirated from joints level so that a surgical team can be assembled quickly. We present a diffuse reflectance spectroscopy (DRS) system for noncontact determination of infection. Using a light-tight syringe holder and fiber optic probe, diffusely reflected light from 475 to 655 nm was acquired from 18 patient samples through the wall of a syringe in a noncontact and sterile manner. We determined the reflectance ratios at two different wavelengths-R 490/R 600 and R 580/R 600 and found statistically significant differences (p < 0.05) in both ratios between the infected and noninfected groups. Critically, the R 490/R 600 and R 580/R 600 ratios were significantly correlated with clinical biomarkers-the white blood cell (WBC) and red blood cell (RBC) counts, respectively. This study demonstrates the potential of DRS as a rapid diagnostic tool for joint infections.

Effect of Preoperative Antibiotic Therapy on Operative Culture Yield for Diagnosis of Native Joint Septic Arthritis

BACKGROUND

Native joint septic arthritis (NJSA) is definitively diagnosed by a positive Gram stain or culture, along with supportive clinical findings. Preoperative antibiotics are known to alter synovial fluid cell count, Gram stain, and culture results and are typically postponed until after arthrocentesis to optimize diagnostic accuracy. However, data on the impact of preoperative antibiotics on operative culture yield for NJSA diagnosis are limited.

METHODS

We retrospectively reviewed adult cases of NJSA who underwent surgery at Mayo Clinic facilities from 2012 to 2021 to analyze the effect of preoperative antibiotics on operative culture yield through a paired analysis of preoperative culture (POC) and operative culture (OC) results using logistic regression and generalized estimating equations.

RESULTS

Two hundred ninety-nine patients with NJSA affecting 321 joints were included. Among those receiving preoperative antibiotics, yield significantly decreased from 68.0% at POC to 57.1% at OC (P < .001). In contrast, for patients without preoperative antibiotics there was a non-significant increase in yield from 60.9% at POC to 67.4% at OC (P = .244). In a logistic regression model for paired data, preoperative antibiotic exposure was more likely to decrease OC yield compared to non-exposure (odds ratio [OR] = 2.12; 95% confidence interval [CI] = 1.24-3.64; P = .006). Within the preoperative antibiotic group, additional antibiotic doses and earlier antibiotic initiation were associated with lower OC yield.

CONCLUSIONS

In patients with NJSA, preoperative antibiotic exposure resulted in a significant decrease in microbiologic yield of operative cultures as compared to patients in whom antibiotic therapy was held prior to obtaining operative cultures.

Increased Incidence and Clinical Features of Septic Arthritis in Patients Aged 80 Years and above: A Comparative Analysis with Younger Cohorts

BACKGROUND

This study aimed to determine the incidence of septic arthritis across adult age groups in Västra Götaland Region (VGR) of Sweden, while also comparing disease characteristics among different age groups with hematogenous septic arthritis.

METHODS

Using ICD-10 codes for septic arthritis from 2016 to 2019, we identified 955 patients in VGR. We reviewed the medical records of 216 adult patients with hematogenous septic arthritis and compared data across age groups.

RESULTS

The overall incidence of septic arthritis in adults was 4 per 100,000 persons annually, rising to 14 per 100,000 in those ≥80 years. The median age of the 216 patients was 71. The comparison across age groups (18-64, 65-79, and ≥80) showed significantly longer hospital stays and higher mortality rate in the older groups. CRP levels were higher in the middle age group, SF-WBC counts were lower in the youngest age group, and synovial fluid crystals were more common in the oldest. No differences were found in joint involvement or the organisms isolated.

CONCLUSION

The incidence of septic arthritis is 6.5 times higher in patients aged ≥ 80 compared to those under 65, highlighting the need to consider age-related differences in disease management.

The long-term time course of septic arthritis

Aims

The aims of this study were to: 1) report on a cohort of skeletally mature patients with native hip and knee septic arthritis over a 14-year period; 2) to determine the rate of joint failure in patients who had experienced an episode of hip or knee septic arthritis; and 3) to assess the outcome following septic arthritis relative to the infecting organism, whether those patients infected by Staphylococcus aureus would be more likely to have adverse outcomes than those infected by other organisms.

Methods

All microbiological samples from joint aspirations between March 2000 and December 2014 at our institution were reviewed in order to identify cases of culture-proven septic arthritis. Cases in children (aged < 16 years) and prosthetic joints were excluded. Data were abstracted on age at diagnosis, sex, joint affected (hip or knee), type of organisms isolated, cause of septic arthritis, comorbidities within the Charlson Comorbidity Index (CCI), details of treatment, and outcome.

Results

A total of 142 patients were confirmed to have had an episode of septic arthritis in a native hip (n = 17) or knee joint (n = 125). S. aureus accounted for 57.7% of all hip and knee joint infections. There were 13 inpatient deaths attributed to septic arthritis. The median age of the patients who died was 77.5 (46.9 to 92.2) and their median age-adjusted CCI was 8 (6 to 12). A failure of the joint occurred in 26 knees (21%) and nine hips (53%). Of the knee joints infected by S. aureus (n = 71), 23 knees (32%) went into failure of joint, whereas of those infected by other organisms (n = 54), only three knees (6%) failed.

Conclusion

Based on our study findings, hip and knee septic arthritis long-term outcomes were substantially worse than their immediate outcome suggested. Failure of knee joint is 6.1 times more likely to occur in those infected with S. aureus.

Management of Bone Loss After Multiple Metacarpal and Distal Row Carpal Resection Due to Osteomyelitis

Atraumatic wrist pain can be due to a variety of causes including gout, pseudogout, cellulitis, arthritis flare, or infection of the joint. One important differential to rule out immediately is septic arthritis as it is considered an orthopedic emergency. Due to the rarity of septic arthritis in the wrist, there is limited data to guide diagnosis and treatment. Furthermore, delayed diagnosis of septic arthritis can progress to osteomyelitis and result in severe damage. The primary objective of this study is to present a case of atraumatic septic arthritis with a delayed diagnosis that developed into osteomyelitis in the left wrist and hand of an immunocompetent hand surgeon. In addition, we discuss the surgical treatment including reconstruction of the hand and wrist through a multidisciplinary approach.

Determining the accuracy of the leukocyte esterase reagent strip test in the rapid diagnosis of adult septic arthritis

BACKGROUNDS

Septic arthritis is a dangerous disease that occurs when microorganisms enter synovial fluid. It needs fast and accurate management; otherwise, it can harm the patient's life. Currently, the tests measure WBC and PMN in SF, so we hypothesized to use a proxy that is easier and faster to measure. Leukocyte esterase is an enzyme secreted by neutrophils that can be found in the synovial fluid of SA patients. In this study, we tried to investigate the sensitivity and specificity of leukocyte esterase in diagnosing septic arthritis.

METHODS

We obtained synovial fluid samples from forty-six patients suspected of having septic arthritis and fifty-eight healthy individuals and measured the WBCs, ESR, CRP, PMN, glucose, and protein of SF in 2021. We also used the leukocyte esterase dipstick test to investigate the level of LE in synovial fluid for one minute.

RESULTS

Based on clinical and paraclinical criteria, sixteen out of the forty-six patients were diagnosed with SA. When (++) was considered positive, the sensitivity and specificity of the LE dipstick test for the diagnosis of SA were 93.7% (95% CI: 81.8-100%) and 60% (95% CI: 42.4-77.5%, P = 0.000), respectively. When both (+) and (++) were considered positive, they were 100% and 43.3% (95% CI: 25.6-61.0% P = 0.000), respectively. All the patients in the control group had negative cultures and LE test readings (specificity = 100%).

CONCLUSION

The LE dipstick test can be a valuable diagnostic tool in the initial diagnosis of SA since it is affordable, fast, and reliable.

Tuning molecular assembly behavior to amplify the sonodynamic activity of porphyrins for efficient antibacterial therapy

Sonodynamic therapy (SDT) is a promising strategy to treat deep-seated bacterial infections with good tissue penetration and spatiotemporal controllability. However, the low ROS generation efficiency of current sonosensitizers limits the development of SDT. Herein, we report a porphyrin derivative, TAPyPP-2, the sonodynamic activity of which is enhanced with less oxygen dependence by tuning its molecular assembly behavior. TAPyPP-2 can spontaneously form an ultra-small nano-assembly with a diameter of 6 nm in water by conjugation with primary amine salt-decorated pyridinium via π-π staking. The ultra-small assembly behavior can lower the energy gap between singlet and triplet states to 0.01 eV and promote the separation of holes and electrons, which facilitates ROS generation under ultrasound irradiation, in particular type I ROS. The unique hydrophilic ratio and positive charges endow TAPyPP-2 with superior abilities to interact with Staphylococcus aureus, resulting in extremely high sonodynamic antibacterial activity. Therefore, TAPyPP-2 successfully kills Staphylococcus aureus bacteria in the enclosed cavity of synovial joint and achieves effective SDT of septic arthritis. This work is anticipated to motivate enormous interest in the development of efficient SDT.

Native and prosthetic septic arthritis in a university hospital in Saudi Arabia: A retrospective study

BACKGROUND

Septic arthritis, whether native or prosthetic, poses a significant challenge in clinical practice due to its potentially devastating consequences. Despite its clinical importance, there remains a dearth of comprehensive studies and standardized diagnostic criteria, particularly in the Kingdom of Saudi Arabia.

AIM

To investigate the epidemiology, microbiological profiles, and clinical characteristics of native and prosthetic septic joints in the Saudi Arabian population.

METHODS

Medical records of patients diagnosed with septic arthritis between January 1, 2015, and December 31, 2022, were retrospectively reviewed. Data regarding patient demographics, clinical presentation, microbiological cultures, treatment modalities, and outcomes were analyzed.

RESULTS

In a retrospective review of 52 cases of septic arthritis, a balanced gender distribution was observed (1:1 ratio), with the knee being the most commonly affected joint (80.8%). Methicillin-resistant Staphylococcus aureus predominated in native joints (24.2%), while Brucella spp. was more prevalent in prosthetic joints (21.1%). Joint preservation was achieved in most cases (84.6%), with no significant difference in clinical features between native and prosthetic joints. However, certain comorbidities were more common in native joint cases, including renal impairment (P = 0.002), hemodialysis (P = 0.004), heart disease (P = 0.013), and chronic liver disease (P = 0.048). At the same time, osteoarthritis was more prevalent in prosthetic joint cases (P = 0.013). Vancomycin was the most frequently used antibiotic (26.9%), and most patients received antibiotics before joint aspiration (57.7%). Surgical intervention, predominantly arthrotomy, was required in most cases (32.7%). Notably, a significant association was found between joint type and mortality (odds ratio = 0.587, P = 0.048), as well as the Charlson comorbidity index and mortality (P = 0.001).

CONCLUSION

This study highlighted distinctive microbiological profiles and etiological factors in septic arthritis cases in the Saudi Arabian population.

Evaluation of a BioFire multiplex PCR panel for detection of joint infections using retrospective and prospectively collected specimens

The BioFire Joint Infection Panel (JI panel) is a newly FDA-approved multiplex PCR assay for detection of common bone and joint pathogens with 39 targets which include select Gram-positive and Gram-negative bacteria, yeast, and antimicrobial resistance genes. We evaluated the performance of the JI panel in detecting joint infections in our patient population. Sixty-three frozen, residual joint fluid specimens were retrospectively tested using the JI panel. An additional 104 residual joint fluid specimens were de-identified and prospectively tested within 1 week of collection. Results from routine bacterial cultures were used as the reference standard, which included inoculation to agar plates and blood culture bottles. For the frozen specimens, the JI panel showed a positive percent agreement (PPA) of 92.8% and a negative percent agreement (NPA) of 97.1%. PPA was 71.4% and NPA was 94.8% for fresh specimens. A total of 12 discrepancies were observed among the 167 specimens tested. The JI panel demonstrated good overall agreement with routine culture for the detection of joint infections and may improve timely diagnosis when used in conjunction with bacterial culture. However, potential false-positive and false-negative results were observed in both retrospective and prospective testing of specimens.IMPORTANCEThe BioFire JI panel is a new commercially available multiplex PCR assay for detecting common pathogens causing bone and joint infections. The test is performed directly on joint fluids with a fast turnaround time of 1 hour. Our study shows that while the JI panel overall shows good agreement with routine culture, discrepancies were observed in 7% of cases and results should be interpreted with appropriate clinical context.

Utilization of In Vivo Imaging System to Study Staphylococcal Sepsis and Septic Arthritis Progression in Mouse Model

Staphylococcus aureus [S. aureus] is a leading cause of sepsis and septic arthritis, conditions that pose significant medical challenges due to their high mortality and morbidity. No studies have used an in vivo imaging system [IVIS] to monitor S. aureus sepsis and septic arthritis. Here, we employed a bioluminescent reporter strain of S. aureus, Newman AH5016, administered intravenously to induce sepsis and intra-articularly to induce local septic arthritis in mice. Disease progression was monitored using IVIS to capture bioluminescent signals from kidneys, joints, and whole mice. Cytokines in the blood and joints were measured. The efficacy of cloxacillin treatment was evaluated. In the sepsis model, bioluminescent signals from kidneys, but not from whole mice, were correlated with kidney bacterial load and abscess formation. Ex vivo kidney imaging detected increased bacterial load and abscess formation from day 3 to day 10. Antibiotic treatment significantly reduced kidney signals, correlating with decreased bacterial counts and IL-6 levels, indicating effective infection control. In the local infection model, early-phase bioluminescent signals from joints were correlated with macroscopic arthritis and bacterial burden. Thus, signal detection from kidneys using IVIS is useful for monitoring S. aureus sepsis and assessing antibiotic efficacy, though it may only be effective for early-phase monitoring of local septic arthritis.

The accuracy and diagnostic value of gram staining joint aspirates in suspected joint infections

BACKGROUND

Septic arthritis is a debilitating condition with prolonged treatment and adverse outcomes. A gram stain is often performed from the joint aspirate sample, followed by a definitive culture. In our study, we assessed the accuracy of gram staining for suspected septic arthritis and explored factors associated with positive culture growth and false negatives in the gram stain.

METHODS

We retrospectively reviewed joint aspirates performed from 2015-2021 at a major trauma centre. Aspirates not cultured for septic arthritis were excluded. Data collected included aspirate site, gram stain and culture result delay, patient demographics, orthopaedic/rheumatological history, and comorbidities. Outcomes measured were gram stain sensitivity and specificity. Factors influencing positive cultures and false negative gram stain results were analysed using logistic regression.

RESULTS

Of 408 joint aspirates meeting the criteria, 37 did not undergo initial gram staining. Gram stain sensitivity was 30.4%, specificity was 97.6%. The delay from aspirate to definitive gram stain and culture results was 1.1 and 5.4 days, respectively Logistic regression identified that prosthetic joint(p = 0.007), past joint infections(p = 0.006), arthritis(p < 0.001), hypertension(p = 0.007), diabetes(p = 0.019) were positively associated with positive cultures. Past joint infections(p = 0.004) were positively associated with false negative gram stain results. Patients on antibiotics during the aspirate had a higher risk of false negative gram stain results (OR = 5.538, 95%CI, 2.802-10.948; p < 0.001).

CONCLUSIONS

In conclusion, the initial gram stain has limited sensitivity and caution should be exercised when interpreting negative results. Vigilance is crucial when the highlighted comorbidities or antibiotic use are present, to assess patients with potential joint infections.

A prospective multicentre evaluation of BioFire® Joint Infection Panel for the rapid microbiological documentation of acute arthritis

OBJECTIVES

To assess the performance of the rapid syndromic BioFire® Joint Infection Panel (BF-JIP) to detect bacterial and fungal pathogens, as well as antibiotic resistance genes, directly in synovial fluid specimens collected from patients with acute arthritis.

METHODS

The study was conducted in six French bacteriological laboratories. To assess the performances of BF-JIP, results were compared with those of synovial fluid 14-day culture and, in case of discrepancy, with those of complementary molecular methods and intraoperative samples. A total of 308 synovial fluid specimens were tested after collection from 308 adults and children presenting with clinical and biological suspicion of acute arthritis; patients presenting with acute periprosthetic joint infection were included according to the European Bone and Joint Infection Society 2021 criteria.

RESULTS

Only one specimen failed (no result). On the basis of the consolidated data, the BF-JIP was concordant with the 14-day culture in 280 (91.2%) of the 307 specimens finally included in the study. The positive percentage agreement was 84.9% (95% CI, 78.8-89.8%) and the negative percentage agreement was 100% (95% CI, 97.2-100%). The positive predictive value was extremely high (100%; 95% CI, 97.6-100%), whereas the negative predictive value was lower (82.6%; 95% CI, 75.7-88.2%), partially explained by the missing target species in the panel.

DISCUSSION

The BF-JIP showed high performances to detect pathogens involved in acute arthritis.

Septic arthritis of the facet joint is also a severe vertebral infection: A multicenter retrospective study of 65 patients

OBJECTIVE

Septic arthritis of the Facet Joints (SAFJ) is a rare condition. Little data has been published on the subject. We aimed to describe the clinical, biological and imagery presentations, as well as the course of this rare infection.

METHODS

We included patients hospitalized between January 1st, 2016 and December 31th, 2019, in the Departments of Infectious Diseases or Rheumatology in 5 French centres in the CRIOGO network. We defined septic arthritis according to Newman's criteria and facet joint arthritis using imagery.

RESULTS

Sixty-five patients were included, predominantly males (64.6%), with a mean age of 68.1 years. The mean time to diagnosis was 25.0 days. The principal symptoms at diagnosis were acute back pain (95.2%) and fever (76.9%). Neurological symptoms were present for 60.7% of the patients, including 16.4% motor deficit or cauda equina syndrome. SAFJ was located on the lumbosacral spine (73.4%) and was rarely multifocal (4.7%). Bacteriological identification was performed by blood cultures in 84.4% of the cases, and the pathogen was mainly Staphylococcus aureus (49.2%). Infective endocarditis was present for 26.9% of patients assessed by echocardiography. On MRI, soft tissue abscess or inflammation, epiduritis and epidural abscess were present in 87.1%, 66.7% and 33.9% of cases, and the pathogen was significantly more frequently Staphylococcus aureus. Mortality reached 9.2%, 18.5% and 23% at one, two, and three years respectively.

CONCLUSION

SAFJ is a rare but severe disease. Microbiological diagnosis is primarily made on blood cultures, and S. Aureus was the main pathogen. Our results highlight the fact that SAFJ is associated with high morbidity and mortality, and with infective endocarditis.

Effect of Antibiotic Therapy Before Arthrocentesis on Synovial Fluid Cell Count and Differential for Diagnosis of Native Joint Septic Arthritis

We examined the effect of preoperative antibiotic exposure and duration on synovial fluid samples from patients with native joint septic arthritis of the hip/knee. While exposure before diagnostic arthrocentesis did not affect fluid parameters, increased duration was associated with a decreased total nucleated cell count, underscoring the complex antibiotic effects on synovial fluid parameters.

Functional Articulating Antibiotic Spacers for Chronic Native Septic Knee Arthritis

Background

Semipermanent functional spacers are now utilized for prosthetic joint infection in an attempt to avoid another surgery with 2-stage treatment. This study evaluates the results of metal-on-polyethylene articulating spacers for the treatment of chronic native septic knee arthritis.

Methods

This is a retrospective review of 18 patients treated with metal-on-polyethylene articulating antibiotic spacers constructed with all-polyethylene tibial components or with polyethylene inserts (PIs) with Steinmann pins or screws for chronic native knee infection. Demographic information, spacer construct type, prior knee surgery, complications, infecting organisms, infection eradication, and functional results were analyzed.

Results

Of 18, 8 (44%) spacers were all-polyethylene tibial components and 10 (56%) were PI. Of 18 patients, 5 (28%) experienced spacer complications. Of 18 patients, 12 (67%) underwent a second reimplantation surgery (mean 106 days), while 6 (33%) retained their spacer (average duration 425 days). The PI group performed better in Knee Injury and Osteoarthritis Outcome score for Joint Replacement according to minimum clinically important difference and patient acceptable symptom state (PASS) criteria. The overall reimplantation group achieved Knee Injury and Osteoarthritis Outcome score for Joint Replacement PASS criteria and minimum clinically important difference criteria, while the maintained articulating spacer group did not achieve PASS criteria; however, they did reach minimum clinically important difference.

Conclusions

Functional articulating spacers are a viable treatment for chronic, native knee septic arthritis. The PI patient group had a greater improvement in Knee Injury and Osteoarthritis Outcome score for Joint Replacement scores and had no significant difference in reimplantation rate as the all-polyethylene tibial components patient group. Both planned 2-stage reimplantation and longer-term spacer retention show promising results for this difficult clinical problem.

Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections-A Five-Year Retrospective Study

Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.

Development of a multiplex Loop-Mediated Isothermal Amplification (LAMP) for the diagnosis of bacterial periprosthetic joint infection

BACKGROUND

Periprosthetic joint infection (PJI) is one of the most serious and debilitating complications that can occur after total joint arthroplasty. Therefore, early diagnosis and appropriate treatment are important for a good prognosis. Recently, molecular diagnostic methods have been widely used to detect the causative microorganisms of PJI sensitively and rapidly. The Multiplex Loop-Mediated Isothermal Amplification (LAMP) method eliminates the complex temperature cycling and delays caused by temperature transitions seen in polymerase chain reaction (PCR) methods, making it faster and easier to perform compared to PCR-based assays. Therefore, this study developed a multiplex LAMP assay for diagnosing bacterial PJI using LAMP technology and evaluated its analytical and clinical performance.

METHODS

We developed a multiplex LAMP assay for the detection of five bacteria: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus agalactiae, Pseudomonas aeruginosa, and Escherichia coli, frequently observed to be the causative agents of PJI. The method of analytical sensitivity and cross-reactivity were determined by spiking standard strains into the joint synovial fluid. The analytical sensitivity of the multiplex LAMP assay was compared with that of a quantitative real-time PCR (qPCR) assay. Clinical performance was evaluated using 20 joint synovial fluid samples collected from patients suspected of having bacterial PJI.

RESULTS

The analytical sensitivity of the gram-positive bacterial multiplex LAMP assay and qPCR were 105/104 CFU/mL, 103/103 CFU/mL, and 105/104 CFU/mL against S. agalactiae, S. epidermidis, and S. aureus, respectively. For P. aeruginosa and E. coli, the analytical sensitivity of the multiplex LAMP and qPCR assays were 105/104 and 106/104 CFU/mL, respectively. The multiplex LAMP assay detects target bacteria without cross-reacting with other bacteria, and exhibited 100% sensitivity and specificity in clinical performance evaluation.

CONCLUSIONS

This multiplex LAMP assay can rapidly detect five high-prevalence bacterial species causing bacterial PJI, with excellent sensitivity and specificity, in less than 1 h, and it may be useful for the early diagnosis of PJI.

Orthopedic Articular and Periarticular Joint Infections

Acute nontraumatic joint pain has an extensive differential. Emergency physicians must be adept at identifying limb and potentially life-threatening infection. Chief among these is septic arthritis. In addition to knowing how these joint infections typically present, clinicians need to be aware of host and pathogen factors that can lead to more insidious presentations and how these factors impact the interpretation of diagnostic tests.

Does arthroscopic or open washout in native knee septic arthritis result in superior post-operative function? A systematic review and meta-analysis of randomised controlled trials and observational studies

AIMS

Septic arthritis (SA) of the native knee joint is associated with significant morbidity. This review compared post-operative functional outcomes (patient-reported outcome measures (PROMs) and range of movement (ROM)) following arthroscopic washout (AW) and open washout (OW) amongst adult patients with SA of the native knee. The need for further operative intervention was also considered.

METHODS

Electronic databases of PubMed, MEDLINE, Embase, Cochrane, Web of Science and Scopus were searched between 16 February 2023 and 18 March 2023. Randomised controlled trials (RCTs) and comparative observational analytic studies comparing function (reflected in PROMs or ROM) at latest follow-up following AW and OW were included. A narrative summary was provided concerning post-operative PROMs. Pooled estimates for mean ROM and re-operation rates were conducted using the random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool-2 for RCTs and the Risk of Bias in Non-Randomized Studies of Interventions tool for observational analytic studies.

RESULTS

Of 2580 retrieved citations, 7 articles (1 RCT and 6 cohort studies) met the inclusion criteria. Of these, five had some concerns/moderate risk of bias, and two had serious risk. There was a slight tendency for superior mean PROMs following AW compared with OW, but due to small effect sizes, this was unlikely clinically relevant. Additionally, the use of four different PROMs scales made direct comparisons impossible. AW was associated with superior ROM (mean difference 20.18° (95% CI 14.35, 26.02; p < 0.00001)), whilst there was a tendency for lower re-operation requirements following AW (OR 0.64, 95% CI 0.26, 1.57, p = 0.44).

CONCLUSIONS

AW was associated with equivalent to superior post-operative function and lower requirement for further intervention compared with OW. Results need to be interpreted cautiously, taking into consideration the methodological and clinical heterogeneity of the included studies.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2022, CRD42022364062.

Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies

Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.

The Septic Elbow Joint: Treatment Approaches for Improved Patient Outcomes

Septic arthritis of the elbow is a serious problem requiring prompt, accurate diagnosis and urgent surgical intervention. Achieving successful patient outcomes depends heavily on early diagnosis and efficient streamlined surgical treatment. Essential tactics for treating the septic elbow joint include immediate joint irrigation and debridement in addition to administration of appropriate antibiotics. This comprehensive review delves into the cause of the septic elbow joint, identifies associated risk factors, and provides a comprehensive approach encompassing the diagnosis and treatment of the septic elbow. The aim of this review is to optimize patient care and outcomes.