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Management and outcome of native joint septic arthritis: a nationwide survey in French rheumatology departments, 2016–2017
  1. Pauline Richebé1,
  2. Guillaume Coiffier2,
  3. Pascal Guggenbuhl3,
  4. Denis Mulleman4,
  5. Marion Couderc5,
  6. Emanuelle Dernis6,
  7. Valentine Deprez7,
  8. Carine Salliot8,
  9. Saik urien9,
  10. Rachel Brault10,
  11. Adeline Ruyssen-Witrand11,
  12. Emmanuel Hoppe12,
  13. Emmanuel Chatelus13,
  14. Christian hubert roux14,
  15. Sebastien Ottaviani15,
  16. Marie Baufrere16,
  17. Alexia Michaut17,
  18. Loic Pauvele18,
  19. Christelle Darrieutort-Laffite19,20,
  20. Daniel Wendling21,
  21. Pascal Coquerelle22,
  22. Géraldine Bart23,
  23. Elisabeth Gervais24,
  24. Vincent Goeb25,
  25. Marc Ardizzone26,
  26. Edouard Pertuiset27,
  27. Sophie Derolez28,
  28. Jean Marc Ziza29,
  29. René-Marc Flipo30,
  30. Sophie Godot29,
  31. Raphaele Seror31
  1. 1 Service de rhumatologie, Hôpitaux universitaires Paris-Sud, Le Kremlin-Bicetre, France
  2. 2 Service de Rhumatologie, GHT Rance-Emeraude, CH Dinan et Saint-Malo, France, Dinan, France
  3. 3 Service de Rhumatologie, CHU Rennes Univ Rennes, INSERM UMR 1241, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France, Rennes, France
  4. 4 Service de rhumatologie, Centre de Référence en Infections Ostéo-Articulaires Complexes du grand Ouest, CHRU de Tours, Tours, France
  5. 5 Rheumatology, CHU Gabriel Montpied, Clermont-Ferrand, France
  6. 6 Rheumatology, Le mans hospital, Le Mans, France
  7. 7 Rheumatology, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France
  8. 8 Rheumatology, Nouvel Hôpital d'Orléans CHRO La Source, Orleans, France
  9. 9 INSERN et Unité de recherche clinique, Site Tarnier (hôpital Cochin), Paris, France
  10. 10 Service rhumatologie, CHU Poitiers, Poitiers, France
  11. 11 Rheumatology, Service de Rhumatologie, C.H.U. Purpan, Toulouse, France
  12. 12 Rheumatology, CHU Angers, Angers, France
  13. 13 Rheumatology, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
  14. 14 Rheumatology, CHU Nice, Nice, France
  15. 15 Rheumatology, Hospital Bichat—Claude-Bernard, Paris, France
  16. 16 Rheumatology, Hôpital Ambroise-Pare, Boulogne-Billancourt, France
  17. 17 Centre Hospitalier Départemental Vendée Hôpital de Montaigu, Montaigu, France
  18. 18 Rheumatology, Centre Hospitalier Universitaire de Reims Hôpital d'enfants, Reims, France
  19. 19 Rheumatology, CHU Nantes, Nantes, France
  20. 20 Rheumatology, CHU de Nantes Hôtel-Dieu, Nantes, France
  21. 21 Rheumatology, CHU Jean Minjoz, Besancon, France
  22. 22 Rheumatology, CH Bethune, Beuvry, France
  23. 23 Rhumatology, CHU de RENNES, Rennes, France
  24. 24 Rheumatology, CHRU de Poitiers, Poitiers, France
  25. 25 Rhumatology, CHU d'Amiens, Amiens, France
  26. 26 Rheumatology, Centre Hospitalier de Mulhouse, Mulhouse, France
  27. 27 Rhumatologie, Centre Hospitalier René Dubos, Pontoise, France
  28. 28 Rheumatology, Hôpital Bicêtre, Le Kremlin-Bicetre, France
  29. 29 Rheumatology, Hôpital de la Croix Saint-Simon, Paris, France
  30. 30 Service de Rhumatologie, CHU Roger Salengro, Université de Lille, Lille, France
  31. 31 Rheumatology, Hôpitaux universitaires Paris-Sud, Le Kremlin Bicêtre, France
  1. Correspondence to Dr Pauline Richebé, Université Paris-Sud Bibliothèque Universitaire Kremlin-Bicêtre, Le Kremlin-Bicetre 94270, France; pauline{at}richebe.com

Abstract

Objectives To describe current management and outcome of native joint septic arthritis (NJSA) in French rheumatology departments.

Methods For this retrospective, nationwide multicentric study, 127 French rheumatology departments were contacted to report up to 12 cases of NJSA that occurred between 1 January 2016 and 31 December 2017. Characteristics, diagnosis procedures, therapeutic management and outcome were recorded.

Results Overall, 362 patients were included (mean age 64.0±18.6 years, median Charlson comorbidity index 3.5 (0–14)). Knee was the most frequent site (n=160 (38.9%)), and Staphylococcus sp (n=185 (51.4%)), the most frequent pathogen. All patients received antibiotics for a mean duration of 46.8 (±22.0) days, including intravenous route for a mean of 17.2 (±15.4) days. Management was heterogeneous. Surgical procedure was performed in 171 (48.3%), joint immobilisation in 128 (43.8%). During follow-up, 91 (28.3%) patients have had serious complications and 28 (9.2%) of them died. Factors associated with 1-year mortality were age (OR 1.08, 95% CI 1.04 to 1.13; p<0.001), Charlson’s index (OR 1.30, 95% CI 1.06 to 1.58; p=0.012), presence of bacteraemia (OR 4.02, 95% CI 1.35 to 11.99; p=0.008), antibiotic use in the previous 3 months (OR 3.32, 95% CI 1.11 to 9.87; p=0.029) and Staphylococcus aureus NJSA compared with Streptococcus sp. NJSA (OR 7.24, 95% CI 1.26 to 41.68, p=0.027). The complete recovery with no adverse joint outcome at 1 year was observed in n=125/278 patients (55.0%).

Conclusion Prognosis of NJSA remained severe with a high rate of morbimortality. Its management was very heterogeneous. This study highlights the importance of the new French recommendations, published after the completion of the study, in order to facilitate NJSA management.

  • Arthritis, Infectious
  • Epidemiology
  • Arthritis

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request. all data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ard-2022-222143

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    Data availability statement

    Data are available upon reasonable request. Data are available upon reasonable request. all data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Handling editor Josef S Smolen

    • SG and RS contributed equally.

    • Collaborators French Rheumatology Society Bone Joint infection working group.

    • Contributors On May 2017, the French Society for Rheumatology (SFR) launched the ‘French Rheumatology Society Bone Joint infection working group’. The present work “Prise En charGe des Arthrites sEptiques - PEGAsE” (Management of septic arthritis) was supported and coordinated by SFR. RS is author acting as guarantor, had full access to all data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis and controlled the decision to publish. RS and SG contributed equally. Conception and design of the study RS, SG, PR. Analysis of data RS, SG, PR. Interpretation of data all authors. Drafting of the manuscript RS, SG, PR. Critical revision of the manuscript all authors. Contribution of data all authors. All authors approved the manuscript’s content before submission.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.