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a Rheumatology Unit,
City Hospital, Nottingham, b Department of Orthopaedic
Surgery, c and PHLS, d Queen's
Medical Centre, Nottingham
Correspondence to: Dr V C Weston, PHLS, University Hospital, Queen's Medical Centre, Derby Road, Nottingham NG7 2UH.
Accepted for publication 14 January 1999.
AIMS
To determine the
clinical features of a large number of unselected UK hospital patients
with confirmed septic arthritis and to determine those features
associated with a poor outcome.
STUDY
DESIGNRetrospective, case-note survey.
SETTINGA single
English Health District.
PATIENTSAll patients
admitted to hospital in Nottingham during the period 1 January 1982 to 31 December 1991 with confirmed septic arthritis were included.
OUTCOME
MEASURESDeath, osteomyelitis and recorded
functional impairment.
RESULTSThe spectrum
of causative organisms remains similar to that seen in previous studies
with the Gram positive organisms Staphylococcus aureus and Streptococci responsible for 74% of cases,
gonococcal infections though were less common. Culture of joint
aspirates and or blood were positive in 82% of cases, with the Gram
stain demonstrating the causative organism in 50% of cases.
Pre-existing joint disease was evident in 35% of cases. The mortality
remains high at 11.5% with a significant additional morbidity of
31.6%. Multivariate analysis suggests that important predictors of
death are: confusion at presentation, age 
65 years, multiple joint sepsis or involvement of the elbow joint, and of morbidity are: age 65 years, diabetes mellitus, open surgical drainage, and Gram positive
infections other than S aureus.
CONCLUSIONSSeptic
arthritis continues to be associated with a considerable degree of
morbidity and mortality. These results confirm the importance of
obtaining synovial fluid and blood for culture before starting
antimicrobial treatment. The apparent poorer outcome found with
surgical intervention is in line with some previous suggestions but
should be interpreted with caution in light of the retrospective nature
of this study.
This article has been cited by other articles:
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  C J Mathews, G Kingsley, M Field, A Jones, V C Weston, M Phillips, D Walker, and G Coakley Management of septic arthritis: a systematic review Postgrad. Med. J., May 1, 2008; 84(991): 265 - 270. [Abstract] [Full Text] [PDF]
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 A J Geirsson, S Statkevicius, and A Vikingsson Septic arthritis in Iceland 1990-2002: increasing incidence due to iatrogenic infections Ann Rheum Dis, May 1, 2008; 67(5): 638 - 643. [Abstract] [Full Text] [PDF]
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C J Mathews, G Kingsley, M Field, A Jones, V C Weston, M Phillips, D Walker, and G Coakley Management of septic arthritis: a systematic review Ann Rheum Dis, April 1, 2007; 66(4): 440 - 445. [Abstract] [Full Text] [PDF]
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