Clinical Rheumatology

, Volume 34, Issue 11, pp 1961–1967 | Cite as

Predictors of treatment failure and mortality in native septic arthritis

  • Jose R. ManeiroEmail author
  • Alejandro Souto
  • Evelin C. Cervantes
  • Antonio Mera
  • Loreto Carmona
  • Juan J. Gomez-Reino
Original Article


The aims of this study are to analyse the characteristics of septic arthritis stratified by age and to identify the predictors of treatment failure and mortality in septic arthritis. A retrospective single-centre study was conducted in patients with native septic arthritis between 1994 and 2012. The primary outcome was treatment failure. Secondary outcomes included mortality, complications, endocarditis, bacteraemia, hospital readmission and the duration of the hospital stay. Logistic regression analyses with a propensity score were performed to identify the predictors of response and mortality. Additional analyses were performed according to age and the initial treatment (surgery or conservative). A total of 186 patients were studied. The median (interquartile range) age was 64 (46, 74) years, and the percentage of male patients was 68.9 %. A logistic regression analysis showed that Staphylococcus aureus infection [OR 2.39 (1.20–4.77), p = 0.013], endocarditis [OR 4.74 (1.16–19.24), p = 0.029] and the involvement of joints difficult to access with needle drainage [OR 2.33 (1.06–5.11), p = 0.034] predict treatment failure and that age [OR 1.27 (1.07 = 1.50), p = 0.005], the leucocyte count at baseline [OR 1.01 (1.00–1.02), p = 0.023], bacteraemia [OR 27.66 (1.39–551.20), p = 0.030], diabetes mellitus [OR 15.33 (1.36–172.67), p = 0.027] and chronic renal failure [OR 81.27 (3.32–1990.20), p = 0.007] predict mortality. No significant differences in treatment failure by age were found. In septic arthritis, the predictors of mortality and the predictors of treatment failure differ. The predictors of treatment failure concern local factors and systemic complications, whereas conditions related to the host’s immune competence, such as age and comorbidities that hamper the host’s response, predict mortality.


Age Joint drainage Mortality Septic arthritis Treatment 


Conflict of interest

All authors have declared no conflicts of interest.




J.R.M. took part in the study design, collection and interpretation of data and drafting the article. A.S. took part in the study design, collection and interpretation of data and drafting the article. E.C. took part in the collection of data. A.M. took part in the interpretation of data. L.C. took part in the interpretation of data. J.J.G.-R took part in the conception and study design, interpretation of data, drafting the article and critically revising it for important intellectual content. All authors gave the final approval for submission for publication.

Supplementary material

10067_2014_2844_MOESM1_ESM.docx (19 kb)
ESM 1 (DOCX 18 kb)


  1. 1.
    Ward J, Cohen AS, Bauer W (1960) The diagnosis and therapy of acute suppurative arthritis. Arthritis Rheum 3:522–535CrossRefPubMedGoogle Scholar
  2. 2.
    Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M (1999) Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis 58(4):214–219PubMedCentralCrossRefPubMedGoogle Scholar
  3. 3.
    Yu LP, Bradley JD, Hugenberg ST, Brandt KD (1992) Predictors of mortality in non-post-operative patients with septic arthritis. Scand J Rheumatol 21(3):142–144CrossRefPubMedGoogle Scholar
  4. 4.
    Cooper C, Cawley MI (1986) Bacterial arthritis in the elderly. Gerontology 32(4):222–227CrossRefPubMedGoogle Scholar
  5. 5.
    Vincent GM, Amirault JD (1990) Septic arthritis in the elderly. Clin Orthop Relat Res 251:241–245PubMedGoogle Scholar
  6. 6.
    McGuire NM, Kauffman CA (1985) Septic arthritis in the elderly. J Am Geriatr Soc 33(3):170–174CrossRefPubMedGoogle Scholar
  7. 7.
    Gavet F, Tournadre A, Soubrier M, Ristori JM, Dubost JJ (2005) Septic arthritis in patients aged 80 and older: a comparison with younger adults. J Am Geriatr Soc 53(7):1210–1213CrossRefPubMedGoogle Scholar
  8. 8.
    Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM et al (1993) Polyarticular septic arthritis. Medicine (Baltimore) 72(5):296–310CrossRefGoogle Scholar
  9. 9.
    Vyskocil JJ, McIlroy MA, Brennan TA, Wilson FM (1991) Pyogenic infection of the sacroiliac joint. Case reports and review of the literature. Medicine (Baltimore) 70(3):188–197CrossRefGoogle Scholar
  10. 10.
    Bynum DK Jr, Nunley JA, Goldner JL, Martinez S (1982) Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint. South Med J 75(10):1232, –1235, 1238CrossRefPubMedGoogle Scholar
  11. 11.
    Broy SB, Stulberg SD, Schmid FR (1986) The role of arthroscopy in the diagnosis and management of the septic joint. Clin Rheum Dis 12(2):489–500PubMedGoogle Scholar
  12. 12.
    Mathews CJ, Weston VC, Jones A, Field M, Coakley G (2010) Bacterial septic arthritis in adults. Lancet 375(9717):846–855CrossRefPubMedGoogle Scholar
  13. 13.
    Dubost JJ, Soubrier M, De Champs C, Ristori JM, Bussiere JL, Sauvezie B (2002) No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis 61(3):267–269PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Wolfe F, Lassere M, van der Heijde D, Stucki G, Suarez-Almazor M, Pincus T et al (1999) Preliminary core set of domains and reporting requirements for longitudinal observational studies in rheumatology. J Rheumatol 26(2):484–489PubMedGoogle Scholar
  15. 15.
    Hosmer D, Lemeshow S (2000) Applied logistic regression. Wiley, New YorkCrossRefGoogle Scholar
  16. 16.
    Kaandorp CJ, Van Schaardenburg D, Krijnen P, Habbema JD, van de Laar MA (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38(12):1819–1825CrossRefPubMedGoogle Scholar
  17. 17.
    Doran MF, Crowson CS, Pond GR, O’Fallon WM, Gabriel SE (2002) Frequency of infection in patients with rheumatoid arthritis compared with controls: a population-based study. Arthritis Rheum 46(9):2287–2293CrossRefPubMedGoogle Scholar
  18. 18.
    Edwards CJ, Cooper C, Fisher D, Field M, van Staa TP, Arden NK (2007) The importance of the disease process and disease-modifying antirheumatic drug treatment in the development of septic arthritis in patients with rheumatoid arthritis. Arthritis Rheum 57(7):1151–1157CrossRefPubMedGoogle Scholar
  19. 19.
    Dolganiuc A, Stavaru C, Anghel M, Baltaru D, Georgescu E, Olinescu A (2000) The migratory and phagocytic activity of polymorphonuclear leukocytes in rheumatoid arthritis and osteoarthritis patients. Roum Arch Microbiol Immunol 59(1–2):43–53PubMedGoogle Scholar
  20. 20.
    Turner RA, Schumacher R, Myers AR (1973) Phagocytic function of polymorphonuclear leukocytes in rheumatic diseases. J Clin Invest 52(7):1632–1635PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Goldenberg DL (1989) Infectious arthritis complicating rheumatoid arthritis and other chronic rheumatic disorders. Arthritis Rheum 32(4):496–502CrossRefPubMedGoogle Scholar
  22. 22.
    Strangfeld A, Listing J (2006) Infection and musculoskeletal conditions: bacterial and opportunistic infections during anti-TNF therapy. Best Prac Res Clin Rheumatol 20(6):1181–1195CrossRefGoogle Scholar
  23. 23.
    Galloway JB, Hyrich KL, Mercer LK, Dixon WG, Ustianowski AP, Helbert M 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(10):1810–1814PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Ross JJ, Shamsuddin H (2004) Sternoclavicular septic arthritis: review of 180 cases. Medicine (Baltimore) 83(3):139–148CrossRefGoogle Scholar
  25. 25.
    Ross JJ, Hu LT (2003) Septic arthritis of the pubic symphysis: review of 100 cases. Medicine (Baltimore) 82(5):340–345CrossRefGoogle Scholar
  26. 26.
    Lossos IS, Yossepowitch O, Kandel L, Yardeni D, Arber N (1998) Septic arthritis of the glenohumeral joint. A report of 11 cases and review of the literature. Medicine (Baltimore) 77(3):177–187CrossRefGoogle Scholar
  27. 27.
    Keynan Y, Rubinstein E (2013) Staphylococcus aureus bacteremia, risk factors, complications, and management. Crit Care Clin 29(3):547–562CrossRefPubMedGoogle Scholar
  28. 28.
    Ispahani P, Weston VC, Turner DP, Donald FE (1999) Septic arthritis due to Streptococcus pneumoniae in Nottingham, United Kingdom, 1985–1998. Clin Infect Dis 29(6):1450–1454CrossRefPubMedGoogle Scholar
  29. 29.
    Ross JJ, Saltzman CL, Carling P, Shapiro DS (2003) Pneumococcal septic arthritis: review of 190 cases. Clin Infect Dis 36(3):319–327CrossRefPubMedGoogle Scholar
  30. 30.
    Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES (1975) Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage. Arthritis Rheum 18(1):83–90CrossRefPubMedGoogle Scholar
  31. 31.
    Sammer DM, Shin AY (2009) Comparison of arthroscopic and open treatment of septic arthritis of the wrist. J Bone Joint Surg Am 91(6):1387–1393CrossRefPubMedGoogle Scholar
  32. 32.
    Nusem I, Jabur MK, Playford EG (2006) Arthroscopic treatment of septic arthritis of the hip. Arthroscopy 22(8):e901–903CrossRefGoogle Scholar
  33. 33.
    de Labry LO, Campion EW, Glynn RJ, Vokonas PS (1990) White blood cell count as a predictor of mortality: results over 18 years from the Normative Aging Study. J Clin Epidemiol 43(2):153–157CrossRefPubMedGoogle Scholar
  34. 34.
    Barron HV, Harr SD, Radford MJ, Wang Y, Krumholz HM (2001) The association between white blood cell count and acute myocardial infarction mortality in patients > or =65 years of age: findings from the cooperative cardiovascular project. J Am Coll Cardiol 38(6):1654–1661CrossRefPubMedGoogle Scholar
  35. 35.
    Cannon CP, McCabe CH, Wilcox RG, Bentley JH, Braunwald E (2001) Association of white blood cell count with increased mortality in acute myocardial infarction and unstable angina pectoris. OPUS-TIMI 16 Investigators. Am J Cardiol 87(5):636, –639, A610CrossRefPubMedGoogle Scholar
  36. 36.
    Asadollahi K, Hastings IM, Beeching NJ, Gill GV (2007) Laboratory risk factors for hospital mortality in acutely admitted patients. QJM : Mon J Assoc Physicians 100(8):501–507CrossRefGoogle Scholar

Copyright information

© International League of Associations for Rheumatology (ILAR) 2014

Authors and Affiliations

  • Jose R. Maneiro
    • 1
    Email author
  • Alejandro Souto
    • 1
  • Evelin C. Cervantes
    • 1
  • Antonio Mera
    • 1
    • 2
  • Loreto Carmona
    • 1
    • 3
  • Juan J. Gomez-Reino
    • 1
    • 2
  1. 1.Rheumatology DepartmentComplejo Hospitalario Universitario de Santiago de CompostelaSantiagoSpain
  2. 2.Department of Medicine, Medical SchoolUniversidad de Santiago de CompostelaSantiagoSpain
  3. 3.Instituto de Salud MusculoesqueleticaMadridSpain

Personalised recommendations