Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis

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.

Intermittent hemodialysis: a review of the top antimicrobial stewardship practices to be employed

The vulnerability of patients on hemodialysis (HD) to infections is evident by their increased susceptibility to infections in general and to resistant organisms in particular. Unnecessary, inappropriate, or suboptimal antimicrobial prescribing is common in dialysis units. This underscores the need for dedicated antimicrobial stewardship (AMS) interventions that can be implemented both in the inpatient and outpatient settings. In this review, we provide a comprehensive approach for clinicians with the most updated coordinated AMS principles in HD setting in six areas: prevention, diagnosis, treatment, education and empowerment, monitoring, and research.

Clinical Characteristics and In-Hospital Outcomes in Patients with Iliopsoas Abscess: A Multicenter Study

(1) Background: Iliopsoas abscess (IPA) is usually overlooked due to its nonspecific symptoms and signs. The resulting delayed diagnosis and treatment can increase morbidity and mortality. The purpose of the present study was to identify the risk factors for the unfavorable outcomes associated with IPA. (2) Methods: We included patients who presented to the emergency department and were diagnosed with IPA. The primary outcome was in-hospital mortality. Variables were compared, and the associated factors were examined with Cox proportional hazards model. (3) Results: Of the 176 patients enrolled, IPA was of primary origin in 50 patients (28.4%) and of secondary origin in 126 (71.6%). Skeletal origin was the most common source of secondary IPA (n = 92, 52.3%). The most common pathogens were Gram-positive cocci. Eighty-eight (50%) patients underwent percutaneous drainage, 32 (18.2%) patients underwent surgical debridement, and 56 (31.8%) patients received antibiotics. Multivariate analyses indicated that age > 65 (year) (HR = 5.12; CI 1.03-25.53; p = 0.046), congestive heart failure (HR = 5.13; CI 1.29-20.45; p = 0.021), and platelet < 150 (103/μL) (HR = 9.26; CI 2.59-33.09; p = 0.001) were significant independent predictors of in-hospital mortality in Model A, while the predictors in Model B included age > 65 (year) (HR = 5.12; CI 1.03-25.53; p = 0.046) and septic shock (HR = 61.90; CI 7.37-519.46; p < 0.001). (4) Conclusions: IPA is a medical emergency. Our study reported that patients with advanced age, congestive heart failure, thrombocytopenia, or septic shock had a significantly higher risk of mortality, and the recognition of the associated factors may aid in risk stratification and the determination of the optimal treatment plan for IPA patients.