Analysis of septic arthritis in a sample of Syrian population: a retrospective study

Abstract

Introduction: This study found an increasing incidence and cost burden of septic arthritis because there are no criteria guiding the decision to perform arthrocentesis in adults. In this study, the authors aimed to determine whether arthrocentesis can be used as a diagnostic criterion for suspected septic arthritis. Methods: This retrospective cross-sectional study was conducted in our rheumatology department, and include patients aged greater than 18 years with mono-arthritis suspected to be septic arthritis. The exclusion criteria were prosthetic joints, inflammatory arthritis, participation in the study, and the inability to provide informed consent. Information was registered, including demographic data, smoking, alcoholism, comorbidities, BMI, symptoms and signs via medical history, clinical examinations (joint pain, local fever, and range-of-motion), fever (temperature >38°C), and laboratory markers including white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. The patients were divided into two groups: group 1 (patients who had arthrocentesis) and group 2 (patients who did not). The authors also divided patients who had arthrocentesis into two subgroups: patients with septic arthritis and patients without. Arthrocentesis was done. Results: A total of 256 patients were entered in our study, divided into two groups according to arthrocentesis. In all patients, the joint involved was the knee. Group 1 included 142 knee-aspirated patients (55.46%), and group 2 included 114 nonaspirated patients (44.53%). All aspirations were performed without image guidance. The ages, laboratory markers, physical exams, and comorbidities were not significant between the two groups on multivariate analysis. Synovial cultures were positive in 75.67% of patients. Staphylococcus aureus was the most common germ. No patient had died. The authors did not find any predictive risk factors for whether a joint was septic or not. Fever was significantly more frequent in joint-aspirated patients with septic arthritis. Conclusion: The aspiration decision is still the best in clinical practice in light of available clinical and laboratory findings, although further multicenter, larger studies are needed. Based on our findings, the authors decided to aspirate the joint based on positive guided findings and comorbidity risk factors.