Ann Rheum Dis 1999;58:214-219 ( April )

Extended reports

Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991 V C Weston,^c A C Jones,^a N Bradbury,^b F Fawthrop,^a M Doherty^a

^a Rheumatology Unit, City Hospital, Nottingham, ^b Department of Orthopaedic Surgery, ^c and PHLS, ^d Queen's Medical Centre, Nottingham

Correspondence to: Dr V C Weston, PHLS, University Hospital, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH.

Accepted for publication 14 January 1999.

AIMSTo determine the clinical features of a large number of unselected UK hospital patients with confirmed septic arthritis and to determine those features associated with a poor outcome.
STUDY DESIGNRetrospective, case-note survey.
SETTINGA single English Health District.
PATIENTSAll patients admitted to hospital in Nottingham during the period 1 January 1982 to 31 December 1991 with confirmed septic arthritis were included.
OUTCOME MEASURESDeath, osteomyelitis and recorded functional impairment.
RESULTSThe spectrum of causative organisms remains similar to that seen in previous studies with the Gram positive organisms Staphylococcus aureus and Streptococci responsible for 74% of cases, gonococcal infections though were less common. Culture of joint aspirates and or blood were positive in 82% of cases, with the Gram stain demonstrating the causative organism in 50% of cases. Pre-existing joint disease was evident in 35% of cases. The mortality remains high at 11.5% with a significant additional morbidity of 31.6%. Multivariate analysis suggests that important predictors of death are: confusion at presentation, age 65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity are: age  65 years, diabetes mellitus, open surgical drainage, and Gram positive infections other than S aureus.
CONCLUSIONSSeptic arthritis continues to be associated with a considerable degree of morbidity and mortality. These results confirm the importance of obtaining synovial fluid and blood for culture before starting antimicrobial treatment. The apparent poorer outcome found with surgical intervention is in line with some previous suggestions but should be interpreted with caution in light of the retrospective nature of this study.

Keywords: septic arthritis; surgical drainage

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© 1999 by Annals of the Rheumatic Diseases
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