213. Clinical Characteristics and Treatment Outcomes of Patients with Sternoclavicular Septic Arthritis Caused by Staphylococcus aureus
Session: Poster Abstract Session: Clinical: Bone and Joint Infection
Thursday, October 5, 2017
Room: Poster Hall CD
Clinical Characteristics and Treatment Outcomes of Patients with Sternoclavicular Septic Arthritis Caused by Staphylococcus aureus

Background: Aggressive surgical therapy such as en-bloc resection of the joint is favored in the treatment of sternoclavicular (SC) septic arthritis. However, this practice is based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with S. aureus SC septic arthritis treated with medical therapy alone or with limited surgical therapy.

Methods: All adult patients with SC septic arthritis caused by S. aureus at the Asan Medical Center between Sep 2009 and Dec 2016 were retrospectively reviewed. Demographic characteristics, laboratory results, underlying diseases/conditions, patient management, and treatment outcomes were assessed. SC septic arthritis due to S. aureus was defined if patients had positive cultures of specimens from the SC joint, or if blood cultures yielded S. aureus, together with physical findings and imaging studies supporting the diagnosis of SC septic arthritis. Limited surgical therapy was defined as simple incision, drainage, and debridement of infected SC joint.

Results: A total of 22 cases of S. aureus SC septic arthritis were enrolled. Of these 22 patients, 11 received medical therapy alone, 11 underwent limited surgical therapy, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes, and liver cirrhosis, and none had IV drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscess had a tendency to be treated with limited surgery than patients without them (73% vs. 27%, P = 0.09). The median duration of intravenous antibiotics in all patients was 35 days (IQR, 25–46 days). After a median follow-up of 31 months (IQR, 2-40 months), there was no relapse of SC septic arthritis or deterioration of joint function.

Conclusion: Medical therapy alone or with limited surgical therapy appears to be a successful therapeutic strategy for the complicated S. aureus SC septic arthritis in a selected patient.

Byunghan Ryu, MD1, Young-Rock Jang, MD1, Seung Hyun Lee, MD1, Jeongmin Hong, MD1, Min-Chul Kim, MD2, Min Jae Kim, MD1, Heungsup Sung, MD, PhD3, Mi-Na Kim, MD, PhD3, Sung-Han Kim, MD, PhD1, Sang-Oh Lee, MD, PhD1, Sang-Ho Choi, MD, PhD1, Jin-Yong Jeong, PhD4, Yang Soo Kim, MD, PhD1, Jun Hee Woo, MD, PhD1 and Yong Pil Chong, MD, PhD1, (1)Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), (2)Division of Infectious Diseases, Chung-Ang University Hospital, Seoul, Korea, Republic of (South), (3)Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South), (4)Asan Institute for Life Sciences, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of (South)

Disclosures:

B. Ryu, None

Y. R. Jang, None

S. H. Lee, None

J. Hong, None

M. C. Kim, None

M. J. Kim, None

H. Sung, None

M. N. Kim, None

S. H. Kim, None

S. O. Lee, None

S. H. Choi, None

J. Y. Jeong, None

Y. S. Kim, None

J. H. Woo, None

Y. P. Chong, None

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