Salmonella Septic Arthritis-Clinical Features And Two-Stage Arthroplasty

Background: Salmonella septic arthritis is extremely rare and the investigationof its clinical,microbiological and pathological features is also rare,especially,there is only6patients of Salmonella septic coxitis treated by two-stage total hip arthroplasty.Objectives: To analyze the clinical,microbiological and pathological features ofSalmonella septic arthritis by comparing with non-Salmonella one;to investigate therisk factor and to evaluate the effect of two-stage total hip arthroplasty.Method:1.Clinical feature analysis:We retrospect8cases of Salmonella and30cases ofnon-Salmonella septic arthritis from May2008to March2012in301hospital andconduct a control study in the basic condition,clinical symptom and physicalsign,septic arthritis severity extent,laboratory exam and pathological feature;we alsodepict the microbiological manifestation by the analysis of24cases of salmonellosis.2.Risk factor analysis:24cases of Salmonellosis and96randomizednon-Salmonellosis cases are used to conduct a Logistic analysis to study the generalrisk factors,and8cases Salmonella and non-Salmonella septic arthritis are used toconduct a control study of risk factors.3.Two-stage arthroplasty effect evaluation:we followed up the6Salmonella septic coxitis with septic arthritis classification,preoperative and postoperativeHarris score and Blantyre septic arthritis score with the average follow-up duration2.4±1.4（1.6-4.3） years.Result:1.Clinical features:comparing with non-Salmonella,Salmonella septic arthritismore frequently happens to male adult age from18～60years,has higher septicarthritis scores,has more cases with continued fever and remittent fever,has morecases without increasing of WBC count, and the average of10most high count ofmultinuclear giant cell/HPF>5.The differences above are significant.BMI, plasma albumin, urban or rural living place,CRP,ESR,creatinine,carbamide,ALT,AST, andneutrophil count in pathological permanent section are not significantly different. thejoints are mainly infected by Salmonella serogroup C1;The resistant rate ofSalmonella isolates to Penicillins, Quinolone,beta-lactamase inhibitor,sulfanilamideand chloramphenicol is high.2.Risk factor: Steroid using history and SLE are significant risk factors ofSalmonella infection，comparing Salmonella and non-Salmonella septic arthritis,thehiger constituent ratio in risk factors are steroid using, immunosuppressorusing,reptile eating and gender.3. The rate of excellent and good of postoperative Harris score is100%and postoperative Blantyre septic arthritis score is11±0.67（10-12）.all cases follow-up hitherto have no relapse signs.Conclusion:1. Salmonella septic arthritis more frequently happens to male adult age from18～60years;2. continued fever and remittent fever happen morefrequently;3.joint symptom and physical sign are severe;4. WBC count of mostcases do not increase;5.In intraoperative frozen section and permanent sectionof acute stage the average of10most high count of neutrophil>10/HPF and in HE permanent section of acute stage the average of10most high countof multinuclear giant cell>5/HPF;6.Salmonella septic arthritis are mainly infected by serogroup C1;7. The resistant rate of Salmonella isolates to penicillins,quinolone,beta-lactamase inhibitor,sulfanilamide and chloramphenicol is high;8. Steroid using history and SLE are significant risk factors of Salmonella infection，comparing Salmonella and non-Salmonella septic arthritis,the higer constituent ratio in risk factors are steroid using, immunosuppressor using,reptile eating and gender;9.The effect of two-stage THA on Salmonella septic coxitis is encouraging.