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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Septic arthritis is a serious and sometimes fatal complication of rheumatoid arthritis. We have examined the clinical characteristics of 16 patients with infectious arthritis seen during an eight-year period. This represented 0.5% of all admissions to our hospital for patients with rheumatoid arthritis. Although rheumatoid arthritis is considered a predisposing factor for joint sepsis, 15 of our patients had other conditions that most likely increased their susceptibility to infection. Many patients lacked distinctive features of joint sepsis (fever, chills) and only one half had leukocytosis. Six had polyarticular complaints despite documented monarthric sepsis. Delay in diagnosis of joint infection and persistent effusions of the infected joints portended a poor prognosis.
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PMID:Infection versus disease activity in rheumatoid arthritis: eight years' experience. 376 20

Two cases of coexistent gout and septic arthritis are presented. The known increased incidence of joint injections in patients with rheumatoid arthritis is contrasted with the relative rarity of this complication in persons with gouty arthritis. The reason for this dichotomy is not clear but it is suggested that an important factor may be the more episodic nature of the gouty process. For patients presenting with acute arthritis the possible concurrence of sepsis and gout should be considered.
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PMID:Coexistent gout and septic arthritis: a report of two cases and literature review. 390 98

The abrupt onset of monoarthritis in an older patient--especially knee, but also wrist, elbow, ankle, or shoulder--should alert the clinician to the possibility of pseudogout. Joint damage or synovitis may predispose aged patients to sepsis. Rheumatoid synovium, for example, has altered synovial resistance to bacterial seeding; thus, septic arthritis in rheumatoid patients may be polyarticular.
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PMID:Treating joint inflammation in the elderly: an update. 396 57

The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Fifteen patients had pre-existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Eight patients had underlying systemic illnesses, and eight patients were receiving systemic corticosteroid therapy prior to the development of septic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2 per cent of patients), enteric gram-negative bacilli were found in seven of 23 patients (30.4 per cent). Five patients died (21.7 per cent mortality), two as a result of their infection and three of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4 per cent) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre-existing joint disease is very common and enteric gram-negative bacilli are often the causative organisms.
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PMID:Septic arthritis in the elderly. 397 35

Sepsis due to methicillin-resistant Staphylococcus epidermidis occurred in a neutropenic man during management with a Hickman-Broviac catheter. Despite catheter removal and 10 days of i.v. cefazolin therapy, he developed septic arthritis 6 weeks later in a nonprosthetic hip joint. S. epidermidis was isolated from the joint and found to have plasmid and phage susceptibility patterns identical to the previous blood isolate. This case is the first to document a metastatic infection from catheter-associated S. epidermidis bacteremia. It suggests that cephalosporins may not be optimal in such infections despite in vitro sensitivity. Vancomycin appears to be the drug of choice for S. epidermidis bacteremia in the neutropenic population.
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PMID:Staphylococcus epidermidis arthritis following catheter-induced bacteremia in a neutropenic patient. 397 18

Septic arthritis is a recognised complication of rheumatoid arthritis but has not been well described in sero-negative spondarthritis. We report 3 patients with sero-negative inflammatory joint disease who developed joint sepsis early in the course of the disease. In none was there a recognisable source of infection. Two cases were complicated by osteomyelitis and in one the sepsis has been recurrent over thirty years.
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PMID:Joint sepsis as a complication of sero-negative arthritis. 398 1

Broviac central venous catheters were placed in twenty patients who required long-term intravenous antibiotics for the treatment of osteomyelitis, septic arthritis, or an infected total joint arthroplasty. As a group, the twenty patients completed a total of 1,131 days with the catheter in place. There was only one catheter-related complication: extrusion of the Dacron cuff after removal of the catheter. Six antibiotic-related complications occurred, all of which resolved when the antibiotic was changed. No patient had sepsis related to use of the catheter, breakage of the catheter, or thrombosis. Twelve patients had part of their antibiotic treatment on an outpatient basis.
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PMID:Use of the Broviac central venous catheter for intravenous antibiotic therapy in the orthopaedic patient. 403 Aug 30

Timentin, a combination of clavulanic acid (0.1 g) and ticarcillin (3.0 g), has proved effective in vitro against bacterial pathogens that produce beta-lactamases. The usual etiologic bacteria of osteochondritis of the foot (Pseudomonas species) and osteomyelitis/septic arthritis (Staphylococcus aureus) are commonly resistant to penicillins. To date, we have used Timentin to treat 30 children with bone, joint, and deep soft tissue infections. Timentin was administered intravenously at an average dosage of 207 mg/kg per day for mild to moderate infection and 310 mg/kg per day for bone and joint infections with systemic signs (sepsis). The lower dose was used in 24 patients and the other six patients, who had signs of sepsis, received the higher dose. All patients received Timentin intravenously over 30 minutes every four to six hours for a minimum of five days (mean 6.6 +/- 2.6 days, range five to 14 days). The mean time to defervescence and/or reduction in clinical symptoms was 1.6 +/- 1.3 days (range zero to four days). Osteochondritis due to P. aeruginosa was diagnosed in six patients, and septic bursitis, osteomyelitis, or septic arthritis due to S. aureus (13 patients) or Staphylococcus species and group A streptococci (four patients) was diagnosed in 17 patients. All isolates were susceptible to Timentin in vitro by disk-diffusion analysis. All patients showed a response to therapy with Timentin, with or without surgical intervention. All patients had clinical and microbiologic cures; no adverse reactions or side effects were observed. There have been no clinical or microbiologic relapses to date. Timentin may prove to be useful in specific bone and joint infections in children.
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PMID:Timentin therapy for bone, joint, and deep soft tissue infections in children. 407 90

Four patients whose rheumatoid arthritis (RA) was complicated by staphylococcal arthritis were identified. All patients had active, long-standing disease with destructive changes. Affected joints included hip (two patients), knee (one patient), and shoulder (one patient). Pain and loss of motion in the affected joint were prominent, but toxic features of pyogenic infections--hectic fever, chills, sweats, local warmth, or erythema--were conspicuously absent. Two patients had moderate fever and three patients had mild leukocytosis. No patient was leukopenic. When present, fever was attributed to infected decubiti or urinary tract infection and treated with antibiotics. Therapy with corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) probably masked symptoms and delayed the correct diagnosis. Purulent synovial effusions were discovered serendipitously--during arthrography (knee), attempted Girdlestone procedure (hip), and aspiration prior to steroid injection (shoulder). Sepsis was included in the preoperative diagnoses only once (hip). Prior instrumentation (aspiration or injection) of the affected joint was not a feature in any patients, although one patient had undergone insertion of a knee prosthesis one year prior to sepsis. Infectious organisms were Staphylococcus aureus in three patients and Staphylococcus epidermidis in one. Severe sequelae ensued in three of four patients: death from recurrent sepsis (one patient), loss of prosthesis leading to knee arthrodesis (one patient), and protracted sepsis with additional pyarthrosis (one patient). The only patient to regain preseptic joint function (shoulder) had not been on long-standing corticosteroids. Pyarthrosis must be considered in RA patients with unusually painful or stiff joints even in the absence of toxic symptoms.
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PMID:Unrecognized staphylococcal pyarthrosis with rheumatoid arthritis. 408 87

A quantitative analysis of the results obtained by sequential 99mTc methylene diphosphonate (MDP) and 67Ga-citrate (Ga) imaging to disclose and distinguish infections in bone, synovium and adjacent soft tissue is reported. There were 129 patients with proved or probable osteomyelitis, septic arthritis and cellulitis, and 94 patients who were eventually shown to be free of sepsis, but not necessarily free of some other nonseptic affliction. Of the 159 patients referred with a presumptive clinical diagnosis of osteomyelitis 94 were eventually shown to be free of infection. The results of this group by sequential imaging were true positive 0.72, true negative 0.86 and accuracy 0.80 when low-grade Ga uptakes, which were similar in distribution to MDP, were excluded. In 26 patients with septic arthritis, the true-positive fraction for combined MDP and Ga was 0.84. The true-positive fraction for Ga in 38 patients with cellulitis was 0.79.
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PMID:Sequential use of radiophosphate and radiogallium imaging in the differential diagnosis of bone, joint and soft tissue infection: quantitative analysis. 621 37


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