Background Septic arthritis may cause damage and inflammation in short period of time. The germ determination must be the first objective to allow targeted treatment. Bacteriological tests remain negative in 7–35% of cases of septic arthritis.
Objectives The aim of this study was to determine the impact of biological and radiographic findings on germ identification during septic arthritis.
Methods This a retrospective study which included medical records of patients treated for septic arthritis during the seventeen past years. Epidemiologic, clinical, biologic, bacteriologic and therapeutic data were recorded and analysed. We made a comparison between patients who had a germ identified (Group 1) with whom who hadn't (Group 2).
Results Fifty nine patients with septic arthritis were included in this study. The mean age of the patients was 54.6±19 years and a sex ratio (F/M) of 0.9. Causative agents were isolated in 27 patients (45.7%). Biological data showed leukocytosis in 25 (42.4%) patients. Mean leukocyte count was 10673±5003. Leukopenia was noted in 1 case. One patient had neutropenia. Lymphopenia was observed in 4 patients (6.7%). Two patients had hyperlymphocytosis. Anemia, mainly of the inflammatory type, was noted in 47 cases (79.66%). The mean Creactive protein (CRP) was 150.6±106, and the mean erythrocyte sedimentation rate (ESR) was 104.9. Twenty three patients (38.9%) had other perturbations of the biological balance: cholestasis (n=1), cytolysis (n=4) and renal perturbation (n=15). Radiological signs suggestive of septic arthritis were observed in 40 cases (67.8%): articular pinching (28.8%), geodes and erosions (14%), total destruction of the joint (0.67%) or thickening f the soft parts at the beginning (11.86%). Ultrasound exam, performed in 22 cases, showed articular effusion (n=15), synovial thickening (n=8), a soft tissue collection (n=3), and periarticular erosion (n=2). CT, performed in 6 patients, was normal in one case. The abnormalities noted were: collection of soft parts (n=2), joint effusion (n=2), bone demineralization (n=1), bone erosion (n=1) and osteochondritis (n=1). MRI, performed in 2 patients, was pathological in both cases and showed synovitis and cortical erosion with medullary edema. The comparison of the 2 groups according to germ identification showed that biological inflammatory syndrome was more frequent in group 2 (100% versus 96.8%) but without a statistically significant difference (p=0.346). Mean value of CRP and ESR were comparable in the two groups (p=0.65 and 0.19). The mean value of hemoglobin was comparable in the two groups (10.87 versus 10.54 g/dl) (p=0.566). It was similar about the blood count. Abnormalities of standard x-rays were similar in both groups (70.4% in group 1 versus 65.5% in group 2) (p=0.784). The most frequent radiological abnormality in the two groups was articular pinching (40.7% in group 1 and 46.8% in group 2).
Conclusions In our study, the biological and radiological data had not shown any impact on the identification of the germ.
Disclosure of Interest None declared