title: Clinical findings of bacteremic septic arthritis according to the site of acquisition: The overlap between health care-related and community- and nosocomial-acquired cases.
abstract: BACKGROUND
  The site of acquisition of infection may have a major impact on outcome. The health care-related (HCR) environment has recently come under scrutiny. In a group of patients with bacteremic septic arthritis (SA), we compared their characteristics, type of SA, microbiology and prognosis according to the site of acquisition: community-acquired (CA), nosocomial-acquired (NA), and HCR.
  
  
  METHODS
  We studied all patients with bacteremic SA seen at our institution between 1985 and 2013. Data were obtained from a protocol of prospectively recorded bacteremia cases.
  
  
  RESULTS
  There were 273 cases of bacteremic SA (CA: 51%; NA: 31%; and HCR: 18%). NA and HCR sites were more frequent in older and fragile patients. SA of peripheral joints was the most common presentation; infections of the axial skeleton predominated in CA and HCR (24%), and prosthetic joint infection in NA (44%). MRSA and Pseudomonas aeruginosa were mainly found in NA (21% and 6% respectively) and HCR (14% and 8% respectively), whereas Streptococcus spp. was more frequent in CA (30%) and HCR (28%). The 30-day mortality rates were: CA 7%, HCR 18%, and NA 26%.
  
  
  CONCLUSIONS
  The characteristics of HCR-SA overlapped with those of the CA or NA-SA cases. The HCR and NA cases presented more advanced age, greater fragility, and the predominance of difficult-to-treat microorganisms, while the HCR and CA cases presented an involvement of the axial skeleton, streptococcal etiology, and a lower number of prosthetic joint infections. Our data show that the site of acquisition should be considered when planning diagnostic and therapeutic management for SA.
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain. Electronic address: omurillo@bellvitgehospital.cat.
authors.forename: Oscar
authors.initials: O
authors.lastname: Murillo
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Gomez-Junyent
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
authors.forename: Imma
authors.initials: I
authors.lastname: Grau
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Ribera
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
authors.forename: Celina
authors.initials: C
authors.lastname: Cabrera
authors.affiliation: Orthopaedic Surgery Department, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Salvador
authors.initials: S
authors.lastname: Pedrero
authors.affiliation: Microbiology Department, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Fe
authors.initials: F
authors.lastname: Tubau
authors.affiliation: Rheumatology Department, Hospital Bellvitge, Barcelona, Spain.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Nolla
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Ariza
authors.affiliation: Infectious Disease Department, Hospital Bellvitge, Feixa Llarga s/n, 08907 L'Hospitalet, Barcelona, Spain.
authors.forename: Roman
authors.initials: R
authors.lastname: Pallares
mesh_terms: D017677:Age Distribution; D000368:Aged; D001170:Arthritis, Infectious / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D005260:Female; D006801:Humans; D007595:Joint Prosthesis; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D011550:Pseudomonas aeruginosa; D013030:Spain / Q000453:epidemiology; D013122:Spinal Diseases / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality
keywords: Bacteremia; Community; Healthcare-related; Nosocomial; Septic arthritis