Post-traumatic Septic Arthritis

Caroline Di Benedetto, Pierre J Hoffmeyer, Daniel Lew, Ilker Uçkay
European Musculoskeletal Review, 2012;7(1):38-42
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Abstract

Trauma-related septic arthritis is a rare and serious infection. Little is known about its microbiologic spectrum, clinical pattern and outcome. We reviewed the literature from 1945 to 2010 with an emphasis on post-traumatic cases. We retrieved 14 large-scale epidemiological surveys without detailed stratification regarding the origin of septic arthritis (3,340 episodes) and 131 case reports. Post-traumatic septic arthritis is witnessed predominantly in young healthy males (75 %; median age, 31 years) and involves the knee in 54 % of cases. Four distinct origins differ in pathogenesis and microbiology: bites; thorn punctures; and trauma sustained in terrestrial or aquatic environments. Overall, causative micro-organisms in post-traumatic arthritis seem to be predominantly Gram-negative (51 %), in contrast to primary native joint arthritis where Staphylococcus aureus prevails. Variability for the choice of antimicrobial agents is larger than in primary native arthritis, but the duration of antibiotic therapy and surgical therapy remain similar. Mortality equals zero and microbiological cure is achieved in 96 % of cases. Severe functional mechanical sequelae, such as ankylosis or amputation, occur in 15 % of cases. Post-traumatic septic arthritis has a different clinical and microbiological pattern to primary native joint arthritis. In the case of empirical antibiotic treatment, a broader spectrum covering Gram-negative rods is more appropriate than simple anti-Gram-positive therapy.

Acknowledgement: We are indebted to Rosemary Sudan for editorial assistance.
Keywords
Post-traumatic, septic, arthritis, trauma, Gram-negative rods
Disclosure The authors have no conflicts of interest to declare.
Received: November 02, 2011 Accepted January 04, 2012
Correspondence: Ilker Uçkay, Orthopaedic Surgery Service, Service of Infectious Diseases, University of Geneva Hospitals, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. E: ilker.uckay@hcuge.ch

Septic arthritis harbours a high burden of morbidity and mortality oscillating in the range 2–11.5 % and 20–50 %, respectively.1–5 Most cases are primary native arthritis with presumed or proven haematogenous origin with an annual incidence of 2–10/100,000 persons.1,2,4,6–9 The weight-bearing joints are most affected, with the knee accounting for half of all cases.2–4,8–13 Gram-positive cocci such as Staphylococcus aureus or streptococci are responsible for the vast majority of primary native arthritis. Gram-negative rods account for 9–17 % of all cases, and anaerobes are found in 1–3 %.2,4,8–11,13–16 This pathogen distribution is similar for post-surgical arthritis (surgical site infection). However, septic arthritis can also result directly from a penetrating traumatic accidental injury. This third clinical entity has rarely been investigated and, to the best of our knowledge, no reviews have been performed on this topic. The purpose of our contribution is to fill this gap and to highlight the variability of causative pathogens according to the setting.

Methods

We searched the English, French and German-language literature published before 1 November 2010 in PubMed and other internet sources for studies on the epidemiology, risk factors, clinical pattern, treatment and outcome of bacterial post-traumatic septic arthritis in adult and paediatric populations. The search was conducted using the MeSH terms ‘trauma’, ‘arthritis’, ‘septic’ and ‘infectious’. Reference lists of retrieved articles, as well as cross-references in PubMed, were searched to trace other sources, including case reports and abstracts of conference presentations. We excluded experimental animal models, vertebral arthritis, viral arthritis and arthritis in the context of surgical site infections, open bone fractures or intravenous drug use.

Results
Type of Published Reports

We retrieved 14 epidemiological surveys of septic arthritis without a detailed distinction between primary native joint arthritis, surgical site infections or post-traumatic septic cases.1–4,7,9–17 These 14 surveys included a total of 3,340 episodes; only two were prospective. Two included paediatric patients only,11,12 and five were restricted to adults.7,8,10,13,15

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Post-traumatic Septic Arthritis

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