Skip to main content

Advertisement

SpringerLink
Log in

Clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis

  • Brief Report
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Collins AJ, Foley R, Herzog C, Chavers B, Gilbertson D, Ishani A, Kasiske B, Liu J, Mau LW, McBean M, Murray A, St Peter W, Xue J, Fan Q, Guo H, Li Q, Li S, Li S, Peng Y, Qiu Y, Roberts T, Skeans M, Snyder J, Solid C, Wang C, Weinhandl E, Zaun D, Zhang R, Arko C, Chen SC, Dalleska F, Daniels F, Dunning S, Ebben J, Frazier E, Hanzlik C, Johnson R, Sheets D, Wang X, Forrest B, Constantini E, Everson S, Eggers P, Agodoa L (2008) Excerpts from the United States Renal Data System 2007 annual data report. Am J Kidney Dis 51:S1–S320

    PubMed  Google Scholar 

  2. Sarnak MJ, Jaber BL (2000) Mortality caused by sepsis in patients with end stage renal disease compared with the general population. Kidney Int 58:1758–1764

    Article  CAS  Google Scholar 

  3. Fram D, Meiry FPO, Taminato M et al (2015) Risk factors for bloodstream infection in patients at a Brazilian hemodialysis center: a case-control study. BMC Infect Dis 15:158

    Article  Google Scholar 

  4. Jiang L, Shao X, Xing W, Sun Y (2019) Biomarkers and risk factors for sepsis in stage 5 chronic kidney disease: a retrospective case-control study. Int Urol Nephrol 51:691–698

    Article  CAS  Google Scholar 

  5. Mokrzycki MH, Zhang M, Cohen H, Golestaneh L, Laut JM, Rosenberg SO (2006) Tunnelled haemodialysis catheter bacteraemia: risk factors for bacteraemia recurrence, infectious complications and mortality. Nephrol Dial Transplant 21:1024–1031

    Article  Google Scholar 

  6. 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 58:214–219

    Article  CAS  Google Scholar 

  7. Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D, Phillips M, Bradish C, McLachlan A, Mohammed R, Weston V, British Society for Rheumatology Standards, Guidelines and Audit Working Group (2006) BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford) 45:1039–1041

    Article  CAS  Google Scholar 

  8. Mathews CJ, Weston VC, Jones A, Field M, Coakley G (2010) Bacterial septic arthritis in adults. Lancet 375:846–855

    Article  Google Scholar 

  9. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554

    Article  Google Scholar 

  10. Sakhuja A, Kumar G, Gupta S, Mittal T, Taneja A, Nanchal RS (2015) Acute kidney injury requiring dialysis in severe sepsis. Am J Respir Crit Care Med 192:951–957

    Article  Google Scholar 

  11. Sakhuja A, Nanchal RS, Gupta S, Amer H, Kumar G, Albright RC, Kashani KB (2016) Trends and outcomes of severe sepsis in patients on maintenance dialysis. Am J Nephrol 43:97–103

    Article  CAS  Google Scholar 

  12. Kaandorp CJ, Dinant HJ, Van de Laar MA 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  Google Scholar 

  13. Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117:423–428

    Article  CAS  Google Scholar 

  14. Geirsson AJ, Statkevicius S, Vikingsson A (2008) Septic arthritis in Iceland 1990–2002: increasing incidence due to iatrogenic infections. Ann Rheum Dis 67:638–643

    Article  CAS  Google Scholar 

  15. 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  Google Scholar 

  16. Al Nammari SS, Gulati V, Patel R et al (2008) Septic arthritis in haemodialysis patients: a seven year multi-centre review. J Orthop Surg (Hong Kong) 16:54–57

    Article  Google Scholar 

  17. Klevens RM, Edwards JR, Andrus ML, Peterson KD, Dudeck MA, Horan TC, NHSN Participants in Outpatient Dialysis Surveillance (2008) Dialysis surveillance report: National Healthcare Safety Network (NHSN)-data summary for 2006. Semin Dial 21:24–28

    Article  Google Scholar 

  18. Patel PR, Yi SH, Booth S, Bren V, Downham G, Hess S, Kelley K, Lincoln M, Morrissette K, Lindberg C, Jernigan JA, Kallen AJ (2013) Bloodstream infection rates in outpatient hemodialysis facilities participating in a collaborative prevention effort: a quality improvement report. Am J Kidney Dis 62:322–330

    Article  Google Scholar 

  19. Nguyen DB, Lessa FC, Belflower R, Mu Y, Wise M, Nadle J, Bamberg WM, Petit S, Ray SM, Harrison LH, Lynfield R, Dumyati G, Thompson J, Schaffner W, Patel PR, for the Active Bacterial Core Surveillance (ABCs) MRSA Investigators of the Emerging Infections Program (2013) Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011. Clin Infect Dis 57:1393–1400

    Article  CAS  Google Scholar 

  20. Patel PR, Kallen AJ, Arduino MJ (2010) Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients. Am J Kidney Dis 56:566–577

    Article  Google Scholar 

  21. Fysaraki M, Samonis G, Valachis A, Daphnis E, Karageorgopoulos DE, Falagas ME, Stylianou K, Kofteridis DP (2013) Incidence, clinical, microbiological features and outcome of bloodstream infections in patients undergoing hemodialysis. Int J Med Sci 10:1632–1638

    Article  Google Scholar 

  22. Esmanhoto CG, Taminato M, Fram DS, Belasco AGS, Barbosa DA (2013) Microorganisms isolated from patients on hemodialysis by central venous catheter and related clinical evolution. Acta Paul Enferm 26:413–420

    Article  Google Scholar 

  23. Dubost JJ, Soubrier M, De Champs C et al (2002) No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis 61:267–269

    Article  CAS  Google Scholar 

  24. Jung SW, Kim DH, Shin SJ et al (2018) Septic arthritis associated with systemic sepsis. Int Orthop 42:1–7

    Article  Google Scholar 

  25. 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 57:1151–1157

    Article  Google Scholar 

  26. Lewis SS, Sexton DJ (2012) Metastatic complications of bloodstream infections in hemodialysis patients. Semin Dial 26:47–53

    Article  Google Scholar 

  27. Lawrence JS, Bremner JM, Bier F (1996) Osteo-arthrosis. Prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 25:1–24

    Article  Google Scholar 

  28. Gupta MN, Sturrock RD, Field M (2001) A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford) 40:24–30

    Article  CAS  Google Scholar 

  29. Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G (2007) Management of septic arthritis: a systematic review. Ann Rheum Dis 66:440–445

    PubMed  PubMed Central  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Nephrology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325000, Zhejiang, China

    Jianna Zhang & Xiaohan You

Authors
  1. Jianna Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Xiaohan You
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Xiaohan You.

Ethics declarations

Disclosures

None.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Zhang, J., You, X. Clinical features, risk factors, and outcomes of septic arthritis in patients on maintenance hemodialysis. Clin Rheumatol 39, 3065–3069 (2020). https://doi.org/10.1007/s10067-020-05114-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-020-05114-3

Keywords

Search

Navigation