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Septische Arthritis des Erwachsenen

Septic arthritis in adults

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Zusammenfassung

Septische Arthritiden sind ein echter rheumatologischer Notfall und erfordern sofortiges und umsichtiges Handeln zur raschen Diagnosefindung und Therapieeinleitung. Kinder und ältere Personen, Abwehrgeschwächte sowie Patienten mit Gelenkvorschädigung und entzündlich-rheumatischen Gelenkerkrankungen sind bevorzugt betroffen. Bakteriämien, operative Eingriffe am Gelenk und intraartikuläre Injektionen stellen Risikosituationen für die Entstehung eines Gelenkinfektes dar. Häufigster Erreger ist Staphylococcus aureus, weitere wichtige Erregergruppen sind koagulasenegative Staphylokokken, Streptokokken und Mykobakterien. Die Synoviaanalyse (Aussehen, Zellzahl, mikrobiologische Diagnostik) ist der wichtigste Schritt zur Diagnosefindung. Therapeutische Säulen sind Gelenkdrainage und antibiotische Behandlung. Das Vorgehen bei infizierten Endoprothesen ist abhängig von der Symptomdauer, Erregerart und individuellen Faktoren.

Abstract

Septic arthritis is a true rheumatological emergency requiring immediate and thoughtful effort for rapid diagnosis establishment and treatment initiation. Children and elderly persons as well as immunocompromised individuals, patients with pre-existing joint damage and with inflammatory rheumatic joint diseases are preferentially affected. Bacteremia, joint surgery and intra-articular injections pose risk situations for the development of joint infections. The most frequent causative organism is Staphylococcus aureus but other relevant pathogens include coagulase-negative staphylococci, streptococci and mycobacteria. Synovial fluid analysis (e.g. appearance, cell count and microbiological examination) is the most important step to establish the diagnosis. The two main components of therapy consist of joint drainage and antibiotic treatment. The approach to periprosthetic joint infections depends on the duration of symptoms, causative organism and individual factors.

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Literatur

  1. Newman JH (1976) Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis 35:198–205

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  2. Shirtliff ME, Mader JT (2002) Acute septic arthritis. Clin Microbiol Rev 15:527–544

    Article  PubMed Central  PubMed  Google Scholar 

  3. Roy S, Bhawan J (1975) Ultrastructure of articular cartilage in pyogenic arthritis. Arch Pathol 99:44–47

    CAS  PubMed  Google Scholar 

  4. Kaandorp CJE, Dinant HJ, Laar MAFJ van de et al (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56:470–475

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Weston VC, Jones AC, Bradbury N et al (1999) Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis 58:214–219

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  6. Nade S (2003) Septic arthritis. Best Pract Res Clin Rheumatol 17:183–200

    Article  PubMed  Google Scholar 

  7. Kaandorp CJ, Van Schaardenburg D, Krijnen P et al (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38:1819–1825

    Article  CAS  PubMed  Google Scholar 

  8. Chander S, Coakley G (2011) What’s new in the management of bacterial septic arthritis? Curr Infect Dis Rep 13:478–484

    Article  PubMed  Google Scholar 

  9. Ostensson A, Geborek P (1991) Septic arthritis as a non-surgical complication in rheumatoid arthritis: relation to disease severity and therapy. Br J Rheumatol 30:35–38

    Article  CAS  PubMed  Google Scholar 

  10. Albert C, Brocq O, Gerard D et al (2006) Septic knee arthritis after intra-articular hyaluronate injection. Two case reports. Joint Bone Spine 73:205–207

    Article  PubMed  Google Scholar 

  11. Favero M, Schiavon F, Riato L et al (2008) Rheumatoid arthritis is the major risk factor for septic arthritis in rheumatological settings. Autoimmun Rev 8:59–61

    Article  CAS  PubMed  Google Scholar 

  12. Galloway JB, Hyrich KL, Mercer LK et al (2011) Risk of septic arthritis in patients with rheumatoid arthritis and the effect of anti-TNF therapy: results from the British Society for Rheumatology Biologics Register. Ann Rheum Dis 70:1810–1814

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Cole BJ (2005) Injectable corticosteroids in modern practice. J Am Acad Orthop Surg 13:37–46

    PubMed  Google Scholar 

  14. Ross JJ, Saltzman CL, Carling P et al (2003) Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis 36:319–327

    Article  PubMed  Google Scholar 

  15. Ryan MJ, Kavanagh R, Wall PG et al (1997) Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period. Br J Rheumatol 36:370–373

    Article  CAS  PubMed  Google Scholar 

  16. Schattner A, Vosti KL (1998) Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 77:122–139

  17. Saur M, Distler O, Müller N (2008) Bakterielle Arthritis? Gonokokken-Infektion trotz negativen Kulturen. Praxis (Bern 1994) 97:977–983

  18. Cuéllar ML, Silveira LH, Espinoza LR (1992) Fungal arthritis. Ann Rheum Dis 51:690–697

    Article  PubMed Central  PubMed  Google Scholar 

  19. Sande WW van de (2013) Global burden of human mycetoma: a systematic review and meta-analysis. PLoS Negl Trop Dis 7:e2550

    Article  PubMed Central  PubMed  Google Scholar 

  20. Aggarwal VK, Bakhshi H, Ecker NU et al (2014) Organism profile in periprosthetic joint infection: pathogens differ at two arthroplasty infection referral centers in Europe and in the United States. J Knee Surg [Epub ahead of print]

  21. Sharff KA, Richards EP, Towns JM (2013) Clinical management of septic arthritis. Curr Rheumatol Rep 15:332

    Article  PubMed  Google Scholar 

  22. Coakley G (2006) BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology 45:1039–1041

    Article  CAS  PubMed  Google Scholar 

  23. Diefenbeck M, Abitzsch D, Hofmann GO (2012) Die Gelenkinfektion. Bekanntes und neue Trends. Unfallchirurg 115:489–495

    Article  CAS  PubMed  Google Scholar 

  24. Margaretten ME, Kohlwes J, Moore D et al (2007) Does this adult patient have septic arthritis? JAMA 297:1478–1488

    Article  CAS  PubMed  Google Scholar 

  25. Zmistowski B, Della Valle C, Bauer TW et al (2014) Diagnosis of periprosthetic joint infection. J Arthroplasty 29(2 Suppl):77–83

    Article  PubMed  Google Scholar 

  26. Shah K, Spear J, Nathanson LA et al (2007) Does the presence of crystal arthritis rule out septic arthritis? J Emerg Med 32:23–26

    Article  PubMed  Google Scholar 

  27. Li SF, Henderson J, Dickman E et al (2004) Laboratory tests in adults with monoarticular arthritis: can they rule out a septic joint? Acad Emerg Med 11:276–280

    Article  PubMed  Google Scholar 

  28. Knöss P, Knöss M, Otto M et al (2008) Das differenzialdiagnostische Spektrum der Synovialitis. Z Rheumatol 67:8–16

    Article  PubMed  Google Scholar 

  29. Morawietz L, Classen RA, Schröder JH et al (2006) Proposal for a histopathological consensus classification of the periprosthetic interface membrane. J Clin Pathol 59:591–597

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Chairmen Parvizi J, Gehrke T (2013) Proceedings of the International Consensus Meeting on Periprosthetic Joint Infection. http://www.msis-na.org/international-consensus

  31. Tsaras G, Osmon DR, Mabry T et al (2012) Incidence, secular trends, and outcomes of prosthetic joint infection: a population-based study, olmsted county, Minnesota, 1969–2007. Infect Control Hosp Epidemiol 33:1207–1212

    Article  PubMed Central  PubMed  Google Scholar 

  32. Bongartz T (2008) Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum 59:1713–1720

    Article  PubMed Central  PubMed  Google Scholar 

  33. Della Valle CJ, Sporer SM, Jacobs JJ et al (2007) Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty 22(6 Suppl 2):90–93

    Article  Google Scholar 

  34. Ghanem E, Parvizi J, Burnett RS et al (2008) Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am 90:1637–1643

    Article  PubMed  Google Scholar 

  35. Trampuz A, Hanssen AD, Osmon DR et al (2004) Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 117:556–562

    Article  PubMed  Google Scholar 

  36. Schinsky MF, Della Valle CJ, Sporer SM et al (2008) Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am 90:1869–1875

    Article  PubMed  Google Scholar 

  37. Schäfer P, Fink B, Sandow D et al (2008) Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis 47:1403–1409

    Article  PubMed  Google Scholar 

  38. Evangelopoulos DS, Stathopoulos IP, Morassi GP et al (2013) Sonication: a valuable technique for diagnosis and treatment of periprosthetic joint infections. Scientific World J 2013:375140

    Article  CAS  Google Scholar 

  39. Ravindran V, Logan I, Bourke BE (2009) Medical vs. surgical treatment for the native joint in septic arthritis: a 6-year single UK academic centre experience. Rheumatology (Oxford) 48:1320–1322

  40. Garcia-Arias M, Balsa A, Mola EM (2011) Septic arthritis. Best Pract Res Clin Rheumatol 25:407–421

    Article  PubMed  Google Scholar 

  41. Barth RE, Vogely HC, Hoepelman AI et al (2011) „To bead or not to bead?“ Treatment of osteomyelitis and prosthetic joint-associated infections with gentamicin bead chains. Int J Antimicrob Agents 38:371–375

    Article  CAS  PubMed  Google Scholar 

  42. Bodmann KF, Grabein B, Die Expertenkommission der Paul-Ehrlich-Gesellschaft für Chemotherapie (2010) Empfehlungen zur kalkulierten parenteralen Initialtherapie bei Erwachsenen – Update 2010. Chemother J 6:179–255

    Google Scholar 

  43. S2k-Leitlinie Gonorrhoe bei Erwachsenen und Adoleszenten (2013). http://www.awmf.org/leitlinien/detail/ll/059-004.html

  44. Osmon DR, Berbari EF, Berendt AR et al (2013) Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:1–10

    Article  PubMed  Google Scholar 

  45. Darouiche RO (2004) Treatment of infections associated with surgical implants. N Engl J Med 350:1422–1429

    Article  CAS  PubMed  Google Scholar 

  46. Gehrke T, Zahar A, Kendoff D (2013) One-stage exchange: it all began here. Bone Joint J 95-B(11 Suppl A):77–83

  47. Parvizi J, Saleh KJ, Ragland PS et al (2008) Efficacy of antibiotic-impregnated cement in total hip replacement. Acta Orthop 79:335–341

    Article  PubMed  Google Scholar 

  48. Odio CM, Ramirez T, Arias G et al (2003) Double blind, randomized, placebo-controlled study of dexamethasone therapy for hematogenous septic arthritis in children. Pediatr Infect Dis J 22:883–888

    Article  PubMed  Google Scholar 

  49. Harel L, Prais D, Bar-On E et al (2011) Dexamethasone therapy for septic arthritis in children: results of a randomized double-blind placebo-controlled study. J Pediatr Orthop 31:211–215

    Article  PubMed  Google Scholar 

  50. Sakiniene E, Bremell T, Tarkowski A (1996) Addition of corticosteroids to antibiotic treatment ameliorates the course of experimental Staphylococcus aureus arthritis. Arthritis Rheum 39:1596–1605

    Article  CAS  PubMed  Google Scholar 

  51. Wysenbeek AJ, Volchek J, Amit M et al (1998) Treatment of staphylococcal septic arthritis in rabbits by systemic antibiotics and intra-articular corticosteroids. Ann Rheum Dis 57:687–690

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  52. Chen CM (2013) Surgical treatment for septic arthritis of the knee joint in elderly patients: a 10-year retrospective clinical study. Orthopedics 36:e434–e443

    Article  PubMed  Google Scholar 

  53. Vispo Seara J (2002) Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 122:204–211

    Article  Google Scholar 

  54. Eberst-Ledoux J, Tournadre A, Mathieu S et al (2012) Septic arthritis with negative bacteriological findings in adult native joints: a retrospective study of 74 cases. Joint Bone Spine 79:156–159

    Article  PubMed  Google Scholar 

  55. Hsieh PH (2013) Prosthetic joint infection in patients with rheumatoid arthritis: an outcome analysis compared with controls. PLoS One 8:e71666

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  56. Berbari EF, Osmon DR, Duffy MC et al (2006) Outcome of prosthetic joint infection in patients with rheumatoid arthritis: the impact of medical and surgical therapy in 200 episodes. Clin Infect Dis 42:216–223

    Article  PubMed  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J. Loock, N. Haustedt und J. Wollenhaupt geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Rheumatologie und klinische Immunologie, Schön Klinikum Hamburg Eilbek, Dehnhaide 120, 22081, Hamburg, Deutschland

    J. Loock & J. Wollenhaupt

  2. Klinik für Septische Knochen- und Weichteilchirurgie, Schön Klinikum Hamburg Eilbek, Hamburg, Deutschland

    N. Haustedt

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  1. J. Loock
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Correspondence to J. Loock.

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Loock, J., Haustedt, N. & Wollenhaupt, J. Septische Arthritis des Erwachsenen. Z. Rheumatol. 73, 623–635 (2014). https://doi.org/10.1007/s00393-014-1463-3

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