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Title: Diagnosis of septic arthritis in the acute care setting: the value of routine intra-operative sample culture.
Austin Authors: Shamdasani, Pallavi ;Liew, David F L ;Nohrenberg, Michael;Leroi, Marcel M;McMaster, Christopher ;Owen, Claire E ;Hardidge, Andrew J ;Buchanan, Russell R C 
Affiliation: Rheumatology
Clinical Pharmacology and Therapeutics
Infectious Diseases
Orthopaedic Surgery
Department of Medicine, University of Melbourne, Parkville, VIC, Australia.
Issue Date: Apr-2023
Date: 2023
Publication information: Rheumatology Advances in Practice 2023; 7(Suppl 1)
Abstract: Diagnosing septic arthritis can be challenging and frequently involves clinical assessment, laboratory investigations and synovial fluid analysis. We sought to determine the utility of synovial aspiration and intra-operative synovial fluid and tissue culture for the accurate diagnosis of septic arthritis. We carried out a retrospective review of the records of patients referred to a tertiary orthopaedic unit with possible septic arthritis between 2015 and 2019 inclusive, including clinical and laboratory data for this cohort study. Performance characteristics were determined for synovial aspiration, intra-operative synovial fluid and tissue culture in diagnosing expert review-determined true septic arthritis. Concordance between discharge diagnosis, antibiotic prescribing and true septic arthritis was determined. Of 268 patients identified with suspected septic arthritis, 143 underwent both synovial fluid aspiration and intra-operative synovial fluid and tissue biopsy culture. True septic arthritis was not differentiated significantly by laboratory parameters including serum white cell count (WCC), CRP or synovial WCC. Considering only patients with negative pre-operative synovial aspirate cultures, intra-operative samples led to diagnosis of true septic arthritis in 6 of 63 patients [number needed to treat (NNT) 10.5]. For all patients sampled in theatre, positive synovial tissue biopsy was the only evidence of true septic arthritis in six (NNT 23.9). Despite insufficient microbiological evidence, 27 of the 59 patients who did not have septic arthritis received a discharge diagnosis of septic arthritis, 26 of whom were discharged with antibiotics. Intra-operative sample collection, particularly tissue biopsy, increases the likelihood of a true septic arthritis diagnosis. Such measures might help to reduce diagnostic ambiguity in clinical practice and might therefore reduce overtreatment.
DOI: 10.1093/rap/rkad008
ORCID: 0000-0003-1286-0270
Journal: Rheumatology Advances in Practice
Start page: i12
End page: i18
PubMed URL: 36968633
ISSN: 2514-1775
Type: Journal Article
Subjects: diagnosis
septic arthritis
synovial biopsy
synovial fluid analysis
Appears in Collections:Journal articles

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