高齢者における原発性化膿性関節炎 - 忘れられた殺人者か？後ろ向きコホート研究における5年生存率と危険因子

Primary septic arthritis is an acute emergency associated with high morbidity and mortality in older adults. Rapid diagnosis and treatment are crucial. The study evaluates 5-year survival and identifies prognostic risk factors in elderly patients with primary septic arthritis, including age, American Society of Anesthesiology Physical Status (ASA PS) classification, Charlson Comorbidity Index (CCI), joint involvement, implants, and pathogen spectrum.

50 patients aged ≥ 60 years treated for primary septic arthritis at two hospitals between 2008 and 2020 were included. Demographic, clinical, and microbiological data were collected retrospectively. Survival was assessed by Kaplan-Meier analysis, with log-rank tests to compare subgroups.

The mean age was 71.2 years. Overall survival was 76% at 1 year and 54% at 5 years. Survival declined significantly with increasing age (p = 0.004), higher ASA PS classification (p < 0.001), higher CCI (p = 0.006), joint involvement (p = 0.027), and presence of implants (p < 0.001). Diabetes mellitus, osteoarthritis, and synovial culture status showed no significant effect. Mean survival by joint ranged from 3.65 for the knee to 2.41 years for the shoulder. Patients with implants had markedly shorter survival (1.1 years vs. 3.84 years). Pathogens were isolated in 70% of cases, most frequently Staphylococcus aureus (38%).

Primary septic arthritis in older adults remains a life-threatening condition with high early- and mid-term mortality. Survival is strongly determined by age, ASA PS classification, CCI, joint involvement, and presence of implants, while comorbidities and pathogen detection show no prognostic relevance.