Teresa Rotunno1*#, Camillo Müller T1,2#, Paul Heidekrueger I3, Ergys Gjika1,4, Morgan Gauthier4, Nicolas Lauper4, Jean-Yves Beaulieu4, Paolo Erba1, Thierry Christen1 and Ilker Uçkay5,6
1Department of Plastic Surgery, Hand Surgery Unit, Univesity Hospital of Vaud (CHUV), University of Lausanne, Switzerland
2BGU Ludwigshafen, Plastic Surgery department, Karls-Ruprecht-University of Heidelberg, Germany
3Centre of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, Franz-Josef-Strauß- Allee 11, 93053 Regensburg, Germany
4Department of Orthopeadic Surgery, Hand Surgery Unit, University of Geneva, Switzerland
5Department of Service of Infectious Diseases, University of Geneva, Switzerland
6Department of Infectiology, Balgrist University Hospital, Switzerland
#Authors contributed equally to this work
Purpose: The optimal duration of targeted systemic antibiotic therapy after lavage for native septic hand arthritis is unknown. Significant variation in daily clinical practice has been described across different centers.
Methods: We assessed variables associated with remission in septic hand and wrist arthritis by means of a retrospective cohort study of adult patients hospitalized for septic native joint arthritis of the hand and wrist between March 2007 and March 2013 at 2 university hospitals in Switzerland. The data review was principally focused on antibiotic regimens and surgical procedures.
Results: We included 80 consecutive cases of hand arthritis (median age, 56 years; 26 women and 54 men; 16 immunocompromised individuals). All patients underwent median of a 1 surgical irrigation and received concomitant systemic antibiotic therapy for a median duration of 28 days including 5 days of intravenous therapy. Remission was achieved in 74 cases (93%); however, there were 26 episodes (33%) of non-infectious sequelae such as osteoarthritis or persistent pain. No variables were associated with remission or sequelae in the multivariate logistic regression analysis. Moreover, outcomes were identical for <5 days versus ≥ 5 days of intravenous therapy and for <2 weeks versus >4 weeks of total antibiotic treatment. Conclusions: The rate of post-surgical remission for adult native joint hand septic arthritis is high and independent of immune suppression, number of surgical debridement procedures, and modality/duration of antibiotic therapy. Type of study/Level of evidence: III, retrospective study.
Antibiotic; Hand arthritis; Septic joint arthritis; Joint infection; Joint irrigation
Rotunno T, Camillo T. M�ller, Paul I. Heidekr�ger, Gjika E, Gauthier M, Lauper N, et al. Outcomes of Septic Joint Arthritis of the Hand: A Dual-Center Study. Clin Surg. 2019; 4: 2356.