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{{Septic arthritis}}
{{Septic arthritis}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' Jumana Nagarwala, M.D., ''Senior Staff Physician, Department of Emergency Medicine, Henry Ford Hospital''; {{CZ}}
{{CMG}}; {{AE}}{{VSKP}}
 
== Overview ==
Common risk factors that predisposes septic arthritis include [[rheumatoid arthritis]], [[Prosthetic|prosthetic joint]] or [[joint replacement]] and skin infections. Other risk factors  may include recent history of [[bacteremia]], [[cirrhosis]],[[chronic kidney disease]],[[hypogammaglobulinemia]],[[systemic lupus erythematosis]], [[gout]], [[pseudogout|psuedogout]], and [[charcot joint|charcot's arthropathy]].


==Risk Factors==
==Risk Factors==
The following conditions increase the risk for septic arthritis:
=== Common Risk Factors ===
* Artificial joint [[implant]]s
Most common risk factors that predisposes septic arthritis are [[rheumatoid arthritis]], [[Prosthetic|prosthetic joint]] or [[joint replacement]] and skin infections.<ref name="pmid1852426">Esterhai JL, Gelb I (1991) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1852426 Adult septic arthritis.] ''Orthop Clin North Am'' 22 (3):503-14. PMID: [https://pubmed.gov/1852426 1852426]</ref><ref name="pmid7920511">Dubost JJ, Fis I, Soubrier M, Lopitaux R, Ristori JM, Bussière JL et al. (1994) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7920511 [Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature].] ''Rev Rhum Ed Fr'' 61 (3):153-65. PMID: [https://pubmed.gov/7920511 7920511]</ref><ref name="pmid8150521">Gristina AG, Giridhar G, Gabriel BL, Naylor PT, Myrvik QN (1993) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8150521 Cell biology and molecular mechanisms in artificial device infections.] ''Int J Artif Organs'' 16 (11):755-63. PMID: [https://pubmed.gov/8150521 8150521]</ref><ref name="pmid8849354">Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849354 Risk factors for septic arthritis in patients with joint disease. A prospective study.] ''Arthritis Rheum'' 38 (12):1819-25. PMID: [https://pubmed.gov/8849354 8849354]</ref>
* Bacterial infection somewhere else in the body
 
* Chronic illness or disease (such as [[diabetes]], [[rheumatoid arthritis]], and [[sickle cell disease]])
Other common risk factors that predispose septic arthritis are as follows:<ref name="pmid3792229">Dickie AS (1986) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3792229 Current concepts in the management of infections in bones and joints.] ''Drugs'' 32 (5):458-75. PMID: [https://pubmed.gov/3792229 3792229]</ref><ref name="pmid8849354">Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849354 Risk factors for septic arthritis in patients with joint disease. A prospective study.] ''Arthritis Rheum'' 38 (12):1819-25. PMID: [https://pubmed.gov/8849354 8849354]</ref><ref name="pmid8972665">Morgan DS, Fisher D, Merianos A, Currie BJ (1996) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8972665 An 18 year clinical review of septic arthritis from tropical Australia.] ''Epidemiol Infect'' 117 (3):423-8. PMID: [https://pubmed.gov/8972665 8972665]</ref><ref name="pmid1602850">Rozadilla A, Nolla JM, Mateo L, del Blanco J, Valverde J, Roig D (1992) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1602850 [Septic arthritis induced by pyogenic germs in patients without parenteral drug addiction. Analysis of 44 cases].] ''Med Clin (Barc)'' 98 (14):527-30. PMID: [https://pubmed.gov/1602850 1602850]</ref><ref name="pmid3883171">Goldenberg DL, Reed JI (1985) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883171 Bacterial arthritis.] ''N Engl J Med'' 312 (12):764-71. [http://dx.doi.org/10.1056/NEJM198503213121206 DOI:10.1056/NEJM198503213121206] PMID: [https://pubmed.gov/3883171 3883171]</ref>
* [[Intravenous]] (IV) or [[injection]] drug use
{| border="1"
* Medications that suppress the [[immune system]]
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Type of risk factor'''}}
* Recent joint injury
! colspan="2" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Examples'''}}
* Recent joint [[arthroscopy]] or other surgery
|-
Septic arthritis may be seen at any age. In children, it occurs most often in those younger than 3 years. The hip is often the site of infection in infants. Septic arthritis is uncommon from age 3 to [[adolescence]]. Children with septic arthritis are more likely than adults to be infected with [[Group B Streptococcus|Group B streptococcus]] or [[Haemophilus influenza]], if they have not been vaccinated.
| colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Host phagocytic defects'''}}
|
* [[Complement deficiency|Complement deficiencies]] especially C7 and C8
* Inherited disorders of [[chemotaxis]]
|-
| colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Impaired host defense mechanisms'''}}
|
* Age >80 years<ref name="pmid15374369">Lagaay AM, van Asperen IA, Hijmans W (1992) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15374369 The prevalence of morbidity in the oldest old, aged 85 and over: a population-based survey in Leiden, The Netherlands.] ''Arch Gerontol Geriatr'' 15 (2):115-31. PMID: [https://pubmed.gov/15374369 15374369]</ref>
* Cancer
* [[Immunosuppressive drugs]] (e.g. [[azathioprine]], [[methotrexate]], or [[cyclophosphamide]])
* [[Glucocorticosteroid|Glucocorticosteroids]]
|-
| colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Direct penetration'''}}
|
* Intravenous drug use
* Puncture wonds
* Intra articular [[steroid]] injection
|-
| colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Joint damage'''}}
|
* [[Joint replacement|Prosthetic joint surgery]]
* Degenerative joint diseases such as [[rheumatoid arthritis]] ( [[Prosthetic|Prosthetic joint]] > [[Rheumatoid arthritis]] > [[Osteoarthritis]])<ref name="pmid8849354" />
|-
| colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Other risk factors'''}}
|
* Recent history of [[bacteremia]]
* [[Cirrhosis]]
* [[Chronic kidney disease]]
* [[Hypogammaglobulinemia]]
* [[Systemic lupus erythematosis]]
* [[Gout]]
* [[Pseudogout|Psuedogout]]<ref name="pmid6887177">Lurie DP, Musil G (1983) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6887177 Staphylococcal septic arthritis presenting as acute flare of pseudogout: clinical, pathological and arthroscopic findings with a review of the literature.] ''J Rheumatol'' 10 (3):503-6. PMID: [https://pubmed.gov/6887177 6887177]</ref>
* [[Charcot joint|Charcot's arthropathy]]<ref name="pmid6989540">Rubinow A, Spark EC, Canoso JJ (1980) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=6989540 Septic arthritis in a Charcot joint.] ''Clin Orthop Relat Res''  (147):203-6. PMID: [https://pubmed.gov/6989540 6989540]</ref>
|-
|}
 
===Micrbiological Clue Based on Risk factors===


{| border="1"
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Type of risk factor'''}}
! colspan="1" style="background: #4479BA; text-align: center;" | {{fontcolor|#FFF|'''Examples'''}}
|-
!Rheumatoid arthritis
|[[Staphylococcus aureus]]<ref name="pmid9449882">Goldenberg DL (1998) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9449882 Septic arthritis.] ''Lancet'' 351 (9097):197-202. [http://dx.doi.org/10.1016/S0140-6736(97)09522-6 DOI:10.1016/S0140-6736(97)09522-6] PMID: [https://pubmed.gov/9449882 9449882]</ref><ref name="pmid19665261">Frazee BW, Fee C, Lambert L (2009) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19665261 How common is MRSA in adult septic arthritis?] ''Ann Emerg Med'' 54 (5):695-700. [http://dx.doi.org/10.1016/j.annemergmed.2009.06.511 DOI:10.1016/j.annemergmed.2009.06.511] PMID: [https://pubmed.gov/19665261 19665261]</ref><ref name="pmid3883171">Goldenberg DL, Reed JI (1985) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3883171 Bacterial arthritis.] ''N Engl J Med'' 312 (12):764-71. [http://dx.doi.org/10.1056/NEJM198503213121206 DOI:10.1056/NEJM198503213121206] PMID: [https://pubmed.gov/3883171 3883171]</ref><ref name="pmid18525361">Mathews CJ, Coakley G (2008) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=18525361 Septic arthritis: current diagnostic and therapeutic algorithm.] ''Curr Opin Rheumatol'' 20 (4):457-62. [http://dx.doi.org/10.1097/BOR.0b013e3283036975 DOI:10.1097/BOR.0b013e3283036975] PMID: [https://pubmed.gov/18525361 18525361]</ref><ref name="pmid8849354">Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8849354 Risk factors for septic arthritis in patients with joint disease. A prospective study.] ''Arthritis Rheum'' 38 (12):1819-25. PMID: [https://pubmed.gov/8849354 8849354]</ref>
|-
!Immunocompromised patients
|[[Staphylococcus aureus]], [[Streptococci]], [[Gram-negative bacilli|Enteric gram-negative bacilli]], [[Listeria monocytogenes]]
|-
!Recent joint surgery
|[[Staphylococcus aureus]]
|-
!Intravenous drug use
|[[Staphylococcus aureus]], [[Pseudomonas aeruginosa]]
|-
!Diabetes mellitus
|[[Staphylococcus aureus]], [[Streptococcus agalactiae]]
|-
!Sexually active young adults
Menstruating females
|[[Neisseria gonorrhoeae|Neisseria gonorrhea]]
|-
!Elderly adults
| alingn="center" |[[Staphylococcus aureus]], [[streptococci]], [[Gram-negative bacilli]]
|-
!Post-aspiration or injection
| alingn="center" |''[[Staphylococcus aureus]]''
|-
!Trauma
| alingn="center" |[[Gram-negative bacilli]], [[anaerobes]], [[Staphylococcus aureus]]
|-
!Animal bite (e.g.Cat or dog)
|[[Pasteurella multocida]], [[Capnocytophaga|Capnocytophaga spp]], [[Anaerobes]]
|-
!Human bite
|[[Eikenella corrodens]], [[Viridans streptococci]], [[Anaerobes]]
|-
!Rat bite
|[[Streptobacillus moniliformis]]
|-
!Neonates and children age < 4 years
|[[Kingella|Kingella kingae]], [[Gram-negative bacilli]]
|-
!Unvaccinated children
|[[Haemophilus influenzae|Haemophilus influenza]]
|-
!Systemic lupus erythematosus
| alingn="center" |[[Salmonella]]
|-
!Sickle cell anemia
| alingn="center" |[[Salmonella]]
|-
!Hemophilia
| alingn="center" |[[Staphylococcus aureus]], [[streptococci]], [[Gram-negative bacilli]]
|-
!Ingestion of unpasteurized dairy products
|[[Brucella|Brucella spp]]
|}
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Latest revision as of 00:09, 30 July 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Common risk factors that predisposes septic arthritis include rheumatoid arthritis, prosthetic joint or joint replacement and skin infections. Other risk factors may include recent history of bacteremia, cirrhosis,chronic kidney disease,hypogammaglobulinemia,systemic lupus erythematosis, gout, psuedogout, and charcot's arthropathy.

Risk Factors

Common Risk Factors

Most common risk factors that predisposes septic arthritis are rheumatoid arthritis, prosthetic joint or joint replacement and skin infections.[1][2][3][4]

Other common risk factors that predispose septic arthritis are as follows:[5][4][6][7][8]

Type of risk factor Examples
Host phagocytic defects
Impaired host defense mechanisms
Direct penetration
  • Intravenous drug use
  • Puncture wonds
  • Intra articular steroid injection
Joint damage
Other risk factors

Micrbiological Clue Based on Risk factors

Type of risk factor Examples
Rheumatoid arthritis Staphylococcus aureus[12][13][8][14][4]
Immunocompromised patients Staphylococcus aureus, Streptococci, Enteric gram-negative bacilli, Listeria monocytogenes
Recent joint surgery Staphylococcus aureus
Intravenous drug use Staphylococcus aureus, Pseudomonas aeruginosa
Diabetes mellitus Staphylococcus aureus, Streptococcus agalactiae
Sexually active young adults

Menstruating females

Neisseria gonorrhea
Elderly adults Staphylococcus aureus, streptococci, Gram-negative bacilli
Post-aspiration or injection Staphylococcus aureus
Trauma Gram-negative bacilli, anaerobes, Staphylococcus aureus
Animal bite (e.g.Cat or dog) Pasteurella multocida, Capnocytophaga spp, Anaerobes
Human bite Eikenella corrodens, Viridans streptococci, Anaerobes
Rat bite Streptobacillus moniliformis
Neonates and children age < 4 years Kingella kingae, Gram-negative bacilli
Unvaccinated children Haemophilus influenza
Systemic lupus erythematosus Salmonella
Sickle cell anemia Salmonella
Hemophilia Staphylococcus aureus, streptococci, Gram-negative bacilli
Ingestion of unpasteurized dairy products Brucella spp

References

  1. ↑ Esterhai JL, Gelb I (1991) Adult septic arthritis. Orthop Clin North Am 22 (3):503-14. PMID: 1852426
  2. ↑ Dubost JJ, Fis I, Soubrier M, Lopitaux R, Ristori JM, Bussière JL et al. (1994) [Septic arthritis in rheumatoid polyarthritis. 24 cases and review of the literature.] Rev Rhum Ed Fr 61 (3):153-65. PMID: 7920511
  3. ↑ Gristina AG, Giridhar G, Gabriel BL, Naylor PT, Myrvik QN (1993) Cell biology and molecular mechanisms in artificial device infections. Int J Artif Organs 16 (11):755-63. PMID: 8150521
  4. ↑ 4.0 4.1 4.2 4.3 Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38 (12):1819-25. PMID: 8849354
  5. ↑ Dickie AS (1986) Current concepts in the management of infections in bones and joints. Drugs 32 (5):458-75. PMID: 3792229
  6. ↑ Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117 (3):423-8. PMID: 8972665
  7. ↑ Rozadilla A, Nolla JM, Mateo L, del Blanco J, Valverde J, Roig D (1992) [Septic arthritis induced by pyogenic germs in patients without parenteral drug addiction. Analysis of 44 cases.] Med Clin (Barc) 98 (14):527-30. PMID: 1602850
  8. ↑ 8.0 8.1 Goldenberg DL, Reed JI (1985) Bacterial arthritis. N Engl J Med 312 (12):764-71. DOI:10.1056/NEJM198503213121206 PMID: 3883171
  9. ↑ Lagaay AM, van Asperen IA, Hijmans W (1992) The prevalence of morbidity in the oldest old, aged 85 and over: a population-based survey in Leiden, The Netherlands. Arch Gerontol Geriatr 15 (2):115-31. PMID: 15374369
  10. ↑ Lurie DP, Musil G (1983) Staphylococcal septic arthritis presenting as acute flare of pseudogout: clinical, pathological and arthroscopic findings with a review of the literature. J Rheumatol 10 (3):503-6. PMID: 6887177
  11. ↑ Rubinow A, Spark EC, Canoso JJ (1980) Septic arthritis in a Charcot joint. Clin Orthop Relat Res (147):203-6. PMID: 6989540
  12. ↑ Goldenberg DL (1998) Septic arthritis. Lancet 351 (9097):197-202. DOI:10.1016/S0140-6736(97)09522-6 PMID: 9449882
  13. ↑ Frazee BW, Fee C, Lambert L (2009) How common is MRSA in adult septic arthritis? Ann Emerg Med 54 (5):695-700. DOI:10.1016/j.annemergmed.2009.06.511 PMID: 19665261
  14. ↑ Mathews CJ, Coakley G (2008) Septic arthritis: current diagnostic and therapeutic algorithm. Curr Opin Rheumatol 20 (4):457-62. DOI:10.1097/BOR.0b013e3283036975 PMID: 18525361


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