3 years ago

Artrite séptica do ombro e do cotovelo: análise epidemiológica de uma década em um hospital terciário

Jorge Henrique Assunção, Guilherme Guelfi Noffs, Eduardo Angeli Malavolta, Mauro Emilio Conforto Gracitelli, Ana Lucia Munhoz Lima, Arnaldo Amado Ferreira Neto

Publication date: November–December 2018

Source: Revista Brasileira de Ortopedia, Volume 53, Issue 6

Author(s): Jorge Henrique Assunção, Guilherme Guelfi Noffs, Eduardo Angeli Malavolta, Mauro Emilio Conforto Gracitelli, Ana Lucia Munhoz Lima, Arnaldo Amado Ferreira Neto

Resumo
Objetivo

Descrever as características clínicas e epidemiológicas de pacientes com artrite séptica do ombro ou cotovelo e buscar fatores prognósticos para complicações durante o tratamento.

Métodos

Foi feita uma série de casos retrospectiva com pacientes atendidos entre 2004 e 2014. As características clínicas e epidemiológicas dos pacientes foram coletadas. As complicações clínicas e ortopédicas foram identificadas e possíveis fatores prognósticos foram avaliados.

Resultados

O estudo avaliou 27 pacientes, 17 com pioartrite no ombro e dez no cotovelo. A mediana da idade foi de 46 anos (IIQ 24,5; 61). Doença articular prévia foi observada em nove pacientes (33%). Uma ou mais comorbidades clínicas foram identificadas em 23 pacientes (85%). Staphylococcus aureus foi isolado em 14 casos (52%). Quatorze pacientes (52%) tiveram pelo menos uma complicação clínica e cinco pacientes foram a óbito (19%). Nove pacientes (33%) tiveram alguma complicação ortopédica. O tempo entre o início dos sintomas e o tratamento cirúrgico foi maior nos pacientes com complicações ortopédicas (p = 0,020). Em relação ao desenvolvimento de complicações clínicas, leucocitose na admissão hospitalar (p = 0,021) e presença de comorbidades clínicas (p = 0,041) foram fatores preditivos.

Conclusões

A pioartrite do ombro e cotovelo acomete preferencialmente indivíduos com comorbidades clínicas e/ou imunocomprometidos. O Staphylococcus aureus é o patógeno mais frequente no Brasil. Leucocitose na admissão hospitalar e a presença de comorbidades clínicas são fatores associados à presença de complicações clínicas. Maior tempo entre o início dos sintomas e o tratamento cirúrgico foi correlacionado a complicações ortopédicas.

Abstract
Objective

To describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment.

Methods

A retrospective case series was studied with patients treated between 2004 and 2014. The patients’ clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated.

Results

Twenty‐seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors.

Conclusions

Septic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. Staphylococcus aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.

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