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Failure risk higher in certain patients after single surgical debridement for septic joints
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Most cases of septic joints were effectively managed after a single surgical debridement; however, patients with a history of inflammatory arthropathy, involvement of large joints, infection with Staphylococcus aureus, history of diabetes or high synovial-fluid nucleated cell count had a greater chance of a failed debridement, requiring additional debridement procedures, according to study results.
Researchers retrospectively reviewed the medical records of 128 patients (132 affected joints) who underwent at least one surgical debridement for the treatment of acute septic arthritis to obtain serologic and joint-fluid analysis results. To identify possible risk factors for failure of the initial surgical debridement, the researchers utilized univariate analyses with logistic regression analyses. Using stepwise variable selection, the researchers created a prognostic model that identified the probability a single surgical debridement would fail.
Results showed 49 of the 128 patients patients needed at least a second surgical debridement after the initial surgical debridement failed. The other 62% of septic joints were effectively managed by the initial surgical debridement.
The most common bacterial isolate observed was S. aureus. Methicillin-resistant Staphylococcus aureus (MRSA) was observed more frequently in joints after failure of initial surgical debridement, according to the researchers.
Although the researchers observed no statistically significant differences in the effectiveness of a single surgical debridement with regard to sex, race or age, the patients who failed a single debridement varied from the successfully treated patients in terms of duration of prodromal symptoms, positive Gram stain from arthrocentesis, history of diabetes, history of immunosuppression, history of inflammatory arthroplasty, coronary artery disease, S. Aureus infection, MRSA infection, positive blood culture, large joint involvement and initial C-reactive protein level of higher than 180 mg/L, a white blood cell count of higher than 11.5 × 109/L and a synovial fluid nucleated cell count of higher than 85 × 109 cells/L.
There was no significant difference between how effective open and arthroscopic debridements were compared with a single surgical debridement, according to the researchers. ‒ by Monica Jaramillo
Disclosure: The researchers report no relevant financial disclosures.
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