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OBJECTIVE: The objective of this study was to evaluate the association between frailty status and risk of readmissions, inpatient death, and cost of admission among patients with systemic lupus erythematosus (SLE). METHODS: We conducted a retrospective cohort study using the National Readmissions Database. Using International Statistical Classification of Diseases, Tenth Revision codes, we identified individuals >18 years of age who had a primary or secondary diagnosis of SLE and were hospitalized between January and June 2018. Using the validated claims-based Hospital Frailty Risk Score, we categorized individuals as frail (score ≥ 5) or nonfrail (score < 5) at the time of index hospitalization. Our primary outcome was readmission rates post discharge from index hospitalization. Secondary outcomes were rates of inpatient mortality and the total cost of hospitalizations. Cox proportional hazard models were used to estimate the association between frailty and risk of readmissions, with adjustment for age, sex, insurance type, household income, and Elixhauser Comorbidity Index score. RESULTS: A total of 39,738 patients with SLE met eligibility criteria. Over a median follow-up of eight months, frail patients with SLE (n = 18,385) had higher Elixhauser Comorbidity Index scores and longer length of stay compared to nonfrail patients with SLE (n = 21,353). Frail patients with SLE had higher readmission rates, a higher proportion of prolonged hospitalizations, and higher costs per hospitalization. Frailty was independently associated with a 10% higher risk of readmission after adjustment for covariates. CONCLUSION: Among hospitalized adults with SLE, presence of frailty was associated with higher readmission and inpatient mortality rates. Our results highlight that frailty status can help risk stratify patients with SLE at increased risk for readmissions and other adverse health outcomes.
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BACKGROUND: Physical activity levels remain suboptimal in older adults. Exploration of potentially modifiable factors such as social support is needed to inform the development and implementation of patient-oriented physical activity interventions for older adults. The impact of general health on the relationship between social support and physical activity is not well understood. We aimed to determine the association between social support and self-reported physical activity in a study of community-dwelling older adults. In addition, we examined whether self-reported general health mediates the relationship between social support and self-reported physical activity. METHOD: This cross-sectional study analyzed baseline data collected as part of a randomized controlled trial comparing a digital physical activity intervention, which included social support features, with a tablet-based educational control. Adults ≥ 60 years of age were enrolled at 2 sites. Self-reported general health, social support, physical activity, and sociodemographic characteristics and comorbid conditions were assessed. Pearson and point-biserial correlations were computed to evaluate the relationship between physical activity and general health, social support, and sociodemographic features. Social support (exposure), general health (mediator), and physical activity (outcome) were incorporated into a mediation model. RESULTS: Among 181 participants (mean age of 70.1 years), significant correlations were found between physical activity and both general health and social support (r = -0.19 and r = 0.21, respectively; both p < 0.01). General health significantly mediated the relationship between social support and physical activity (unstandardized ß coefficient 416.9; 95% confidence interval 96.4, 842.0). CONCLUSIONS: Augmentation of social support, particularly when coupled with other modes of health promotion to improve personal wellbeing, may be a valuable component of physical activity promotion programs. Further longitudinal research is needed to clarify the potential mechanistic pathways linking social support, general health, and physical activity to inform development of evidence-based physical activity interventions for older adults and improve downstream health-related outcomes. TRIAL REGISTRATION: ClinicalTrials.gov, ClinicalTrials.gov identifier NCT03538158 . Registered May 25, 2018.
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OBJECTIVE: To determine next steps for lay health worker (LHW) intervention research, specifically in patients with rheumatic musculoskeletal diseases (RMDs), there is a need to establish what strategies have been effective for chronic disease management thus far. The goal of this scoping review is to collate the literature of LHW interventions for adults with RMDs to inform next steps for LHW research. METHODS: A comprehensive literature search was performed in the following databases from inception to September 2021: Ovid Medline, Ovid Embase, CINAHL, PsycINFO, and The Cochrane Library. Studies retrieved were then screened for eligibility against predefined inclusion and exclusion criteria. RESULTS: Twenty-two articles were eligible and included in this review. The most common RMDs studied, not mutually exclusive, were osteoarthritis (n = 13), rheumatoid arthritis (n = 9), and unspecified or other RMD (n = 14). Most studies had a homogenous patient population, enrolling White, non-Hispanic, or Latina women over the age of 60 (n = 13). Eight studies observed statistically significant results in the intervention arm compared with the control. Only one of these studies exhibited sustained treatment effects past one year. CONCLUSION: There are not enough data to conclude if LHW interventions have a positive, null, or negative effect on patients with RMDs. Future LHW interventions should specify a priori hypotheses, be powered to detect statistical significance for primary outcomes, employ a theoretical framework, include an active control, describe training protocols for LHWs, and increase minority representation to establish the effectiveness of LHWs for patients with RMDs.
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Agentes Comunitários de Saúde , Reumatologia , Humanos , Doenças Reumáticas/terapia , Feminino , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: Frailty and objective hand grip strength (one of the components of the frailty phenotype) are both risk factors for worse health outcomes in SLE. Whether telomere length, an established cellular senescence marker, is a biologic correlate of the frailty phenotype and hand grip strength in patients with SLE is not clear. First, we aimed to evaluate differences in telomere length between frail and non-frail women with SLE and then assessed whether frailty or hand grip strength is differentially associated with telomere length after adjusting for relevant confounders. METHODS: Women ≥18 years of age with validated SLE enrolled at a single medical centre. Fried frailty status (which includes hand grip strength), clinical characteristics and telomere length were assessed cross-sectionally. Differences between frail and non-frail participants were evaluated using Fisher's exact or Wilcoxon rank-sum tests. The associations between frailty and hand grip strength and telomere length were determined using linear regression. RESULTS: Of the 150 enrolled participants, 131 had sufficient data for determination of frailty classification; 26% were frail with a median age of 45 years. There was a non-significant trend towards shorter telomere length in frail versus non-frail participants (p=0.07). Hand grip strength was significantly associated with telomere length (beta coefficient 0.02, 95% CI 0.004, 0.04), including after adjustment for age, SLE disease activity and organ damage, and comorbidity (beta coefficient 0.02, 95% CI 0.002, 0.04). CONCLUSIONS: Decreased hand grip strength, but not frailty, was independently associated with shortened telomere length in a cohort of non-elderly women with SLE. Frailty in this middle-aged cohort may be multifactorial rather than strictly a manifestation of accelerated ageing.
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Fragilidade , Lúpus Eritematoso Sistêmico , Idoso , Pessoa de Meia-Idade , Humanos , Feminino , Idoso Fragilizado , Força da Mão , Encurtamento do Telômero , Telômero , Lúpus Eritematoso Sistêmico/genética , FenótipoRESUMO
OBJECTIVES: Frailty is a risk factor for adverse health in systemic lupus erythematosus (SLE). The Fried phenotype (FP) and the Systemic Lupus International Collaborating Clinics Frailty Index (SLICC-FI) are common frailty metrics reflecting distinct approaches to frailty assessment. We aimed to 1) compare frailty prevalence according to both metrics in women with SLE and describe differences between frail and non-frail participants using each method and 2) evaluate for cross-sectional associations between each metric and self-report disability. METHODS: Women aged 18-70 years with SLE were enrolled. FP and SLICC-FI were measured, and agreement calculated using a kappa statistic. Physician-reported disease activity and damage, Patient Reported Outcome Measurement Information System (PROMIS) computerized adaptive tests, and Valued Life Activities (VLA) self-report disability were assessed. Differences between frail and non-frail participants were evaluated cross-sectionally, and the association of frailty with disability was determined for both metrics. RESULTS: Of 67 participants, 17.9% (FP) and 26.9% (SLICC-FI) were frail according to each metric (kappa = 0.41, p< 0.01). Compared with non-frail women, frail women had greater disease damage, worse PROMIS scores, and greater disability (all p< 0.01 for FP and SLICC-FI). After age adjustment, frailty remained associated with a greater odds of disability (FP: odds ratio [OR] 4.7, 95% confidence interval [CI] 1.2-18.8; SLICC-FI: OR 4.6, 95% CI 1.3-15.8). CONCLUSION: Frailty is present in 17.9-26.9% of women with SLE. These metrics identified a similar, but non-identical group of women as frail. Further studies are needed to explore which metric is most informative in this population.
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OBJECTIVE: Frailty is a risk factor for adverse health in adults with SLE, including those <65 years. Emergency department (ED) utilisation is high in adults with SLE, but to our knowledge, whether frailty is associated with ED use is unknown. In a large administrative claims dataset, we assessed risk of ED utilisation among frail adults with SLE ≤65 years of age relative to non-frail adults ≤65 years of age with SLE. METHODS: Using the MarketScan Medicaid subset from 2011 to 2015, we identified beneficiaries 18-65 years with SLE (≥3 SLE International Classification of Diseases, Ninth Revision codes ≥30 days apart). Comparators without a systemic rheumatic disease (SRD) were matched 4:1 on age and gender. Frailty status in 2011 was determined using two claims-based frailty indices (CFIs). We compared risk of recurrent ED utilisation among frail and non-frail beneficiaries with SLE using an extension of the Cox proportional hazard model for recurrent events data. RESULTS: Of 2262 beneficiaries with SLE and 9048 non-SRD comparators, 28.8% and 11.6% were frail, respectively, according to both CFIs. Compared with non-frail beneficiaries with SLE, frail beneficiaries with SLE had significantly higher hazard of recurrent ED use (HR 1.75, 95% CI 1.48 to 2.08). CONCLUSION: Frailty increased hazard of recurrent ED visits in frail adults ≤65 years of age with SLE relative to comparable non-frail adults with SLE. Frailty is a potential target for efforts to improve quality of care in SLE.
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Fragilidade , Lúpus Eritematoso Sistêmico , Estados Unidos/epidemiologia , Adulto , Humanos , Idoso , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/epidemiologia , Fragilidade/complicações , Fragilidade/epidemiologia , Medicaid , Serviço Hospitalar de Emergência , Análise de DadosRESUMO
OBJECTIVE: To describe the prevalence of frailty in a single-centre cohort of patients with PMR and describe its association with health-related quality of life (HRQoL), cognition and sarcopenia. METHODS: This was a cross-sectional study of patients with PMR, according to 2012 EULAR/ACR Classification Criteria, presenting within 12 months of diagnosis and on treatment with glucocorticoids. Frailty was defined according to the Fried frailty criteria. HRQoL was assessed using Patient-Reported Outcomes Measurement Information System Computerized Adaptive Test (PROMIS-CAT) and cognition was assessed using the Mini-Mental State Examination. Sarcopenia was measured by DXA. RESULTS: Forty-one patients were enrolled. Prevalence of frailty and pre-frailty was 17% and 59%, respectively. Frail patients had higher inflammatory markers at diagnosis compared with pre-frail and robust patients. Of 27 patients with DXA results, 26% were sarcopenic. Frail patients had worse physical function, and more pain behaviour and interference compared with pre-frail and robust patients. In univariable analyses, frail patients were more likely to have worse physical function, and more pain behaviour and pain interference, which remained significant after adjusting for age. There were no significant associations between cognition or sarcopenia and frailty. CONCLUSIONS: In this cohort of PMR patients, there was a higher prevalence of frailty and pre-frailty compared with that reported in community-dwelling elderly. Frailty was associated with worse physical function, and increased pain behaviour and pain interference, differences that were also clinically meaningful. Larger prospective studies are needed to confirm these findings and analyse the association of frailty with other PMR disease outcomes.
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Fragilidade , Polimialgia Reumática , Sarcopenia , Humanos , Idoso , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Sarcopenia/epidemiologia , Qualidade de Vida , Idoso Fragilizado , Prevalência , Estudos Transversais , Cognição , Dor , Avaliação Geriátrica/métodosRESUMO
OBJECTIVE: Frailty is associated with disability and mortality independent of age. Although studies have evaluated frailty in rheumatoid arthritis (RA), information on the prevalence of frailty in ankylosing spondylitis (AS) and psoriatic arthritis (PsA) is limited. We aimed to determine the prevalence of frailty in AS and PsA and to evaluate whether characteristics known to be associated with frailty, including anxiety, differ among these three types of inflammatory arthritis. METHODS: We performed a cross sectional study of Centers for Medicare & Medicaid Services (CMS) beneficiaries aged 65 years or older with AS, PsA, or RA enrolled in 2014. We operationalized frailty using a validated claims-based frailty index. We also explored the prevalence of frailty among CMS beneficiaries younger than age 65 years with work disability, a younger population that also may be at risk of frailty. RESULTS: The prevalence of frailty in beneficiaries aged 65 years or older with AS and PsA was 45.2% and 46.7%, respectively, significantly lower than in RA (65.9%, P < 0.05). The prevalence of frailty in beneficiaries less than 65 years old was much lower overall, though still highest in RA; 11.7%, 4.4%, and 7.0% in RA, AS, and PsA, respectively (P < 0.05). Anxiety was significantly associated with frailty in subjects of all ages, particularly among those less than 65 years old (P < 0.05). CONCLUSION: Almost half of beneficiaries with AS or PsA aged 65 years old or older were frail, higher than in younger disabled beneficiaries. Further studies are needed to understand the risks of developing frailty in these diseases. Frailty was associated with anxiety, particularly in the younger age groups.
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OBJECTIVE: Frailty is associated with mortality in systemic lupus erythematosus (SLE), but how best to measure frailty is unclear. We aimed to compare 2 frailty metrics, the self-reported Fatigue, Resistance, Ambulation, Illnesses, and Loss of weight (FRAIL) scale (FS) and the Fried phenotype (FP), in SLE to evaluate differences between frail and nonfrail women and whether frailty is associated with self-reported disability. METHODS: Adult women aged < 70 years with validated SLE and mild/moderate disease enrolled in this cross-sectional study between August 2018 and October 2019. Correlation and agreement between the FS and the FP were determined. Differences in sociodemographic and disease characteristics, patient-reported outcome measures (PROMs), and biomarkers between frail and nonfrail participants were evaluated, as well as the association of frailty with Valued Life Activities disability. RESULTS: Of 67 participants, 27% and 18% were frail according to the FS and the FP, respectively. Correlation (r = 0.51; P < 0.0001) and agreement (κ = 0.46; P = 0.0004) between the FS and the FP were significant. Frail women had greater disease damage, high-sensitivity C-reactive protein, and interleukin 6, and worse PROMs according to both frailty definitions. Both frailty measures were associated with self-reported disability after adjustment for age, comorbidity, and disease activity and damage; this relationship was attenuated for the FP. CONCLUSION: Frailty prevalence was high in this cohort of women with SLE using both frailty definitions, suggesting that frailty may be accelerated in women with SLE, particularly when based exclusively on self-report. Frailty remained associated with self-reported disability in adjusted analyses. The FS may be an informative point-of-care tool to identify frail women with SLE.
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Fragilidade , Lúpus Eritematoso Sistêmico , Idoso , Estudos Transversais , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Avaliação Geriátrica , Humanos , Medidas de Resultados Relatados pelo PacienteRESUMO
BACKGROUND: Septic arthritis (SA) is associated with significant morbidity and mortality. Delayed or inadequate treatment may result in joint destruction, osteomyelitis and sepsis. Like other types of infection, the causative agents of SA may have changed over time. Early targeted intervention is important in cases of SA and can be achieved only by understanding the current trends in the microbiology of SA. OBJECTIVES: To determine the trends in the microbiology of SA over the last two decades. METHODS: We conducted a retrospective study including all patients 18 and older with culture positive, surgically treated, native joint septic arthritis (NJSA), admitted to a single tertiary medical centre in Boston between the years of 1997 and 2015. We excluded cases of osteomyelitis and septic bursitis. We focused our analysis on the microbiology data which included synovial fluid gram stain and culture, blood cultures and synovial biopsy cultures. RESULTS: Among 260 cases, the most common bacteria isolated were Methicillin Sensitive Staphylococcus aureus (MSSA, 36%), Methicillin Resistant Staphylococcus aureus (MRSA, 17.6%), Coagulase Negative Staphylococci (CoNS, 13%) and Group B Streptococcus (GBS, 7.3%). Trends in the rates of these bacteria demonstrated no significant variation. The knee was the most common joint affected, followed by the shoulder and hip. Shoulder SA was most commonly caused by MRSA while MSSA was the leading causative organism in other joints. GBS was a causative bacterium in shoulder SA significantly more often than in knee or hip infections. CONCLUSIONS: Although no significant trends were noted in the microbiology of SA over nearly 2 decades, we observed meaningful findings regarding shoulder SA as MRSA was the most common bacterial because of SA in this joint. Prompt joint aspiration, microbiologic testing of synovial fluid and empiric antibiotic therapy that covers MRSA may improve outcomes in SA.
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Artrite Infecciosa , Staphylococcus aureus Resistente à Meticilina , Osteomielite , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/epidemiologia , Humanos , Osteomielite/tratamento farmacológico , Estudos Retrospectivos , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologia , Estados UnidosRESUMO
Background: Peri-prosthetic joint infection (PJI) is a debilitating and costly complication of joint replacement. Synovial fluid cultures are negative in up to 25% of PJI cases. The purpose of this study was to compare the clinical characteristics and outcomes of culture negative and culture positive PJI. Patients and Methods: We conducted a retrospective study including all patients aged 18 and older admitted to a single tertiary-care hospital between 1998 and 2015 diagnosed with PJI and treated with antibiotic agents and surgery. Results: One hundred ninety-six patients with PJI were identified; 48 (24.5%) were culture-negative (CN) and 148 (75.5%) were culture-positive (CP). The groups were similar in age and presence of associated comorbidities. Fever was more common among the CP patients (CN, 23.8%; CP, 38.4%; p = 0.03) as was sepsis defined by Sepsis-2 criteria (CN, 12.8%; CP, 28.7%; p = 0.03). Patients who were CP had higher synovial white blood cell (WBC) count (CN, 30,500 per milliliter; CP, 95,400 per milliliter; p < 0.01), a longer length of stay (CN, 3.8%; CP,7.9%; p = 0.02), and fewer alternative diagnoses established within one year (CN, 25.0%; CP, 2.7%; p < 0.01). Our logistic regression models also found that CP patients had an adjusted odds ratio (OR) of 2.59 for rehabilitation placement with 95% confidence interval (CI) of 1.15-5.83 and adjusted OR of 0.04 for an alternative diagnosis within one year with 95% CI, 0.009-0.22 compared with their CN counterparts. Conclusions: This study suggests that patients with CN PJI have less severe disease, better outcomes, and higher rates of alternative diagnoses within one year.
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Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Líquido SinovialRESUMO
OBJECTIVE: To determine the incidence of dementia in patients with rheumatoid arthritis (RA) 65 years and older, and compare the incidence of dementia in patients with RA with prevalent cardiovascular (CV) disease (CVD), CV risk factors but no prevalent CVD and neither (referent group). METHODS: We analyzed claims data from the Center for Medicare & Medicaid Services (CMS) from 2006-2014. Eligibility criteria included continuous medical and pharmacy coverage for ≥ 12 months (baseline period 2006), > 2 RA diagnoses by a rheumatologist and at least 1 medication for RA. CVD and CV risk factors were identified using codes from the Chronic Condition Data Warehouse. Incident dementia was defined by 1 inpatient or 2 outpatient claims, or one dementia specific medication. Age-adjusted incident rates were calculated within each age strata. Univariate and multivariate Cox proportional hazard models were used to calculate Hazard Ratios (HR) and 95% confidence intervals. RESULTS: Among 56,567 patients with RA, 11,789 (20.1%) incident cases of dementia were included in the main analysis. Age adjusted incident rates were high among all groups and increased with age. After adjustment for age, sex, comorbidities and baseline CV and RA medications, patients with CVD and CV risk factors between 65 and 74 years had an increased risk for incident dementia compared to those without CVD and without CV risk factors (HR 1.18 (95% CI 1.04-1.33) and HR 1.03 (95% CI 1.00-1.11), respectively). We observed a trend towards increased risk in patients between 75 and 84 years with CVD at baseline. CONCLUSION: Patients with RA with both CVD and CV risk factors alone are at an increased risk for dementia compared to those with neither CVD nor CV risk factors; however, this risk is attenuated with increasing age. The impact of RA treatment and CV primary prevention strategies in the prevention of dementia in patients with RA warrants further studies.
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Artrite Reumatoide , Doenças Cardiovasculares , Demência , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/epidemiologia , Doenças Cardiovasculares/epidemiologia , Demência/epidemiologia , Fatores de Risco de Doenças Cardíacas , Humanos , Incidência , Medicare , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
RATIONALE, AIMS AND OBJECTIVES: Approximately 20 000 cases of septic arthritis (SA) occur in the U.S. yearly. We examined whether gender-related differences exist in the presentation, management, and outcomes of patients with native joint septic arthritis (NJSA). METHODS: This was a retrospective study of medical files of patients aged 18 years and older admitted between 1998 and 2015 to a single tertiary care hospital and diagnosed with NJSA. All study subjects had positive synovial fluid or blood cultures and each was managed surgically. Patients' charts were reviewed for demographics, comorbidities, clinical presentations, microbiology profiles, management, and outcomes. Cases of osteomyelitis, septic bursitis, prosthetic joint, and culture-negative SA were excluded. RESULTS: Of 324 NJSA patients, those who were female (n = 130; 40.1%) were significantly older at presentation than males (mean age: 63.6 vs 58.3; P = .006). Prior joint pathology was more common amongst females, including osteoarthritis (20.8% vs 12.9%; P = .04) and rheumatoid arthritis (10% vs 3.6%; P = .03). Female patients had a higher frequency of hip involvement (17.7% vs 10.8%; P = .05). No differences were observed in clinical presentations, culture results, medical management, or outcomes between genders. CONCLUSIONS: Compared to men, women with NJSA presented at an older age and had more prior joint pathology and a higher frequency of hip involvement. These differences, however, had no significant impact on the clinical presentation, medical management, or outcomes of NJSA.
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Artrite Infecciosa , Idoso , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/terapia , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Líquido Sinovial , Resultado do TratamentoRESUMO
Background: Patients with culture-negative septic arthritis patients are often treated surgically but might be successfully managed medically. We compared clinical characteristics and outcomes in patients with culture negative and culture positive native joint monoarticular septic arthritis.Methods: This retrospective study included all patients age ≥18 years admitted to a single, tertiary-care hospital between 1998 and 2015 with native joint monoarticular SA and treated with antibiotics and surgery.Results: Of 306 patients, 85 had negative and 221 had positive cultures. Mean C-reactive protein (p < .01) and mean percentage of peripheral polymorphonuclear cells (p = .01) were higher in culture-positive patients who had higher intensive care unit admission rates (16.7% vs. 4.7%, respectively, [p < .01]), longer length of hospital stay (11.4 vs. 7.1 days, respectively, [p < .01]) and higher mortality rates within 30 days (0% vs. 5.5%, respectively,[p = .02]). Of culture-negative patients, 28.6% received an alternative diagnosis within one year. Logistic regression models showed that culture positive patients had an adjusted odds ratio for length of stay of 4.5 (2.69, 7.51), intensive care unit admission of 5.76 (1.31, 25.22), discharge to rehabilitation of 4.7 (2.28, 9.71) and an alternative diagnosis within one year of 0.05 (0.02, 0.15) compared to culture negative patients.Conclusion: Patients with culture-negative native joint septic arthritis had less severe disease, better outcomes and higher rates of alternative diagnosis within one year than patients with positive cultures.
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Artrite Infecciosa , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/mortalidade , Artrite Infecciosa/cirurgia , Humanos , Tempo de Internação , Estudos Retrospectivos , Centros de Atenção TerciáriaRESUMO
Septic arthritis (SA) is typically managed with antibiotic therapy with or without surgery. Little is known about how patients without surgery differ from their operatively managed counterparts. We compared SA patients who received antibiotic treatment with and without surgery. We conducted a retrospective study of patients with monoarticular septic arthritis admitted to a single tertiary care centre between 1998 and 2015. All 441 monoarticular septic arthritis patients received antibiotics; 382 were also managed operatively and 59 nonoperatively. Nonoperative patients were older (64.4 vs 58.3 years old; p = 0.02) and less likely to have prior joint pathology (44.1% vs 67.5%; p < 0.001). Nonoperative patients presented more often with sepsis (37.3% vs 31.9; p = 0.02) and were more frequently admitted to the intensive care unit (23.7% vs 16.5%; p = 0.04). Nonoperative patients were less often discharged to a rehabilitation facility (37.9% vs 55.8%; p = 0.002) and less frequently readmitted to hospital within 60 days of initial discharge (15.3% vs 18.6%; p = 0.05). However, nonoperative patients were more likely to expire within 30 days after hospital discharge (11.9% vs 3.9%; p = 0.009). Nonoperative patients were sicker at presentation; despite deferral of surgery, they had a relatively high survival rate (88%). Among survivors whose data was available, there were no significant sequelae in post-discharge imaging. These findings support the nonsurgical approach as effective for patients with septic arthritis who are not critically ill at time of presentation.
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Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Artrite Infecciosa/mortalidade , Cuidados Críticos , Estado Terminal , Feminino , Cirurgia Geral , Humanos , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Estudos Retrospectivos , Fatores de Risco , Sepse/tratamento farmacológico , Sepse/etiologia , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
PURPOSE: Patients with septic arthritis (SA) often undergo echocardiographic evaluation to identify concomitant infective endocarditis (IE). The purpose of this study is to identify distinguishing features of patients with SA and IE by comparing them to patients with SA alone. METHODS: We conducted a retrospective study of all patients 18 and older admitted to a single tertiary hospital between 1998 and 2015 with culture-positive SA. Patients were stratified by echocardiogram status and the presence of vegetations: those who had echocardiographic evaluation with no evidence of infective endocarditis (ECHO + IE-) or with a vegetation present (ECHO + IE+) and those who had no echocardiographic evaluation (ECHO-). Demographic data, clinical characteristics, microbiology data, treatment strategies, and patient outcomes were recorded and compared. RESULTS: We identified 513 patients with SA. Transthoracic echocardiogram and/or transesophageal echocardiogram were performed in 263 patients (51.2%) and demonstrated evidence for IE in 19 patients (3.7%). While most demographic features, comorbidities, and clinical characteristics did not differ significantly between those with and without IE, those with IE had higher rates of sepsis and septic shock. In addition, patients with SA and IE had higher rates of positive blood cultures and Methicillin-sensitive staphylococcus aureus (MSSA) infection when compared to those with SA without IE. Patients with IE had higher rates of intensive care unit admission and increased 30-day mortality. CONCLUSIONS: IE is uncommon among patients with SA. Echocardiography may be overutilized and may be more useful among patients presenting with sepsis, shock, or positive blood cultures, especially when MSSA is isolated.
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Artrite Infecciosa/microbiologia , Endocardite Bacteriana/diagnóstico , Centros de Atenção Terciária , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Artrite Infecciosa/mortalidade , Ecocardiografia , Ecocardiografia Transesofagiana , Registros Eletrônicos de Saúde , Endocardite Bacteriana/complicações , Feminino , Humanos , Joelho/microbiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Séptico/complicações , Choque Séptico/microbiologia , Adulto JovemRESUMO
Little is known about the incidence, risk factors, clinical characteristics, and outcomes of patients with polymicrobial SA (PMSA). We aimed to determine the unique characteristics of patients with PMSA by comparing them to patients with monomicrobial SA (MMSA). We conducted a retrospective cohort study of patients 18 years and older admitted to a single tertiary care medical center, between 1998 and 2015, with surgically treated culture-positive SA affecting one or more joints. Patients were separated into two groups by the presence of one (MMSA) or more organisms (PMSA). A total of 441 patients with MMSA and 47 with PMSA were identified. Prior history of SA was more common among the PMSA group (31.9% vs. 18.6%; p = 0.03) as well as higher rates of prosthetic joint involvement (48.9% vs. 36.1%; p = 0.06). Patients with PMSA were sicker with higher rates of shock at presentation (14.9% vs. 5.5%; p = 0.02), intensive care unit admissions (39.1% vs. 18%; p < 0.001), and longer mean length of stay (16.1 vs. 10.9 days; p < 0.001). The most prevalent pathogens in the PMSA group were coagulase-negative Staphylococcus (31%), followed by methicillin-sensitive Staphylococcus aureus (29%), and Enterococcus (24%). To our knowledge, this is the first study to determine the clinical and microbiologic profiles of patients with PMSA. Important differences were noted such as more frequent involvement of atypical and prosthetic joints in PMSA. PMSA should be suspected in patients with these clinical features, and broad-spectrum antibiotics should be considered as these patients appear to be sicker and have worse outcomes.
Assuntos
Artrite Infecciosa/microbiologia , Bactérias/isolamento & purificação , Coinfecção/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Idoso , Coinfecção/complicações , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção TerciáriaRESUMO
OBJECTIVES: Septic polyarthritis is rarer than septic monoarthritis, but associated with higher mortality. Septic polyarthritis may be difficult to distinguish clinically from noninfectious inflammatory arthritis. We describe one of the largest samples of septic polyarthritis with the aim of distinguishing septic monoarthritis from polyarthritis. METHODS: We conducted a retrospective study of adults admitted to tertiary care with septic monoarthritis and polyarthritis. Baseline characteristics, microbial profiles, joint involvement, length of stay, and 60-day readmission rates were determined. RESULTS: We identified 464 and 42 cases of septic monoarthritis and polyarthritis, respectively, including 7 cases of septic polyarthritis with comorbid rheumatoid arthritis. Compared to those with septic monoarthritis, patients with septic polyarthritis were more likely to have rheumatoid arthritis (P<0.01), sepsis (P<0.01), and higher peripheral (P<0.001) and synovial (P<0.001) white blood cell counts. Operative intervention rates were similar, but mean length of stay was longer in polyarticular septic arthritis (P<0.001). Patients with septic polyarthritis with/without underlying rheumatoid arthritis were similar in terms of presenting features and outcomes, except for more frequent immunosuppressive therapy in rheumatoid arthritis (P<0.01). CONCLUSIONS: In this sample of patients with septic arthritis, patients with septic polyarthritis were more likely to have systemic infection at presentation than those with septic monoarthritis. Despite this difference, patients with septic monoarthritis and polyarthritis tended to have similar outcomes. While rheumatoid arthritis was observed more frequently among patients with septic polyarthritis, those with/without underlying rheumatoid arthritis had similar presenting features and outcomes.