[Pneumococcal septic arthritis in a Spanish university hospital (1993- 2003)]. / Artritis neumocócica bacteriémica en un Hospital Universitario de Madrid (1993-2003).

INTRODUCTION: Cases of pneumococcal septic arthritis treated in the Fundación Jiménez Díaz (Madrid, Spain) were reviewed. METHODS: A retrospective record review was conducted for all patients presenting with pneumococcal septic arthritis between January 1993 and August 2003. RESULTS: Four patients out of a total of 267 reviewed had a clinical and microbiological diagnosis of septic arthritis caused by Streptococcus pneumoniae. The most frequent locations were the knee, ankle and tarsus. Three of the four patients had underlying diseases and one patient died. CONCLUSIONS: Pneumococcal septic arthritis, a very rare clinical entity diagnosed by clinical and microbiological findings, should be suspected in patients with underlying disease. Early antibiotic therapy focussed on the most common microorganisms causing septic arthritis is necessary for optimal outcome.

Artritis neumocócica bacteriémica en un Hospital Universitario de Madrid (1993-2003) / Pneumococcal septic arthritis in a Spanish university hospital (1993- 2003)

INTRODUCCIÓN. Revisar los casos de artritis séptica bacteriémica por Streptococcus pneumoniae en la Fundación Jiménez Díaz (Madrid-España). MÉTODOS. Se realizó una revisión retrospectiva de las historias clínicas que presentaron dicha entidad durante el período de enero de 1993 a agosto de 2003. RESULTADOS. Cuatro de 267 pacientes, presentaron el diagnóstico clínico y microbiológico de artritis séptica neumocócica bacteriémica. Las localizaciones más frecuentes fueron rodilla, tobillo y tarso. Tres de los cuatro pacientes presentaron enfermedad de base y uno falleció. CONCLUSIONES. Se describe una entidad clínica muy poco frecuente que debe ser sospechada en pacientes con enfermedad de base, diagnosticarse clínica y microbiológicamente. El tratamiento dirigido a los gérmenes que frecuentemente causan la artritis séptica debe instaurarse precozmente para un mejor pronóstico (AU)

INTRODUCTION. Cases of pneumococcal septic arthritis treated in the Fundación Jiménez Díaz (Madrid, Spain)were reviewed. METHODS. A retrospective record review was conducted for all patients presenting with pneumococcal septic arthritis between January 1993 and August 2003. RESULTS. Four patients out of a total of 267 reviewed hada clinical and microbiological diagnosis of septic arthritis caused by Streptococcus pneumoniae. The most frequent locations were the knee, ankle and tarsus. Three of the four patients had underlying diseases and one patient died. CONCLUSIONS. Pneumococcal septic arthritis, a very rare clinical entity diagnosed by clinical and microbiological findings, should be suspected in patients with underlying disease. Early antibiotic therapy focussed on the most common microorganisms causing septic arthritis is necessary for optimal outcome (AU)

[Risk factors of mortality in invasive pneumococcal disease]. / Factores relacionados con la mortalidad de la enfermedad neumocócica invasiva.

BACKGROUND AND OBJECTIVE: To analyze the risk factors associated with mortality in invasive pneumococcal disease in the university hospital Fundación Jiménez Díaz (Madrid, Spain) during 11 years. PATIENTS AND METHOD: We performed a retrospective study of patients attending the emergency service of the hospital from January 1993 to August 2003. We registered data on mortality, clinical and microbiological evolution and relapses. RESULTS: We studied 263 patients with pneumococcal baceteremia and invasive disease caused by Streptococcus pneumoniae (pneumonia, meningitis, sepsis, bacteremia of unknown origin and oligoarthritis). Mortality was 12.5%. Variables associated with mortality in a logistic regression analysis included absence of leukocytosis (p = 0.04), acidosis (p < 0.01), respiratory signs and symptoms (tachypnea, pleuritic pain) (p = 0.02), and neurologic manifestations (decreased consciousness level; (p < 0.01). CONCLUSION: Patients at highest risk of death because of invasive pneumococcal disease are critically ill, with no leukocytosis, with severe respiratory or neurological symptoms and undergoing invasive procedures such as mechanical ventilation and tracheostomy.