Micro-Organisms causing septic arthritis in adult patients at Chris Hani Baragwanath Academic Hospital

• Main Author: Matekane, Katleho Motseki
• Format: Others
• Language: en
• Published: 2018
• Online Access: https://hdl.handle.net/10539/24742

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Orthopaedic Surgery Johannesburg, 2017. === Septic arthritis is a very common orthopaedic emergency. Surgical debridement and empiric antibiotic cover together make up the vital initial management of septic arthritis. Empiric antibiotic cover is determined using the most prevalent bacteria in a specific clinical setting given the patient profile. The purpose of the study was to determine the microbiological spectrum that is responsible for septic arthritis at our centre and the antibiotic sensitivity thereof. This retrospective study included 82 patients who were admitted with a diagnosis of septic arthritis. The microbiological and biochemical results of these patients were retrospectively reviewed. All patients older than 18 years with a clinical diagnosis of septic arthritis who were taken to theatre for an arthrotomy were included in the study. Gram positive species were more common compared to gram negative species at 51% and 40% respectively, with Staphylococcus aureus being the most common gram positive and Pseudomonas species the most common gram-negative pathogen. Antibiotic resistant bacteria like Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii were each found to be responsible in 7% of cases. The use of Cloxacillin as empiric antibiotic cover was effective in only 30% of cases. To increase cover the use of vancomycin as empiric antibiotic should be considered, as vancomycin had better empiric cover at 54% against all isolates. In cases of suspected Streptococcal infections, Penicillin or Erythromycin should be considered. Gram negative species are rarely isolated as offending organisms in septic arthritis, when found these infections can be difficult to treat. According to our study Amikacin and Gentamycin should be considered in all cases of suspected gram negative septic arthritis. Mycobacterium tuberculosis complex should be considered in patients at risk as the antibiotic treatment used is unique and for a relatively extended period compared to other bacteria. Regular microbiological profiling of bacteria in each centre is important in determining the appropriate empiric antibiotic treatment for septic arthritis. === LG2018