Clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis
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BRIEF REPORT
Clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis Jianna Zhang 1 & Xiaohan You 1 Received: 29 November 2019 / Revised: 11 March 2020 / Accepted: 16 April 2020 # International League of Associations for Rheumatology (ILAR) 2020
Abstract The aim of this study was to investigate the clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis (HD). We systematically reviewed medical records of 16 HD patients with septic arthritis admitted to our hospital from April 2008 to April 2018. A total of 16 HD in patients with bloodstream infection but without septic arthritis were randomly selected as controls. The incidence of septic arthritis in our patient group was 0.2% per year. Organisms isolated were Staphylococcus aureus in 11 (68.7%), Gram-negative bacilli in 3, streptococci in 1, and fungi in 1. Patients with septic arthritis were significantly older (72.7 ± 9.4 vs 63.5 ± 8.7 years, p = 0.035) and had more joint diseases (62.5% vs 12.5%, p = 0.003) and a longer duration of hospitalization (35.2 ± 5.7 vs 22.1 ± 3.5 days, p = 0.021) than the control group. In a logistic regression analysis, patients with older age and more joint diseases were more likely to have septic arthritis compared with controls (OR = 1.39, p = 0.024 and OR = 3.24, p = 0.003, respectively). These findings indicate that old age and joint diseases (osteoarthritis or inflammatory arthritis) were independent risk factors for septic arthritis in patients on HD when bloodstream infection occurred. Key Points • Patients with septic arthritis were significantly older and had more joint diseases than the control group. • Old age and joint diseases are independent risk factors for septic arthritis in patients on HD when bloodstream infection occurs.
Keywords Hemodialysis . Joint disease . Risk factors . Septic arthritis
Introduction Infection is the second leading cause of mortality among patients on maintenance hemodialysis (HD) [1, 2]. Bloodstream infections are particularly problematic, accounting for a substantial number of hospitalizations in these patients [3, 4]. Infectious complications occur in 7% of tunneled catheterrelated bloodstream infections in HD patients [5], the most common being endocarditis, osteomyelitis, spinal epidural abscess, and septic arthritis. Septic arthritis is an important medical emergency, with high morbidity and mortality [6, 7]. In addition, these patients
* Xiaohan You [email protected] 1
Department of Nephrology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, China
have many possible aseptic causes for arthritis, such as gouty arthritis, making early diagnosis difficult [8]. Delayed or inadequate treatment can lead to irreversible joint destruction [8]. Here, we describe 16 cases of septic arthritis in patients on maintenance HD during the past 10 years in our hospital.
Patients and methods Patients In this retrospective study, we reviewed the medical records of
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