[Purulent arthritis and bursitis after local injection of depot steroids]

The occurrence of severe joint and bursal infections preceded by local steroid injection was investigated in a retrospective survey. Of 37 consecutive patients with pyogenic arthritis or bursitis admitted to two hospitals over a three-year-period, nine (95% confidence limits 12-41%) had received previous intraarticular or intrabursal injections of steroid. Staphylococcus aureus was cultured in all cases. This incidence rate of endemic iatrogenic infection is at least 60 times higher than earlier reported. The alarming frequency may be attributed to insufficient aseptic precautions and/or the injection of depot steroids into cavities with overlooked established infection. An increased awareness of this complication seems warranted. Meticulous hygienic measures should be emphasized in drug information inserts. Health authorities and quality control bodies should monitor and analyze the occurrence of such accidents.