Introduction

Septic arthritis (SA) of the knee is a medical emergency that requires prompt attention and early treatment in order to avoid permanent damage to the joint. Although the medical literature describes the clinical characteristics and the ideal exploratory techniques for its diagnosis, there is no consensus on emergency management in Spain. The purpose of the study is to review the behavior in the emergency room in patients diagnosed with SA and to compare it with a management guide validated in another country.

Material And Methods

descriptive, retrospective study of positive fluids from native joints validated by the Microbiology service. Its processing consisted of a seeding in conventional means for aerobes, anaerobes and enriched medium BHI. Epidemiological and clinical data were obtained in the first hospital contact and evolution. The diagnostic and therapeutic approach was compared with the Guide for the management of the swollen and warm joint published in 2006 by the British Society of Rheumatology.

Results

46 SA cases were included after being admitted from the Emergency Department. The mean age was 62.3±6.3 years (21 to 89), 54.3% male. Background: DM in 4 cases (8.6%), diabetic neuropathy in 1 (2.1%), previous AS in 5 (10.8%), history of skin opening in 8 (17.3%), infection of skin without opening in 7 (15.2%) and previous arthrocentesis in 6 (13.0%). Analytical tests: the determination of CRP and ESR with clinical suspicion was performed in 10 (21.7%) and 14 (30.4%) cases respectively. Hepatic and renal profiles were performed in 31(67.3%) and 40 (86.9%) cases respectively. Blood cultures performed in 29 cases (63.0%). Arthrocentesis recommendations and joint fluid analysis: In 40 (86.9%) of the 46 cases, suspicion of SA was established in the first consultation, with arthrocentesis performed in 37/40 (92.5%). The samples were sent for GRAM study 19 (41.3%), for microbiological culture 44 (95.6%), for leukocyte count 26 (56.5%) and study of microcrystals 4 (8.6%). Recommendations for treatment and follow-up: 100% of the cases were treated with antibiotics empirically and 84.7% (39 cases) according to the recommendations. The request for two ESR/CRP determinations until hospital discharge was made in 44 cases (95.6%). IV antibiotic treatment time: 22.90 ± 6.12 days (7 to 42), oral: 20.08 ± 10.52 (7 to 31) days, total antibiotic therapy time of 35.91±6, 75 (21 to 50). Hospitalization: 25.39 ± 6.05 (8 to 50) days. Surgery was necessary in 18 (39%). The time between the first consultation and the start of the empirical antibiotic: 2.1 ± 1.64 (0 to 6) days.

Discussion

This study reviews the cases of SA demonstrated by positive cultures, so it does not reflect all those cases with clinical suspicion. We accept that the diagnostic suspicion must be much higher than the casuistry that we have presented and we admit that it´s on this population that the recommendations of the guidelines should affect. Therefore, some shortcomings are demonstrated regarding the diagnostic management during the first consultation, hence the importance of disseminating the SA management guidelines to reduce the lack of adherence that we have detected.