BACTERIAL ARTHRITIS: EXPERIENCES IN THE TREATMENT OF 77 PATIENTS

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Abstract
Approximately a fourth of the 77 cases of bacterial arthritis encountered in a 19-year period at the Mayo Clinic were of the acute variety. Infections of the hip and brucellar, gonococcal, fungal and tuberculous infections were excluded from the study. In recent years the number of cases of bacterial arthritis at this institution has decreased, almost entirely because of the lesser number of chronic cases encountered. Penetration of the joint cavity by a wound, while less common in recent years, remains the most common mode of infection in our experience. In 70 patients the infection was monoarticular. The knee, ankle and small joints of the hands and feet were the sites most frequently involved. The microorganisms most often isolated from the involved joints were Staphylococcus pyogenes, Streptococcus pyogenes and gram-negative enteric bacilli. The majority of acute infections responded to conservative therapy, but most of the chronic ones required surgical measures. About 2/3 of the patients with acute infections treated after antibiotics became available had restoration of normal articular function, or were left with only minor disability. The chronic infections were less amenable to treatment, but since the advent of antibiotics the need for amputation has been rare. The disability that has resulted from chronic bacterial arthritis in the past should stimulate the physician to identify bacterial invasion of a joint promptly and to treat it properly.

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