Septic Arthritis in the Elderly

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Abstract
The clinical and microbiologic features of septic arthritis in 23 elderly patients are reviewed. Patients (15) had pre-existing joint diseases, predominantly osteoarthritis and rheumatoid arthritis. Patients (8) had underlying systemic illnesses, and 8 patients were receiving systemic corticosteroid therapy prior to the development of spetic arthritis. The knee was the joint most commonly infected. Although Staphylococcus aureus was the major pathogen (52.2% of patients), enteric gram-negative bacilli were found in 7 of 23 patients (30.4%). Patients (5) died (21.7% mortality), 2 as a result of their infection and 3 of nosocomial Pseudomonas sepsis. Eight of the 18 survivors (44.4%) developed osteomyelitis in the contiguous bone. Return of joint function was slow in all patients. Septic arthritis in the elderly is difficult to treat and has a poor outcome, possibly because pre-existing joint disease is very common and enteric gram-negative bacilli are often the causative organisms.