Characteristics and outcomes of community-onset septic arthritis in adults.
OBJECTIVE
Failure to recognize and to appropriately treat septic arthritis results in substantial morbidity rates. This study compared the demographic characteristics, risk factors, and outcomes of patients with community-onset septic arthritis due to Gram-positive and Gram-negative bacteria.


METHODS
The medical charts of 51 adults with culture-proven community-onset septic arthritis treated at a tertiary medical center in northern Taiwan from January 1, 2004 through December 31, 2007 were retrospectively reviewed. The demographic data and clinical features were analyzed.


RESULTS
There were 39 patients with septic arthritis caused by Gram-positive cocci (76.4%) and 12 with septic arthritis caused by Gram-negative bacteria (23.6%). The most common pathogen was Staphylococcus aureus (n = 30; 58.9%). The most frequently involved joint was the knee (n = 33; 63.5%). By multivariate logistic regression analysis, age (odds ratio [OR], 1.07; 95% confidence interval [CI], 1.01-1.13; p = 0.024) and range of motion limitation (OR, 8.23; 95% CI, 1.14-59.49; p = 0.037) were independent predictive factors for septic arthritis caused by Gram-positive cocci. Diabetes mellitus with end-organ damage (OR, 0.03; 95% CI, 0.00-0.39; p = 0.007) and malignancy (OR, 0.04; 95% CI, 0.00-0.66; p = 0.025) were negative predictive factors for septic arthritis caused by Gram-positive cocci. There were no significant differences in outcomes for patients with Gram-positive and Gram-negative septic arthritis.


CONCLUSIONS
In adult patients with community-onset septic arthritis, older age and limited range of motion predict for Gram-positive cocci as the causative pathogen, while underlying diabetes mellitus with end-organ damage and malignancy predict for Gram-negative bacteria as the causative pathogen.
Chuang
Yu-Chung
YC
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wang
Jiun-Ling
JL
Chen
Yee-Chun
YC
Chang
Shan-Chwen
SC
D000328:Adult; D000368:Aged; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology*; D002648:Child; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology*; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000382:microbiology* / Q000473:pathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012307:Risk Factors