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Artritis séptica politópica: análisis de 19 casos
Polyarticular septic arthritis: analysis of 19 cases
Lourdes Mateo Soria
, Alejandro Olivé Marqués, Elisabet García Casares, Emma García Melchor, Susana Holgado Pérez, Xavier Tena Marsà
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Sección de Reumatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
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Evaluamos las características de los enfermos con artritis séptica poliarticular recogidos en un servicio de reumatología.</p> <span class="elsevierStyleSectionTitle">Material y método</span><p class="elsevierStyleSimplePara elsevierViewall">Análisis retrospectivo de las artritis piógenas con afección oligoarticular o poliarticular. Se incluye únicamente a los enfermos con aislamiento del germen en el líquido articular. Se analizan las variables clínicas, analíticas y radiológicas de la serie.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se registraron 19 casos (14 varones y 5 mujeres) con una media de edad de 55 años. La media del tiempo hasta el diagnóstico fue 6 días. La articulación afectada con mayor frecuencia fue la rodilla, seguida del tobillo. La media de focos infecciosos por paciente fue 3 (intervalo, 2-6). Los factores de riesgo más frecuentes fueron la diabetes mellitus, la insuficiencia renal crónica, la hepatopatía crónica, la gota y la artritis reumatoide. Los gérmenes aislados fueron <span class="elsevierStyleItalic">Staphylococcus aureus</span> (47%), <span class="elsevierStyleItalic">S. agalactiae</span> (21%) y bacilos gramnegativos. Los hemocultivos fueron positivos en el 52,6%, y el 15,8% presentó shock séptico. La gammagrafía con <span class="elsevierStyleSup">99</span>Tc mostró la afección politópica cuando fue realizada. La duración media del tratamiento antibiótico fue 46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>27 días. La evolución fue satisfactoria en el 52,6% y tórpida en el 26%, con mortalidad del 15,8% (3 casos). Se realizó artrotomía en el 21%.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La presencia de oligoartritis o poliartritis no excluye el diagnóstico de artritis infecciosa. Entre los factores de riesgo destacan las artropatías inflamatorias previas. <span class="elsevierStyleItalic">S. aureus</span> es el microorganismo causal más frecuente. La morbilidad y la mortalidad de esta forma de infección articular son importantes, por lo que debe mantenerse un alto índice de sospecha y realizar una exploración sistemática de todas las articulaciones.</p>" ] "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">Polyarticular septic arthritis accounts for 15% of all septic arthritis, but there are few references in the literature. We describe characteristics of patients with polyarticular septic arthritis in a rheumatology service.</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p class="elsevierStyleSimplePara elsevierViewall">Retrospective analysis of patients with septic arthritis involving more than one joint. Only patients with positive culture of synovial fluid were included. Clinical, analytical and radiological variables are reviewed.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">19 patients (14 male) had a polyarticular infection. Mean age was 55 years. Mean time from onset to diagnosis was 6 days. The knee was the most commonly involved joint, followed by ankle. The mean number of joints involved per patient was 3. Risk factors included diabetes, chronic renal or hepatic disease, gout and rheumatoid arthritis. Most commonly isolated agents were <span class="elsevierStyleItalic">S. aureus</span> (47%) and <span class="elsevierStyleItalic">S. agalactiae</span> (21%). Blood cultures were positive in 52,6% and 15.8% had septic shock. Scintygraphic bone scan showed a polyarticular uptake. Mean duration of antibiotic therapy was 46<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>27 days. Clinical outcome was good in 52,6%, complicated in 26%, and mortality rate was 15.8% (3 cases). Joint debridement was performed in 21%.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Multiple joint involvement does not exclude the diagnosis of septic arthritis. Inflammatory arthritis is an important risk factor. S. aureus in the main infectious agent. 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 13 | 20 | 33 |
| 2024 Octubre | 74 | 42 | 116 |
| 2024 Septiembre | 54 | 25 | 79 |
| 2024 Agosto | 68 | 41 | 109 |
| 2024 Julio | 52 | 44 | 96 |
| 2024 Junio | 62 | 40 | 102 |
| 2024 Mayo | 68 | 32 | 100 |
| 2024 Abril | 58 | 36 | 94 |
| 2024 Marzo | 48 | 43 | 91 |
| 2024 Febrero | 42 | 34 | 76 |
| 2024 Enero | 36 | 27 | 63 |
| 2023 Diciembre | 52 | 28 | 80 |
| 2023 Noviembre | 71 | 42 | 113 |
| 2023 Octubre | 47 | 41 | 88 |
| 2023 Septiembre | 61 | 51 | 112 |
| 2023 Agosto | 45 | 25 | 70 |
| 2023 Julio | 53 | 41 | 94 |
| 2023 Junio | 45 | 32 | 77 |
| 2023 Mayo | 49 | 25 | 74 |
| 2023 Abril | 49 | 30 | 79 |
| 2023 Marzo | 31 | 58 | 89 |
| 2023 Febrero | 39 | 39 | 78 |
| 2023 Enero | 33 | 18 | 51 |
| 2022 Diciembre | 34 | 48 | 82 |
| 2022 Noviembre | 50 | 49 | 99 |
| 2022 Octubre | 63 | 48 | 111 |
| 2022 Septiembre | 47 | 52 | 99 |
| 2022 Agosto | 45 | 56 | 101 |
| 2022 Julio | 38 | 72 | 110 |
| 2022 Junio | 47 | 57 | 104 |
| 2022 Mayo | 37 | 74 | 111 |
| 2022 Abril | 49 | 55 | 104 |
| 2022 Marzo | 59 | 66 | 125 |
| 2022 Febrero | 37 | 40 | 77 |
| 2022 Enero | 47 | 75 | 122 |
| 2021 Diciembre | 46 | 65 | 111 |
| 2021 Noviembre | 33 | 68 | 101 |
| 2021 Octubre | 63 | 94 | 157 |
| 2021 Septiembre | 31 | 69 | 100 |
| 2021 Agosto | 46 | 62 | 108 |
| 2021 Julio | 26 | 55 | 81 |
| 2021 Junio | 25 | 64 | 89 |
| 2021 Mayo | 33 | 51 | 84 |
| 2021 Abril | 72 | 128 | 200 |
| 2021 Marzo | 71 | 34 | 105 |
| 2021 Febrero | 40 | 41 | 81 |
| 2021 Enero | 41 | 46 | 87 |
| 2020 Diciembre | 26 | 27 | 53 |
| 2020 Noviembre | 52 | 37 | 89 |
| 2020 Octubre | 31 | 40 | 71 |
| 2020 Septiembre | 31 | 47 | 78 |
| 2020 Agosto | 44 | 43 | 87 |
| 2020 Julio | 24 | 29 | 53 |
| 2020 Junio | 44 | 37 | 81 |
| 2020 Mayo | 39 | 51 | 90 |
| 2020 Abril | 58 | 34 | 92 |
| 2020 Marzo | 58 | 39 | 97 |
| 2020 Febrero | 46 | 41 | 87 |
| 2020 Enero | 40 | 42 | 82 |
| 2019 Diciembre | 36 | 58 | 94 |
| 2019 Noviembre | 23 | 49 | 72 |
| 2019 Octubre | 42 | 54 | 96 |
| 2019 Septiembre | 38 | 91 | 129 |
| 2019 Agosto | 36 | 56 | 92 |
| 2019 Julio | 25 | 63 | 88 |
| 2019 Junio | 97 | 78 | 175 |
| 2019 Mayo | 142 | 174 | 316 |
| 2019 Abril | 42 | 111 | 153 |
| 2019 Marzo | 26 | 104 | 130 |
| 2019 Febrero | 31 | 122 | 153 |
| 2019 Enero | 31 | 102 | 133 |
| 2018 Diciembre | 56 | 124 | 180 |
| 2018 Noviembre | 31 | 16 | 47 |
| 2018 Octubre | 28 | 44 | 72 |
| 2018 Septiembre | 28 | 65 | 93 |
| 2018 Agosto | 19 | 75 | 94 |
| 2018 Julio | 29 | 9 | 38 |
| 2018 Mayo | 4 | 3 | 7 |
| 2018 Abril | 18 | 48 | 66 |
| 2018 Marzo | 34 | 166 | 200 |
| 2018 Febrero | 15 | 20 | 35 |
| 2018 Enero | 16 | 25 | 41 |
| 2017 Diciembre | 21 | 28 | 49 |
| 2017 Noviembre | 20 | 49 | 69 |
| 2017 Octubre | 28 | 44 | 72 |
| 2017 Septiembre | 8 | 43 | 51 |
| 2017 Agosto | 25 | 64 | 89 |
| 2017 Julio | 17 | 31 | 48 |
| 2017 Junio | 31 | 46 | 77 |
| 2017 Mayo | 27 | 55 | 82 |
| 2017 Abril | 38 | 93 | 131 |
| 2017 Marzo | 37 | 110 | 147 |
| 2017 Febrero | 20 | 92 | 112 |
| 2017 Enero | 23 | 25 | 48 |
| 2016 Diciembre | 29 | 29 | 58 |
| 2016 Noviembre | 31 | 48 | 79 |
| 2016 Octubre | 49 | 43 | 92 |
| 2016 Septiembre | 60 | 51 | 111 |
| 2016 Agosto | 76 | 42 | 118 |
| 2016 Julio | 37 | 47 | 84 |
| 2016 Mayo | 1 | 0 | 1 |
| 2016 Enero | 6 | 0 | 6 |
| 2015 Diciembre | 2 | 0 | 2 |
| 2015 Octubre | 1 | 0 | 1 |
| 2015 Julio | 85 | 10 | 95 |
| 2015 Junio | 100 | 26 | 126 |
| 2015 Mayo | 124 | 42 | 166 |
| 2015 Abril | 101 | 28 | 129 |
| 2015 Marzo | 88 | 19 | 107 |
| 2015 Febrero | 92 | 35 | 127 |
| 2015 Enero | 92 | 29 | 121 |
| 2014 Diciembre | 77 | 35 | 112 |
| 2014 Noviembre | 86 | 43 | 129 |
| 2014 Octubre | 76 | 75 | 151 |
| 2014 Septiembre | 70 | 38 | 108 |
| 2014 Agosto | 71 | 24 | 95 |
| 2014 Julio | 168 | 26 | 194 |
| 2014 Junio | 99 | 25 | 124 |
| 2014 Mayo | 107 | 32 | 139 |
| 2014 Abril | 79 | 25 | 104 |
| 2014 Marzo | 120 | 24 | 144 |
| 2014 Febrero | 84 | 24 | 108 |
| 2014 Enero | 80 | 40 | 120 |
| 2013 Diciembre | 89 | 18 | 107 |
| 2013 Noviembre | 100 | 35 | 135 |
| 2013 Octubre | 120 | 29 | 149 |
| 2013 Septiembre | 107 | 23 | 130 |
| 2013 Agosto | 90 | 30 | 120 |
| 2013 Julio | 87 | 27 | 114 |
| 2013 Junio | 71 | 34 | 105 |
| 2013 Mayo | 95 | 24 | 119 |
| 2013 Abril | 80 | 17 | 97 |
| 2013 Marzo | 74 | 21 | 95 |
| 2013 Febrero | 48 | 23 | 71 |
| 2013 Enero | 74 | 22 | 96 |
| 2012 Diciembre | 91 | 14 | 105 |
| 2012 Noviembre | 25 | 17 | 42 |
| 2012 Octubre | 32 | 20 | 52 |
| 2012 Septiembre | 18 | 7 | 25 |
| 2011 Mayo | 7 | 0 | 7 |
| 2011 Abril | 9 | 0 | 9 |
| 2011 Marzo | 33 | 0 | 33 |
| 2011 Febrero | 13 | 0 | 13 |
| 2011 Enero | 22 | 0 | 22 |
| 2010 Diciembre | 17 | 0 | 17 |
| 2010 Noviembre | 46 | 0 | 46 |
| 2010 Octubre | 17 | 0 | 17 |
| 2010 Septiembre | 9 | 0 | 9 |
| 2010 Agosto | 24 | 0 | 24 |
| 2010 Julio | 7 | 0 | 7 |
| 2010 Junio | 8 | 0 | 8 |
| 2010 Mayo | 9 | 0 | 9 |
| 2010 Abril | 11 | 0 | 11 |
| 2010 Marzo | 21 | 0 | 21 |
| 2010 Febrero | 4 | 0 | 4 |
| 2010 Enero | 3 | 0 | 3 |
| 2009 Diciembre | 2 | 0 | 2 |
| 2009 Noviembre | 2 | 0 | 2 |
| 2009 Octubre | 6 | 0 | 6 |
| 2009 Septiembre | 3 | 0 | 3 |
| 2009 Agosto | 6 | 0 | 6 |
| 2009 Julio | 2 | 0 | 2 |
| 2009 Junio | 16 | 0 | 16 |
| 2009 Mayo | 13 | 0 | 13 |
| 2009 Abril | 22 | 0 | 22 |
| 2009 Marzo | 19 | 0 | 19 |
| 2009 Febrero | 4 | 0 | 4 |
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