Antimicrobial management of septic arthritis of the hand and wrist

• Published in: Infection 2014-04, Vol.42 (2), p.379-384
• Main Authors: Kowalski, T. J., Thompson, L. A., Gundrum, J. D.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Arthritis, Infectious - drug therapy; Arthritis, Infectious - microbiology; Arthritis, Infectious - surgery; Biopsy, Needle; Clinical and Epidemiological Study; Debridement; Family Medicine; Female; General Practice; Hand - microbiology; Hand - surgery; Hand Joints - microbiology; Hand Joints - surgery; Humans; Infectious Diseases; Internal Medicine; Male; Medicine; Medicine & Public Health; Middle Aged; Midwestern United States; Mycobacterium; Retrospective Studies; Staphylococcal Infections - drug therapy; Staphylococcal Infections - microbiology; Staphylococcal Infections - surgery; Staphylococcus aureus; Staphylococcus aureus - drug effects; Staphylococcus aureus - physiology; Treatment Outcome
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-013-0566-0

Purpose The optimal antimicrobial treatment for patients with hand or wrist septic arthritis is unknown. We report the treatment outcomes in patients with these infections. Methods The medical records of 40 consecutive adult patients with hand or wrist septic arthritis treated at our institution from 2000 to 2008 were retrospectively reviewed. The primary outcome measure was treatment failure (histopathologic or microbiologic evidence of relapsed infection from the same joint or a contiguous anatomic area). Results Involved joints were the wrist ( n  = 10, 25 %), metacarpal-phalangeal ( n  = 11, 27.5 %), proximal interphalangeal ( n  = 8, 20 %), distal interphalangeal ( n  = 10, 25 %), and thumb interphalangeal ( n  = 1, 2.5 %). Methicillin-sensitive ( n  = 15, 45 %) and -resistant ( n  = 7, 17.5 %) Staphylococcus aureus were the most common pathogens. Surgical therapies included open arthrotomy with debridement ( n  = 33, 82.5 %), arthroscopic debridement ( n  = 2, 5 %), and aspiration alone ( n  = 5, 12.5 %). Most patients (23/40, 58 %) received less than 1 week of parenteral antimicrobial therapy. Only two patients developed definite antimicrobial treatment failure, one of whom had an atypical mycobacterium infection. Patients with subacute to chronic infections were at high risk for finger amputation. Conclusions When combined with surgical debridement, relatively short courses of parenteral antimicrobial treatment (