Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital / Artrite séptica do ombro e do cotovelo: análise epidemiológica de uma década em um hospital terciário

ABSTRACT Objective: To describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment. Methods: A retrospective case series was studied with patients treated between 2004 and 2014. The patients' clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated. Results: Twenty-seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors. Conclusions: Septic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. S. aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.

RESUMO Objetivo: Descrever as características clínicas e epidemiológicas de pacientes com artrite séptica do ombro ou cotovelo e buscar fatores prognósticos para complicações durante o tratamento. Métodos: Foi feita uma série de casos retrospectiva com pacientes atendidos entre 2004 e 2014. As características clínicas e epidemiológicas dos pacientes foram coletadas. As complicações clínicas e ortopédicas foram identificadas e possíveis fatores prognósticos foram avaliados. Resultados: O estudo avaliou 27 pacientes, 17 com pioartrite no ombro e dez no cotovelo. A mediana da idade foi de 46 anos (IIQ 24,5; 61). Doença articular prévia foi observada em nove pacientes (33%). Uma ou mais comorbidades clínicas foram identificadas em 23 pacientes (85%). Staphylococcus aureus foi isolado em 14 casos (52%). Quatorze pacientes (52%) tiveram pelo menos uma complicação clínica e cinco pacientes foram a óbito (19%). Nove pacientes (33%) tiveram alguma complicação ortopédica. O tempo entre o início dos sintomas e o tratamento cirúrgico foi maior nos pacientes com complicações ortopédicas (p = 0,020). Em relação ao desenvolvimento de complicações clínicas, leucocitose na admissão hospitalar (p = 0,021) e presença de comorbidades clínicas (p = 0,041) foram fatores preditivos. Conclusões: A pioartrite do ombro e cotovelo acomete preferencialmente indivíduos com comorbidades clínicas e/ou imunocomprometidos. O Staphylococcus aureus é o patógeno mais frequente no Brasil. Leucocitose na admissão hospitalar e a presença de comorbidades clínicas são fatores associados à presença de complicações clínicas. Maior tempo entre o início dos sintomas e o tratamento cirúrgico foi correlacionado a complicações ortopédicas.

Epidemiology of septic arthritis of the knee at Hospital das Clinicas, Universidade de Sao Paulo

Background: Septic arthritis is an infrequent disease although very important due to the possibility of disastrous outcomes if treatment is not adequately established. Adequate information concerning the epidemiology of septic arthritis is still lacking due to the uncommon nature of the disease as well as the struggle to establish a correct case-definition. Objective: To epidemiologically characterize the population seen at Hospital das Clínicas, University of São Paulo with a diagnosis of septic arthritis between 2006 and 2011. Methods: Sixty-one patients diagnosed with septic arthritis of the knee between 2006 and 2011 were retrospectively evaluated. The patients' clinical and epidemiological characteristics, the microorganisms that caused the infection and the patients' treatment and evolution were analyzed. Results: Septic arthritis of the knee was more common among men, with distribution across a variety of age ranges. Most diagnoses were made through positive synovial fluid cultures. The most prevalent clinical comorbidities were systemic arterial hypertension and diabetes mellitus, and the most commonly reported joint disease was osteoarthritis. Staphylococcus aureus was the prevailing pathogen. Fever was present in 36% of the cases. All patients presented elevation in inflammatory tests. Gram staining was positive in only 50.8% of the synovial fluid samples analyzed. Six patients presented complications and unfavorable evolution of their condition. Conclusion: S. aureus is still the most common pathogen in acute knee infections in our environment. Gram staining, absence of fever and normal leukocyte count cannot be used to rule out septic arthritis. .