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Clinical features of patients with septic arthritis and echocardiographic findings of infective endocarditis

  • Sarah B. LieberEmail author
  • Ori Tishler
  • Kunwal Nasrullah
  • Mary Louise Fowler
  • Robert H. Shmerling
  • Ziv Paz
Original Paper



Patients with septic arthritis (SA) often undergo echocardiographic evaluation to identify concomitant infective endocarditis (IE). The purpose of this study is to identify distinguishing features of patients with SA and IE by comparing them to patients with SA alone.


We conducted a retrospective study of all patients 18 and older admitted to a single tertiary hospital between 1998 and 2015 with culture-positive SA. Patients were stratified by echocardiogram status and the presence of vegetations: those who had echocardiographic evaluation with no evidence of infective endocarditis (ECHO + IE−) or with a vegetation present (ECHO + IE+) and those who had no echocardiographic evaluation (ECHO−). Demographic data, clinical characteristics, microbiology data, treatment strategies, and patient outcomes were recorded and compared.


We identified 513 patients with SA. Transthoracic echocardiogram and/or transesophageal echocardiogram were performed in 263 patients (51.2%) and demonstrated evidence for IE in 19 patients (3.7%). While most demographic features, comorbidities, and clinical characteristics did not differ significantly between those with and without IE, those with IE had higher rates of sepsis and septic shock. In addition, patients with SA and IE had higher rates of positive blood cultures and Methicillin-sensitive staphylococcus aureus (MSSA) infection when compared to those with SA without IE. Patients with IE had higher rates of intensive care unit admission and increased 30-day mortality.


IE is uncommon among patients with SA. Echocardiography may be overutilized and may be more useful among patients presenting with sepsis, shock, or positive blood cultures, especially when MSSA is isolated.


Septic arthritis Infective endocarditis Bacterial infection Echocardiogram 


Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Beth Israel Deaconess Medical Center, Harvard Medical SchoolBostonUSA
  2. 2.Azrieli Faculty of MedicineBar-Ilan UniversityRamat GanIsrael
  3. 3.Boston University School of MedicineBostonUSA
  4. 4.Galilee Medical CenterNahariyaIsrael
  5. 5.Hospital for Special SurgeryNew YorkUSA

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