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Methicillin-Resistant Staphylococcus aureus Arthritis in Adults: Case Report and Review of the Literature

https://doi.org/10.1016/j.semarthrit.2011.06.018Get rights and content

Objective

Methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis has emerged over the past 25 years as an increasingly prevalent and serious infection. We sought to characterize the clinical features of MRSA septic arthritis in adult patients.

Methods

We report a case of community-acquired fatal MRSA septic arthritis of the hip and analyze the clinical features of 56 additional adult patients with native-joint MRSA septic arthritis identified through a systematic literature review.

Results

Among 56 previously reported cases of MRSA native-joint septic arthritis, 42 were men, 14 had polyarticular infections, 5 were previously healthy individuals with community-acquired infections, and 8 had a fatal outcome. The most frequent predisposing factor was a preexisting rheumatologic condition. The knees and shoulders were most commonly affected.

Conclusions

MRSA native-joint septic arthritis is a predominantly male disease that is usually nosocomial in origin but can occur rarely in health care–naive patients. A preexisting rheumatic disease is the most common predisposition. Community-acquired MRSA septic arthritis can be fatal. Cultures should be performed promptly, to identify potential antibiotic resistance. Patients presenting with both community-acquired and nosocomial septic arthritis should receive initial antibiotic treatment that includes coverage for MRSA.

Section snippets

Case Report

A 55-year-old man, an actively employed maintenance engineer, presented to our hospital with a 3-day history of fever, progressive right hip pain without antecedent trauma, and difficulty ambulating. He had a poor appetite and extreme fatigue. On the day of presentation, he developed labored and rapid breathing. He had a history of untreated chronic hepatitis C infection, gouty arthritis, and knee osteoarthritis. The latter was treated with arthroscopic knee surgery 20 months earlier and

Methods

Reports of MRSA septic arthritis in adults (age >18 years) published in the English language were identified using the PubMed and the Embase databases. The following keywords were utilized: “methicillin-resistant Staphylococcus aureus,” “drug resistance, bacterial,” “arthritis, infectious,” and “septic arthritis.” The search was conducted on May 21, 2010. These sources were augmented by hand searches of reference lists in the accessed articles. Cases were excluded if the infection involved a

Results

The characteristics of MRSA native-joint septic arthritis were detailed in the published literature for 56 adult patients, of whom 42 (76%) were men (Table 1) (3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21). The majority represented nosocomial infections occurring in the context of comorbid medical conditions. Only 5 patients developed MRSA septic arthritis in the absence of nosocomial exposures and of other identifiable risk factors. Rheumatologic diseases were reported

Discussion

The occurrence of fatal MRSA native joint septic arthritis in a health care–naive patient has rarely been reported. Although our patient had hepatitis C and gout, he enjoyed good health and was actively employed at the time that he became ill. He died from overwhelming CA-MRSA sepsis. Right hip pain was the patient's initial symptom, suggesting that the septic arthritis was an early feature of the illness. Septic arthritis of the hip is almost always derived from hematogenous seeding of the

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    This work was supported by NIH (Contract NOI-DE-32636) and the Jerome L. Greene Foundation.

    The authors have no conflicts of interest to disclose.

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