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Predictors of treatment failure and mortality in native septic arthritis

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Abstract

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.

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Conflict of interest

All authors have declared no conflicts of interest.

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Contributors

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.

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Authors and Affiliations

  1. Rheumatology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain

    Jose R. Maneiro, Alejandro Souto, Evelin C. Cervantes, Antonio Mera, Loreto Carmona & Juan J. Gomez-Reino

  2. Department of Medicine, Medical School, Universidad de Santiago de Compostela, Santiago, Spain

    Antonio Mera & Juan J. Gomez-Reino

  3. Instituto de Salud Musculoesqueletica, Madrid, Spain

    Loreto Carmona

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  1. Jose R. Maneiro
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Correspondence to Jose R. Maneiro.

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The contribution of Jose R. Maneiro and Alejandro Souto to this article is equal.

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Maneiro, J.R., Souto, A., Cervantes, E.C. et al. Predictors of treatment failure and mortality in native septic arthritis. Clin Rheumatol 34, 1961–1967 (2015). https://doi.org/10.1007/s10067-014-2844-3

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  • DOI: https://doi.org/10.1007/s10067-014-2844-3

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