title: Wrist Septic Arthritis: An 11 Year Review.
abstract: BACKGROUND
  This report utilizes 11 years (2003-2013) of clinical records of patients for a retrospective evaluation of the effectiveness of various combinations of diagnostic methods, treatment options and surgical procedures to try to determine the optimal combinations to improve the rate of success for the treatment of septic wrist arthritis.
  
  
  METHODS
  Analysis of records of 40 patients treated for septic wrist arthritis in our hospital involving records of physical examination, full blood analysis, biochemical, microbial profiles, type of surgical intervention, length of stay, number of surgical interventions to resolution and the rate of morbidity and mortality. The patients were subdivided into 2 groups, consisting of 6 (mortality) in one group and 34 (non-mortality) in the other. The various parameters as listed above were compared for differences. The patient records included those from immunocompromised elderly patients, with other existing medical complications such as gout, pseudogout, cellulitis and arthritic flare that made accurate diagnosis of septic wrist arthritis challenging.
  
  
  RESULTS
  There is a trend showing better success in the treatment of septic wrist arthritis among patients without co-morbid medical problems. Due to the unavoidable delays in microbial identification, it was noted that escalation of antibiotics should be adopted especially for the immunocompromised patients.
  
  
  CONCLUSIONS
  Staphylococcus aureus, the most common microbial pathogen in our findings, point to the need to adopt a lower threshold for escalation of antibiotics for immunocompromised patients with slow reversal of infection in order to reduce morbidity, mortality, number of surgeries and length of post-operative stay.
authors.affiliation: 1 Department of Hand Surgery, Singapore General Hospital, Singapore.
authors.forename: Robert Tze Jin
authors.initials: RT
authors.lastname: Yap
authors.affiliation: 1 Department of Hand Surgery, Singapore General Hospital, Singapore.
authors.forename: Shian Chao
authors.initials: SC
authors.lastname: Tay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000628:therapy; D013211:Staphylococcus aureus; D014955:Wrist Joint; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotics Escalation; Septic Arthritis Wrist