Primarily treated patients versus referred patients in the treatment of native septic arthritis of digits: a retrospective comparative study

• Published in: BMC musculoskeletal disorders 2020-11, Vol.21 (1), p.780-780, Article 780
• Main Authors: Kwak, Sang Ho, Bae, Jung Yun, Oh, Youngkwang, Jang, Hyo Seok, Ahn, Tae Young, Lee, Sang Hyun
• Format: Article
• Language: English
• Subjects: Abscesses; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthritis; Arthritis, Infectious; Arthritis, Infectious - diagnosis; Arthritis, Infectious - epidemiology; Arthritis, Infectious - therapy; Care and treatment; Cartilage; Cefazolin; Comparative analysis; Comparative studies; Debridement; Drug resistance; Empiric antibiotics; Finger injuries; Fingers; Hospitals; Humans; Infectious arthritis; Injuries; Magnetic resonance imaging; Medical referral; Methicillin; Methicillin-Resistant Staphylococcus aureus; Microorganisms; Musculoskeletal diseases; Neutrophils; Osteoarthritis; Patient outcomes; Patients; Primary health care; Retrospective Studies; Rheumatoid arthritis; Risk factors; Septic arthritis; Sinuses; Staphylococcal Infections - diagnosis; Staphylococcal Infections - drug therapy; Staphylococcal Infections - epidemiology; Staphylococcus aureus; Staphylococcus infections; Substance abuse treatment; Surgery; Surgical drainage
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-020-03770-9

Septic arthritis of digits needs urgent treatment. When treatments delayed or insufficient, patients may be referred to the upper-level hospital due to uncontrolled infection. We reviewed the treatment history of referred patients and compared the microorganisms and the clinical course of both primary and referred patients as relevant studies are rare. In this retrospective review of consecutive case series, 45 patients (primary, n = 11; referred, n = 34) were treated with multiple irrigation and debridement. Cefazolin was used as empiric antibiotics, then changed according to microbiologic study. Previously used antibiotics, treatment delay, surgical history of the referred patients were reviewed. Identified microorganisms, required surgical intervention, hospital stay, radiologic outcome, functional outcomes were compared between both groups. In the referred patients, methicillin-resistant Staphylococcus aureus (MRSA) was commonly found and cefazolin was susceptible in only 15% of the cases. Longer hospital stay, prolonged antibiotic therapy, more surgical intervention including flap surgery was required to treat the referred patients. Postoperative pain was not severe in daily activities, but the final range of motion was significantly less in the referred patients compared to the primary patients. This study suggests that in the treatment of uncontrolled septic arthritis of the digits, antibiotic agents covering MRSA may shorten the duration of antibiotic therapy in areas of high MRSA incidence. Besides, more number of I & D including flap surgery may be required for the referred patients compared with the primary patients. These findings can help the surgeon in setting up a treatment plan or in counseling of referred patients with uncontrolled septic arthritis of the digits.