Septic Arthritis: A Need to Strengthen the Referral Chain in a Developing Economy

Septic arthritis is infection of one or more joints by microorganisms. It can be caused by bacterial, viral, and fungal infections. The risks for the development of septic arthritis include a patient taking immune-suppression medicines, intravenous drug abuse, past joint disease, injury or surgery, and underlying medical illnesses which include diabetes, alcoholism, sickle cell disease, rheumatic diseases, and immune deficiency disorders. This retrospective analysis documented the features and factors that potentially affected the outcomes in septic arthritis in the Cross River Basin area of south-south Nigeria.

In this study, a sample of 43 patients who presented with septic arthritis in 45 joints was collected between September 2007 and August 2010. There were 24 males and 19 females (M:F = 1.3:1). Forty patients were children while three were adults. Thirty-three patients were urban dwellers, 8 were semi-urban dwellers and 2 were rural dwellers. Twenty-five children were first seen by a Paediatrician. Only 5 patients were first seen by an Orthopaedic surgeon. Definitive treatment was conservative in 28 children and arthrotomy/washout in 12 children and 3 adults.  And the findings showed that 1) trauma, sickle cell anaemia and sepsis were significant co-morbid factors accounting for 15% each for trauma and sickle cell anaemia, and 12.5% for sepsis in children; 2) Fever, joint swelling, pain and non-weight bearing on the affected limb were the presenting clinical features with a median duration of 7 days in both age groups; 3) The knee was the most commonly affected joint in children (60%) and adults (66.7%) with the left knee predominating in both age groups (37.5%, children and 66.7%, adults). Nineteen (19) patients (44.2%) did not have a microbiological and sensitivity assay done owing to a variety of factors including poverty and faulty equipment and among those who had a microbiological and sensitivity assay performed, Staphylococcus aureus was the most common pathogen (25%), followed by Enterobacteriacae and Pseudomonas auroginosa (5% each).

In conclusion, injudicious interventions in musculoskeletal conditions consisted not only of traditional bone setting and other unorthodox practices, but also sub-optimal orthodox medical practices. Healthcare outcomes in Africa were a function of the skewed distribution of the healthcare workforce and a weak referral chain. The near absence of follow-up culture underscored the need for education on injudicious antibiotic therapy to be directed at patients and physicians. So continuing medical education must seek to draw attention to the issues of intra-professional communication and practices that promote poor outcomes in the developing world.

Article by Ikpeme A. Ikpeme, et al, from University of Calabar Teaching Hospital, Calabar, Nigeria.

Full access: http://mrw.so/3Oa9j3

Image by Health Same, from Flickr-cc.