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Outcomes of Adjunctive Therapy with Open Arthrotomy for Patients with Septic Arthritis Due to Melioidosis: A
Sorawit Chittrakarn1, Pisud Siripaitoon1, Narongdet Kositpantawong1
1Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand.
Abstract:
Melioidosis is a potentially fatal infection caused by the bacterium Burkholderia pseudomallei. Septic arthritis caused by this infection is uncommon and difficult to treat. The role of adjunctive open arthrotomy in this type of infection has not yet been elucidated. We conducted a retrospective study of patients with microbiologically confirmed melioidosis between January 2002 and December 2022. Patients with a clinical condition of septic arthritis and positive cultures for B. pseudomallei were included. Comparisons were made between patients who received adjunctive therapy with open arthrotomy with conventional standard treatment and those who did not in terms of clinical outcomes and hospital expenditures. Of the 478 patients diagnosed with melioidosis microbiological confirmation, 81 patients had septic arthritis, accounting for 17% of cases. Among these patients, only 36 (44%) underwent adjunctive therapy with open arthrotomy. The 14-day and 30-day in-hospital mortality and length of hospital stays of patients who underwent adjunctive therapy with open arthrotomy were more favorable than those of patients who did not receive adjunctive therapy with open arthrotomy; however, the difference was not statistically significant. Patients who underwent adjunctive therapy with open arthrotomy had lower hospital expenditures (antimicrobial and non-antimicrobial costs) than those who did not undergo open arthrotomy. Adjunctive therapy with open arthrotomy for patients with septic arthritis due to melioidosis was associated with favorable clinical outcomes and significantly lower hospital expenditures.
Insights
Adjunctive open arthrotomy for melioidosis septic arthritis may improve outcomes and reduce costs. This surgical approach, while not statistically significant for mortality, showed favorable trends and significant cost savings in a retrospective study.
Area of Science:
- Infectious Diseases
- Surgical Oncology
- Public Health
Background:
- Melioidosis, caused by Burkholderia pseudomallei, is a severe infection.
- Septic arthritis due to melioidosis is rare and challenging to manage.
- The efficacy of open arthrotomy as an adjunctive treatment for melioidosis septic arthritis remains unclear.
Purpose of the Study:
- To evaluate the clinical outcomes and hospital expenditures associated with adjunctive open arthrotomy in patients with melioidosis-induced septic arthritis.
- To compare patients who received open arthrotomy with those who received standard treatment alone.
Main Methods:
- Retrospective study of patients with microbiologically confirmed melioidosis and septic arthritis from January 2002 to December 2022.
- Comparison of clinical outcomes (mortality, length of stay) and hospital costs between patients who underwent adjunctive open arthrotomy and those who did not.
- Analysis of 81 patients with melioidosis septic arthritis, of whom 36 received open arthrotomy.
Main Results:
- Patients undergoing adjunctive open arthrotomy showed more favorable 14-day and 30-day in-hospital mortality and length of hospital stays, though not statistically significant.
- Adjunctive open arthrotomy was associated with significantly lower overall hospital expenditures, including antimicrobial and non-antimicrobial costs.
- Melioidosis septic arthritis represented 17% of all melioidosis cases in the study cohort.
Conclusions:
- Adjunctive open arthrotomy in melioidosis septic arthritis is linked to positive clinical outcomes and substantial cost reductions.
- Further research may be warranted to confirm the statistical significance of clinical outcome improvements.
- Open arthrotomy presents a potentially valuable therapeutic option for managing this uncommon but severe joint infection.
