Abstract
Septic arthritis is important to consider in any patient who presents with joint pain because it is a medical emergency with an 11% fatality rate. Diagnosis and treatment may improve prognosis; however, many patients do not regain full joint function. In patients with end-stage renal disease (ESRD), immune dysfunction due to uremia and chronic vascular access leads to increased risk of infection. We examined the incidence, risk factors and sequelae of septic arthritis in a cohort of hemodialysis patients. The US Renal Data System was queried for diagnoses of septic arthritis and selected sequelae using International Statistical Classification of Diseases and Related Health Problems-9 and Current Procedural Terminology-4 codes in patients who initiated hemodialysis between 2005 and 2010. Multivariable logistic regression was used to determine potential risk factors for septic arthritis and its sequelae. 7009 cases of septic arthritis were identified, an incidence of 514.8 per 100,000 persons per year. Of these patients, 2179 were diagnosed with a documented organism within 30 days prior to or 14 days after the septic arthritis diagnosis, with methicillin-resistant Staphylococcus aureus infections (57.4%) being the most common. Significant risk factors for septic arthritis included history of joint disease, immune compromise (diabetes, HIV, cirrhosis), bacteremia and urinary tract infection. One of the four sequelae examined (joint replacement, amputation, osteomyelitis, Clostridioides difficile infection) occurred in 25% of septic arthritis cases. The high incidence of septic arthritis and the potential for serious sequelae in patients with ESRD suggest that physicians treating individuals with ESRD and joint pain/inflammation should maintain a high clinical suspicion for septic arthritis.
Footnotes
Twitter @StephanieBaerMD
Contributors Conceptualization: MW, LH, SLB, AM, BS, SP and REC. Data curation: JLW. Formal analysis: JLW. Funding acquisition: MK and AM. Investigation: LA, MW and JLW. Methodology: JLW, LH, SLB, AM, BS, SP and REC. Project administration: SLB, AM and WBB. Resources: MK and AM. Supervision: AM, SLB and WBB. Visualization: LA, JLW, ST and WBB. Writing - original draft: LA, MW, JLW and WBB. Writing - review and editing: LA, JLW, LH, SLB, AM, MK, ST, BS, SP, REC and WBB.
Funding This work was supported by the MCG Department of Medicine Translational Research Program, a grant from Dialysis Clinic, Inc. (C-3953 (081-East Albany)) and the Carolyn L Kuckein Student Research Fellowship Program.
Disclaimer The content of this article does not represent the views of the Department of Veterans Affairs or the US Government. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as official policy or interpretation of the US Government.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Author note SLB is an Editorial Board Member of the Journal of Investigative Medicine.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
Data availability statement
Data are available in a public, open access repository. The data underlying this article are available in the USRDS Database, at https://www.usrds.org/for-researchers/simple-data-requests/ and can be accessed by submitting a Simple Data Request form.
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