Evaluation of prognostic factors for septic arthritis in Sudanese patients

Abstract

Background: Septic arthritis is an important rheumatological and orthopaedic emergency and continues to be associated with significant mortality and morbidity, even with effective treatment. Objectives: Aims of this study are to determine the patterns of acute septic arthritis and to evaluate the factors, which may be associated with poor outcome. Patients and methods: This is a cross-sectional hospital based prospective clinical study carried out in Khartoum Teaching Hospital, Orthopaedic units from 31st of March 2002 to 1st of April 2003.All patients with proven and suspected septic arthritis admitted to Khartoum Teaching Hospital during the study period were included. Poor outcome was defined as any residual clinical or radiological abnormalities. Results: There were 57 patients (61 joints), 37 with culture positive septic arthritis and 20 with clinically suspected septic arthritis, but sterile synovial fluid. There were 43 males and 14 females (ratio 3 : 1), their ages ranged between 40 days and 43 years, with mean of 9.6 years, 87.7% were under 16 years of age. The mean duration of symptoms before admission to orthopaedic units was 11.3 days. Trauma was the major risk factor (38.6%). Those who had no readily identifiable risk factor were 26.3%. Over 80% initially were treated by non-orthopaedic specialists and in 65% were diagnosis initially missed. The most common clinical presentations were fever in 80.7% and acute monoarthritis in 93% of cases . Erythrocyte sedimentation rate above 30mm/h was found in all patients at time of admission. Total white cells count raised above 11,000 was seen only in 29.8%. Staph aureus was the most commonly isolated organism (43.4%) in culture positive group and the hip was the most commonly involved joint (47.4%) Poor outcome was observed in 56.1% of patients with late presentation and/or initiation of definitive management (P= 0.000), with hip or multiple joint involvement (P = 0.000) and those treated by antibiotic alone (P= 0.02). Conclusion: The single most important factor for poor prognosis is late diagnosis and/or initiation of definitive management.