Patient Factors Associated With Methicillin-Resistant Staphylococcus aureus Septic Arthritis in Children

C-reactive protein predicts complications in community-associated S. aureus bacteraemia: a cohort study

Background

Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care.

Methods

In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results.

Results

We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications.

Conclusions

We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.

Pediatric Septic Arthritis of the Knee Due to a Multi-Sensitive Streptococcus pyogenes Strain Responsive to Clindamycin-A Case Report

Septic arthritis is an inflammatory process usually generated by a bacterial infection. The knee is one of the most frequently involved joints. The etiology varies depending on age, and hematogenous spread remains the primary cause in children. Herein, we report a case of a previously healthy three-year-old female who was referred to our institution for acute swelling of her right knee. After a clinical and radiological diagnosis of septic arthritis, an empirical treatment with a combination of cefotaxime and clindamycin was initiated. The isolation of a multi-sensitive Streptococcus pyogenes strain from the joint’s effusion prompted the discontinuation of clindamycin and the usage of cefotaxime alone. One week later, an ultrasound was executed due to worsening in the patient’s clinical conditions, and an organized corpuscular intra-articular effusion with diffuse synovial thickening was revealed. Cefotaxime was therefore replaced with clindamycin, which improved the symptoms. Despite the antibiotic sensitivity test having revealed a microorganism with sensitivity to both cephalosporin and clindamycin, clinical resistance to cefotaxime was encountered and a shift in the antimicrobial treatment was necessary to ensure a full recovery. This case study confirms that an antibiotic regimen based solely on a susceptibility test may be ineffective for such cases.

Multicentric Septic Osteomyelitis and Arthritis Caused by Staphylococcus aureus in a Gyrfalcon (Falco rusticolus)

An adult female gyrfalcon (Falco rusticolus) was presented with a right-wing droop and weight loss. Radiographic images revealed osteolysis and osseous proliferation of the right shoulder and the mobile vertebra between the notarium and synsacrum. The tentative diagnosis was vertebral osteomyelitis secondary to septic arthritis. The bird did not respond to antibiotic and anti-inflammatory therapy and represented 10 days later, with feathers soiled with feces, an impacted, dilated cloaca, and an inability to stand due to spastic paralysis of the hind legs. The bird's condition did not improve with 24 hours of supportive care and its quality of life was considered poor; therefore, the patient was euthanatized and submitted for postmortem examination. Multicentric septic osteomyelitis and arthritis were confirmed in the mobile vertebra between the notarium and synsacrum and the right shoulder. Despite 10 days of antibiotic therapy, Staphylococcus aureus was isolated from within the 2 locations in which septic osteomyelitis and arthritis were identified. This report describes the clinical features, diagnosis, and pathologic findings of septic osteomyelitis and arthritis caused by S aureus in a falcon.

Arthroscopy Versus Open Arthrotomy for Treatment of Native Hip Septic Arthritis: An Analysis of 30-Day Complications

PURPOSE

To evaluate differences in short-term complications in patients treated with open arthrotomy or arthroscopy for septic arthritis (SA) of the native hip and identify risk factors associated with return to the operating room (ROR).

METHODS

Patients who underwent hip arthrotomy or arthroscopy for native hip SA between 2007 and 2017 were queried in the Humana database via the PearlDiver research tool. Patients with a previous history of total hip arthroplasty were excluded from this study. Basic demographics and various 30-day perioperative complications, including ROR, were compared between the 2 cohorts. Multivariate analysis was performed for ROR within 30 days following arthroscopy and arthrotomy.

RESULTS

We identified 421 patients with SA of the native hip, of whom 387 (91.9%) and 34 (8.1%) were treated with open arthrotomy and arthroscopy, respectively. There were no significant differences in demographic variables between groups. On univariate analysis, the incidence of total adverse events (arthrotomy: 75.7% vs arthroscopy: 52.9%, P = .0038) was significantly greater in the open arthrotomy cohort. However, there was little difference in ROR between both cohorts (arthrotomy: 45.9% vs arthroscopy: 38.2%, P = .3836). Multivariate analysis identified preoperative septicemia or septic shock (odds ratio [OR] 1.90; 95% confidence interval [CI] 1.25-2.89, P = .0026) as a significant risk factor for ROR within 30 days after surgery. Neither arthrotomy (OR 4.93, 95% CI 0.42-115.2, P = .2174) nor arthroscopy (OR 3.55, 95% CI 0.33-78.01, P = .3077) were significant risk factors to ROR.

CONCLUSIONS

Patients with SA of the hip had similar short-term complication rates and ROR regardless of open arthrotomy or arthroscopic management. This suggests that arthroscopic management may be a safe option for the treatment of SA of the hip with potentially limited morbidity.

LEVEL OF EVIDENCE

Level IV (treatment harms investigation).

Pediatric Septic Arthritis: An Update

Septic arthritis in children is a surgical emergency, and prompt diagnosis and treatment are mandatory. If diagnosed quickly and treated correctly, the outcomes can be good. With delay in diagnosis and without proper treatment, outcomes often are quite devastating, with growth disturbance and joint destruction.