The Microbiology, Management and Outcomes of Native Joint Septic Arthritis of the Hand in Adults of Southeast Queensland.

Abstract

Background: Native joint septic arthritis (NJSA) of the hand is poorly studied. Management guidelines are extrapolated from large joint infections despite differences in epidemiology, anatomy and aetiology. Limited evidence suggests shorter courses of antibiotics can achieve outcomes comparable to longer courses. The aim of our study is to characterise the presentation, management and outcomes of NJSA of the hand in an adult cohort from Southeast Queensland (SEQ) and determine if the route or duration of antibiotics affected the outcome. Our cohort was compared to those in the literature to determine if already published data could be applicable to our population. Methods: A coding based retrospective cohort of adult patients between 2016 and 2022 were assessed. The cohort was divided into short/long course antibiotics and primarily intravenous/oral route for outcome comparison. Results: Seventy-four patients were included with a joint culture positive rate of 75%. The most common aetiology of infection was direct trauma and the most common pathogen was Staphylococcus aureus. Resolution was achieved in 86% of patients after 1-year follow-up, with a median antibiotic duration of 14 days, and 48% had non-infectious sequelae. Failure to achieve resolution was associated with females and taking immunosuppressants. No significant difference was detected when analysed for primary route or duration of antibiotics. Conclusions: There was no difference in the rate of resolution attributable to the route or duration of antibiotics. We demonstrated comparability between our cohorts' demographics, management and outcomes with those in the literature. Based on the findings in our study, noting the retrospective nature and small cohort, the authors conclude for uncomplicated NJSA of the hand, a total antibiotic duration of 14 days in addition to early surgical intervention is likely to be successful in most patients. Level of Evidence: Level III (Therapeutic).