Survival and Risk Factor Analysis in Patients with Septic Arthritis: A Retrospective Study of 192 Cases

Survival and Risk Factor Analysis in Patients with Septic Arthritis: A Retrospective Study of 192 Cases | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Survival and Risk Factor Analysis in Patients with Septic Arthritis: A Retrospective Study of 192 Cases Melanie Schindler, Lorenz Huber, Nike Walter, Josina Straub, Siegmund Lang, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3973771/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Mar, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 12 You are reading this latest preprint version Abstract Background Septic arthritis (SA) poses a complex clinical puzzle and is associated with significant levels of morbidity and mortality. The objective of this study was (1) to explore overall mortality rates and (2) analyze and identify possible factors that might contribute to the risk of death in patients afflicted with SA. Methods This retrospective study focused on patients suffering from SA who received treatment at a German university hospital between January 01, 2011 to December, 31 2021. Identification of patients was carried out through International Classification of Diseases (ICD)-10 diagnosis codes specifically related to SA, denoted as "M00.-". The study analyzed the overall mortality rate as well as comorbidities, and pathogens as potential risk factors. Kaplan–Meier probability plots and odds ratios (OR) for mortality were calculated. Results In a cohort of 192 patients suffering from SA, 64 patients (33.3%) passed away during a mean follow-up time of 54.4 ± 42 months. The overall mortality was 17.5% at one year, 19.9% at two years and 28.3% at five years. Patients being 65 years or older (p < 0.001), arterial hypertension (p = 0.003), congestive heart failure (p = 0.001), chronic renal disease (p < 0.001), chronic liver disease (p = 0.013), peripheral vascular disease (p = 0.026), malignancy (p < 0.001), steroid use (p < 0.001), immunosuppression (p = 0.003) and intraabdominal infection (p = 0.049) demonstrated a significant higher rate of mortality. Comorbidities were found to be associated with mortality. Chronic renal disease (OR = 2.80; p = 0.000), malignancy (OR = 3.40; p = 0.006) and chronic heart failure (OR = 2.62; p = 0.039). Conclusion The vulnerable patient group demonstrated a notably elevated mortality rate. Understanding the intricate interplay of factors contributing to mortality is paramount. Prompt evaluation and addressing of individualized risk factors in the early stages could offer significant advantages in effectively managing and treating SA, thereby lowering the chances of mortality. These results underscore the critical need for vigilant monitoring of SA patients who have pre-existing chronic organ conditions, timely recognition, and prompt intervention for sepsis. septic arthritis mortality comorbidities complication Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Septic arthritis (SA), an infection infiltrating joints, is commonly caused by bacterial invasion [ 1 – 3 ]. Septic arthritis typically presents as monoarticular but can also manifest as polyarticular [ 4 ]. Polyarticular involvement is noted in approximately 10–20% of patients [ 4 ]. The knee is more commonly affected compared to other joints [5; 6]. Despite experienced medical care, diagnosing septic arthritis can be challenging. An infection of a native joint can be classified into acute ( three weeks) categories, collectively referred to as septic arthritis [ 7 ]. Immediate medical attention is essential as it is deemed a surgical emergency, requiring prompt assessment, diagnosis, and intervention. Timely recognition and treatment of SA play a crucial role in significantly reducing the risk of complications and mortality [ 2 ]. Conversely, delayed or insufficient treatment of septic arthritis may result in permanent joint damage, leading to subsequent disability, ultimately, mortality as the most severe consequence [ 5 ]. If an infection is confirmed or suspected, an early arthroscopic joint irrigation and joint debridement in terms of synovectomy should be performed [ 8 ]. SA is a relatively uncommon condition, with reported incidences ranging from four to twelve cases per 100,000 person-years (PY) [ 9 – 11 ]. The highest frequencies occur among individuals aged 55 years and older [6; 12]. Addressing the treatment of elderly patients, who are particularly vulnerable to these infections, is becoming increasingly important due to demographic development and the growing prevalence of comorbidities in an aging population [ 13 ]. The severity of septic arthritis is underscored by reported one-year mortality rates ranging from 11–19% [5; 14; 15]. Intriguingly, in contrast to diagnoses such as spondylodiscitis or major amputations, SA demonstrates comparatively lower mortality rates [ 16 ]. Additionally, a substantial proportion of SA cases, estimated between 24% and 33%, encounter suboptimal functional outcomes [ 17 – 19 ].This joint infection is associated with a spectrum of established risk factors, including rheumatoid arthritis, diabetes mellitus, hemodialysis, intravenous drug use, alcohol dependency, intra-articular steroid injections, prior joint surgeries, cutaneous ulcers, and skin infections [ 14 ] .This study elucidates the complex spectrum of SA and underscores the importance of early detection and tailored interventions to reduce significant mortality rates and complications. Additionally, it highlights the necessity of comprehensive risk assessment, considering patient-specific factors and microbial spectra, to optimize treatment strategies and improve long-term outcomes. The primary objectives of this study were: (1), to scrutinize the mortality rates of individuals affected by SA, stratified based on accompanying comorbidities, and (2), identify potential risk factors contributing to mortality among patients dealing with SA. Methods This retrospective analysis involved patients aged 18 years or older receiving treatment for SA at a German university hospital. Patients were identified through the International Classification of Diseases (ICD)-10 codes for "M00.-, septic arthritis" within the period spanning from January 01, 2011 to December, 31 2021. To verify diagnoses, patients' medical records, surgical reports, laboratory findings, and both microbiological and histopathological records were examined. Demographic data including sex, age, and body mass index (BMI) at the time of surgery and specific SA details, such as the affected joint and identified pathogens, were retrospectively assessed via electronic health records. Obesity was defined as a BMI ≥ 25 kg/m². Comorbidities were evaluated using the Charlson Comorbidity Index (CCI) [ 20 ]. To perform subgroup analyses, we divided the causes of septic arthritis into two categories: community-acquired septic arthritis (CASA) and healthcare-associated septic arthritis (HASA), as defined previously. This concept is adapted from the approach used in studies focusing on vertebral osteomyelitis (VO) [ 21 ]. Healthcare- associated VA (HAVO) was described as the development of symptoms occurring at least one-month post-hospitalization, within six months after hospital discharge, or subsequent to outpatient interventions within the preceding six months [ 22 ]. Specifically, HAVO, typically characterized by bloodstream infections involving low-virulence pathogens, manifests as an insidious disease course with prolonged diagnostic timelines and higher morbidity and mortality rates [ 22 ]. A minimum follow-up period of 24 months was established, during which all patients were contacted via telephone for clinical review. In this study, severe infection or sepsis was identified by meeting the criteria of Systemic Inflammatory Response Syndrome (SIRS). According to this definition, a diagnosis of SIRS was established when a patient met at least two of the following criteria: (1) abnormal body temperature, indicated by a fever exceeding 38.3°C (100.9°F) or hypothermia below 36.0°C (96.8°F); (2) tachycardia, with a heart rate exceeding 90 beats per minute; (3) increased respiratory rate, characterized by over 20 breaths per minute or a decreased partial pressure of carbon dioxide in arterial blood (PaCO2) below 32 mmHg; (4) abnormal white blood cell count, demonstrated by either an elevation (> 12,000 cells/mm³) or a reduction in total white blood cell count (< 4,000 cells/mm³), or the presence of more than 10% immature forms (band forms) in the blood [ 23 ]. Statistical Analysis SPSS Statistics version 28.0 (IBM SPSS Inc, Chicago, IL, USA) was used to analyze the data. Descriptive statistics were computed for all variables, demonstrating continuous variables through mean values and standard deviations. Each variable was individually examined to assess its potential role as a risk factor linked to in-hospital mortality among patients diagnosed with VO. The dataset encompassed various patient outcomes, including instances with and without in-hospital deaths. To evaluate recurrence-free survival, Kaplan-Meier analysis was applied using follow-ups as endpoints. The ANOVA test was employed to establish the statistical significance of the relationship between each parameter and in-hospital mortality. Odds ratios (OR) with lower and upper 95% Confidence Intervals (CI). were calculated for different comorbidities and complications. The strength of the statistical connection between exposure to specific factors and in-hospital mortality was using the odds ratio (OR). An OR less than 1.0 suggested a negative association, indicating reduced odds of in-hospital mortality with exposure to that variable. Conversely, an OR greater than 1.0 suggested a positive association, implying higher odds of the defined outcome with exposure. To explore the relationship between in-hospital mortality and each variable, a Chi-square test or correlation analysis of independence was executed. The level of statistical significance was established as p < 0.05. Ethical Considerations The Ethics Committee at the University Hospital Regensburg granted approval (reference number 20-1681_1-104). This research adhered to the principles outlined in the Declaration of Helsinki, with all participants providing informed consent. Results The study evaluated 192 patients for SA, included 135 men and 57 women. These participants had an average age of 62.0 ± 15 years, ranging from 19 to 90 years. The mean BMI was 28.8 ± 7 kg/m². The mean CCI was recorded as 2.1 ± 2. Most patients (50.5%) had an American Society of Anesthesiologists (ASA) score of III, 22.4% had an ASA score of II, 16.7% had an ASA score of IV, 9.9% had an ASA score of I and 0.5% V (Table 1 ). The mean hospital stay was 28.3 ± 23 days (2-146). Among them, 62 individuals (32.3%) required admission to the Intensive Care Unit (ICU), where they stayed for an average of 14.7 ± 18 days (1–84). In the study, half of the patients underwent open operative treatment, while the other 50% received arthroscopic intervention. Sixty-six patients, accounting for 34.4%, had undergone previous surgery on the infected joint. It was observed that 84.4% (n = 162) of cases presented with a monoarticular involvement, whereas 15.6% (n = 30) exhibited a polyarticular SA. 98 cases (51%) were related to the knee. This was followed by 35 cases (18.2%) associated with the shoulder, 26 cases (13.5%) involving the ankle, and 20 cases (10.4%) concerning the hip (Table 1 ). The etiological distribution of SA in the present study revealed diverse origins. The majority of cases were attributed to hematogenous sources, accounting for 62.0% (n = 119). Concomitant chronic osteomyelitis was diagnosed, accounting for 7.3% of the cases (n = 14) SA occurred in 16 cases following arthroscopy in this joint, whereas SA after previous joint injections accounted for 2.1% (n = 4). Implant-related cases categorized represented 7.8% of instances (n = 15). Posttraumatic reasons were identified in 9.4% of cases (n = 18), with the remaining cases classified under the "other" category at 9.4% (n = 18). Pathogens were identified, with Staphylococcus aureus (S. aureus) (n = 60; 31.3%), Staphylococcus epidermidis (S. epidermidis) (n = 11; 5.7%) and other pathogens´ (n = 11; 5.7%) being the most common. S. aureus significantly presented more frequently as monoarticular arthritis (46 vs. 14, p = 0.047), and the two methicillin-resistant S. aureus (MRSA) cases exclusively exhibit polyarticular involvement. There was no observed correlation between a specific pathogen and increased mortality rates. Table 1 Demographic data All n = 192 Deceased n = 64 Mean Age (a) Age ≥ 65a 62.0 ± 15 85 (44.3%) 69.8 ± 13 41 (64.1%) Sex male female 135 (70.3%) 57 (29.7%) 46 (71.9%) 18 (28.1%) Mean BMI (kg/m²) 28.8 ± 7 28.4 ± 7 Mean CCI 2.10 ± 2 3.4 ± 3 ASA I 19 (9.9%) 2 (3.1%) II 43 (22.4%) 5 (7.8%) III 97 (50.5%) 41 (64.1%) IV 32 (16.7%) 16 (25.0%) Mean lenght of hospital stay (days) 28.3 ± 23 32.1 ± 26 Mean ICU admission (days) 14.7 ± 18 12.9 ± 17 Location of SA Knee 98 (51%) 31 (48.4%) Shoulder 35 (18.2%) 17 (26.6%) Ankle 26 (13.5%) 6 (9.4%) Hip 20 (10.4%) 7 (10.9%) Hand 6 (3.1%) 1 (1.6%) Elbow 4 (2.1%) 1 (1.6%) Sternoclavicular 3 (1.6%) 1 (1.6%) Skin and subcutaneous tissue infections were the predominant focus in 24.5% of cases. (Table 2 ). Table 2 Primary infection foci Infection type n (%) Skin and subcutaneous tissue 47 (24.5%) Pneumogenic 30 (15.6%) Urinary tract 18 (9.4%) Prosthetic joints 17 (8.9%) Intraabdominal 14 (7.3%) Oral/dental 9 (4.7%) (1) The 5-year survival of patients with SA Throughout the study period, 64 patients (33.3%) died. Conversely, the 5-year survival rate was 71.7%. Notably, for 9 individuals (5%), the date of death remains uncertain. The mean duration of follow-up was 54.4 ± 42 months, spanning from 0 to 149 months. The overall mortality was 17.5% at one year, 19.9% at two years and 28.3% at five years. Out of the total sample size of 65 patients (33.9%) died within 30 days (Fig. 1 ). (2) Risk factors for the in-hospital mortality of SA patients Patients who presented with age 65 or older (45.7%; p < 0.001), arterial hypertension (43.2%; p = 0.003), chronic heart failure (13.7%; p = 0.001), chronic renal disease (7.1%; p < 0.001), chronic liver disease (10.3%; p = 0.013), peripheral vascular disease (11.5%; p = 0.026), malignancy (13.7%; p < 0.001), steroid use (25.7%; p < 0.001), immunosuppression (10.0%; p = 0.003), intraabdominal infection (7.1%; p = 0.049), sepsis (24.2%; p < 0.001), septic shock (13.7%; p = 0.049) and ICU admission (30.6%; p < 0.001) demonstrated a significant higher rate of mortality than patients without these conditions (Table 3 ). Otherwise, sex, previous hospitalization, other comorbidities such as diabetes mellitus, rheumatological disease, were not associated with an elevated mortality rate during the follow-up. Table 3 Number of comorbidities and mortality Comorbidities n (%) 1-year mortality 2-year mortality 5-year mortality Age ≥ 65a 81 (44.3%) 29.7% 33.6% 43.6% Arterial hypertension 32 (40.5%) 24.1% 30.8% 39.0% Chronic heart failure 13 (52.0%) 40.0% 40.0% 45.0% Chronic renal disease 24 (54.5%) 43.2% 45.7% 54.9% Chronic liver disease 7 (53.8%) 30.8% 48.7% 61.5% Peripheral vascular disease 10 (47.6%) 33.3% 38.1% 42.9% Malignancy 15 (60%) 37.0% 46.0%% 65.7% Steroid use 22 (46.8%) 34.0% 38.3% 48.2% Immunosuppression 10 (55.6%) 44.4% 50.0% 55.6% Intraabdominal infection 6 (46.2%) 38.5% 47.3% 47.3% Sepsis 23 (52.3%) 40.9% 40.9% 51.4% Septic shock 16 (64.0%) 60.0% 60.0% 65.0% ICU 28 (50.0%) 39.4% 41.3% 48.0% (3) Risk factors for the mortality of SA patients Age 65 years or older (OR = 1.86; 95% CI 1.11 to 3.14; p = 0.002) was significantly associated with in-hospital mortality (Fig. 2 ). Based on the patient records, 81 cases were classified as HASA (42.2%), while 111 cases (57.8%) were categorized as CASA. Neither HASA nor CASA cases demonstrated an increased in-hospital mortality rate (Fig. 2 ). The shoulder was the sole joint affected by a risk factor associated with increased mortality, without statistical significance (OR = 1.89; 95% CI 0.91 to 3.91; p = 0.215) (Fig. 3 ). Chronic renal disease was identified as a risk factor (OR = 2.80; 95% CI 1.47 to 5.35; p = 0.000), malignancy (OR = 3.40; 95% CI 1.47 to 7.85; p = 0.006), as well as chronic heart failure (OR = 2.62; 95% CI 1.19 to 5.97; p = 0.039) (Fig. 4 ). There was a statistically significant correlation found between mortality and CCI (ρ=-0.421; p < 0.001). The ASA score of the 64 those who passed away, was significantly elevated, with a mean of 3.11 compared to 2.58 (p < 0.001). Sepsis (OR = 2.48; 95% CI 1.29 to 4.74; p = 0.004), septic shock (OR = 4.00; 95% CI 1.70 to 9.40; p = 0.001) and multiorgan failure (OR = 4.75; 95% CI 1.97 to 11.44; p < 0.001) were significantly associated with higher mortality. Discussion The present case series demonstrated that SA is linked with a high rate of 30-days mortality and a substantial 5-year mortality rate. Regarding outcomes, the 5-year survival rate was 71.7%, with an overall mortality of 28.3% at five years. Patients with age over 65 years (45.7%), arterial hypertension (43.2%), chronic heart failure (13.7%), chronic renal disease (7.1%), chronic liver disease (10.3%), peripheral vascular disease (11.5%), malignancy (13.7%), steroid use (25.7%), immunosuppression (10.0%), intraabdominal infection (7.1%;), sepsis (24.2%), septic shock (13.7%) and ICU admission (30.6%) had notably higher mortality rates. (1) The 5-year survival of patients with SA The overall mortality was 7.1% at one year, 13.7% at two years and 23% at five years. Patients with septic arthritis and concomitant comorbidities were associated with increased mortality. Being 65 years or older (OR = 1.86), having chronic kidney disease (OR = 2.80) and experiencing congestive heart failure (OR = 2.62) were identified as a significant risk factors for a higher risk of earlier mortality. Additionally, the knee joint was the sole joint affected by a risk factor for a higher mortality (OR = 2.93). The mortality rate found in this study is in line with the rates reported in previous research. Mortality associated with SA has exhibited variability, ranging between 11% and 19%, as indicated by several studies [5; 14; 15; 24]. Notably, a smaller prospective study reported an 11% mortality rate [ 14 ]. Maneiro et al. identified a one-year mortality rate of 16.6% following the diagnosis [ 24 ]. Conversely, Huang et al., in a national cohort study involving 31.491 SA patients, reported mortality rates of 4.3%, 8.6%, and 16.4% at 30 days, 90 days, and one year, respectively [ 15 ]. Another study involving 543 patients revealed a 90-day mortality rate of 5% [ 9 ]. These variations underscore the nuanced nature of mortality outcomes in SA and highlight the importance of contextualizing findings within the broader landscape of existing research. Possible patient factors that vary, as well as microbial spectra and potentially differing healthcare structures may also contribute to these differences. (2) Risk factors for the in-hospital mortality of SA patients In our cohort study, patients over the age of 65 years exhibited a considerable mortality rate of 45.7% (p < 0.001), highlighting the vulnerability of this age group. Furthermore, conditions such as arterial hypertension (43.2%; p = 0.003), chronic heart failure (13.7%; p = 0.001), chronic renal disease (7.1%; p < 0.001), chronic liver disease (10.3%; p = 0.013), peripheral vascular disease (11.5%; p = 0.026), malignancy (13.7%; p < 0.001), steroid use (25.7%; p < 0.001), immunosuppression (10.0%; p = 0.003), intraabdominal infection (7.1%; p = 0.049), sepsis (24.2%; p < 0.001), septic shock (13.7%; p = 0.049), and ICU admission (30.6%; p < 0.001) were significantly associated with increased mortality rates compared to patients without these conditions (Table 1 ). Conversely, factors such as sex, previous hospitalization, and other comorbidities such as diabetes mellitus and rheumatological disease did not exhibit a statistically significant association with elevated mortality during the follow-up period. Notably, a significant correlation was identified between mortality and the CCI (ρ=-0.421; p < 0.001), emphasizing the importance of considering overall health status in prognostic assessments. Additionally, the ASA score among the 64 deceased individuals was found to be significantly higher, underscoring its potential as a predictive factor for adverse outcomes. This comprehensive analysis sheds light on the intricate interplay of various clinical parameters and their impact on mortality, providing valuable insights for risk stratification and patient management strategies. Expanding our understanding of mortality in SA, existing literature indicates a 90-day mortality rate of 7%, escalating to 22%-69% in patients aged 80 and older [ 25 ]. In other studies comorbidities such as diabetes mellitus, rheumatoid arthritis, bacteremia, and low creatinine clearance are also linked to increased mortality [ 17 ]. Specifically, patients with rheumatoid arthritis experiencing joint flare-ups are identified as particularly high-risk individuals [26; 27]. Significant prognostic factors identified in the literature include increasing age (p < .001), female sex (p = .046), higher CCI scores (p < .001), and lacking private insurance [ 28 ]. Yeh et al.'s study on 52 dialysis patients with SA revealed tunneled cuffed catheter and fever as predictors of positive blood culture, with tunneled cuffed catheter being a predictor of in-hospital mortality [ 29 ]. A study examining SA in emergency departments in the United States revealed that the female sex, urban residence, treatment at a metropolitan teaching hospital, and the presence of medical comorbidities including diabetes mellitus, hyperlipidemia, hypertension, chronic obstructive pulmonary disease, coronary heart disease, gout, osteoarthritis, renal failure, and heart failure were associated with an elevated probability of hospitalization [ 30 ]. In line with prior investigations, our study recognized a similar pattern, with the knee emerging as the most frequently affected joint, closely followed by the shoulder. Specifically, 98 cases (51%) were related to the knee. A other study of 491 patients with SA, the knee emerged as the most frequently affected site, constituting 50.1% of cases, followed by the hip (14.4%), other anatomical locations (26.8%), the shoulder (5.5%), and involvement in multiple sites (1.2%) [ 15 ]. These findings align with current literature, emphasizing the significant prevalence of knee involvement [28; 31–33]. The richness of literature on native knee arthritis supports our findings, as it is recognized as the most commonly affected joint [1; 34–38]. Supporting the typical presentation, our study affirmed the predominant pattern of intra-articular infection, primarily characterized by monoarticular involvement. In alignment with established literature, our investigation also identified a congruent pattern, with approximately 20% of cases exhibiting participation in multiple joints, denoted as oligoarticular [9; 27]. In managing SA cases, our study employed arthroscopic or open surgical lavage in each case of SA. Several studies have conducted comparisons between operative intervention and medical therapy [ 39 – 41 ]. In one study, patients received empirical intravenous therapy with cloxacillin and ceftriaxone based on culture results, with treatment adjusted according to microbial sensitivity [ 41 ] .Meanwhile, another study assessed treatment failure after 7 days, with surgical treatment defined as a need for a second surgery [ 39 ]. Notably, in contrast to a study of Mabille et al about knee and hip arthritis [ 39 ], our observed median duration of hospitalization was a little bit higher, specifically 28.3 ± 23 days, with extremes ranging from 2 to 146 days. Mabille et al. found that the median duration of hospitalization was significantly higher in the surgical group compared to the medical group (33.5 vs. 21 days) [ 39 ]. This difference was primarily attributed to post-intervention follow-up, particularly the extended rehabilitation period in a rehabilitation center within the surgical group. These findings confirm data published by Ravindran et al., emphasizing the impact of surgical intervention on post-treatment care and rehabilitation needs [ 40 ]. Timely intervention is imperative, encompassing the initiation of antibiotics alongside surgical lavage and debridement [ 42 ]. Arthroscopic methodologies have demonstrated comparable efficacy to conventional open techniques, offering the supplementary advantages of shorter hospitalization periods and enhanced postoperative recuperation [1; 6; 36; 43–45]. The decision to utilize an arthroscopic approach is based on the discretion of the treating physician, with additional advantages including minimally invasive procedures, wound healing, functional outcomes, and reduced blood loss. The etiology of SA often presents a diagnostic challenge, with a significant proportion of cases lacking an identified causative bacterial organism. However, when a pathogenic organism is identified, S. aureus emerges as the most prevalent, constituting 53% of the cases [9; 28; 29; 32; 36; 39]. In our study, consistent with existing literature, S. aureus was the predominant pathogen identified, comprising 31.3% of cases. These pathogens in SA are associated with elevated mortality rates and profound joint dysfunction [ 31 ]. Furthermore, S. aureus infections exhibit higher rates of cellulitis, abscess formation, and increased morbidity, leading to interventions such as fusion, amputation, or prosthetic joint replacement. Notably, drug-resistant strains, including MRSA , are becoming more prevalent, especially in intravenous (IV) drug users, with vancomycin-resistant strains observed in patients with recurrent healthcare-associated infections [ 46 ]. Other studies identified MRSA infections were frequently associated with oligoarticular arthritis, while group B streptococci were more prevalent in cases of oligoarticular arthritis compared to monoarticular septic arthritis [27; 47]. In our study, the three MRSA cases demonstrated oligoarticular arthritis. Moreover, streptococci cases exhibited a predominance in monoarticular cases (7 vs. 3), and a significant pattern was observed in S. aureus cases. Understanding the microbial landscape of SA is crucial for tailoring effective treatment strategies, particularly in the context of emerging drug-resistant strains and the varied clinical manifestations associated with different pathogens. Further research is warranted to explore the evolving epidemiology of SA pathogens and their implications for patient outcomes. Certain limitations should be acknowledged when interpreting the findings of this study. It is a single-center retrospective design, conducted in a German university hospital, may restrict the generalizability of findings to diverse populations. There is a potential for inherent selection bias as the study exclusively involves patients from an academic medical center, which could influence the observed severity and comorbidity profiles. The sample size of 192 patients, while relatively large compared to other studies, may still constrain the statistical robustness and broader generalizability of the findings. Diagnostic challenges in identifying SA, despite efforts to ensure accuracy, could lead to misclassifications or underdiagnoses. Dependence on electronic health records introduces the potential for data gaps or incompleteness, thereby influencing the precision of comorbidity assessments. The minimum follow-up period of 24 months may not adequately capture long-term outcomes, and statistical methods, while robust, lack specific details. Conclusion A vulnerable patient group demonstrated a notably elevated mortality rate. Understanding the intricate interplay of factors contributing to mortality is paramount. Analyzing the specific risk factors unique to each patient, such as existing health conditions, is crucial in effectively addressing and treating SA. Our results emphasize the critical need for careful monitoring, particularly among SA patients with chronic organ diseases, prompt identification and handling of sepsis. These measures collectively aim to improve the chances of survival for this vulnerable group of patients. Declarations Acknowledgments: Not Applicable. Authors’ contributions : MS developed the conceptualization, methodology, data curation, software, and writing original draft preparation; LH performed much of the data entry and analysis NW, SB, DZ, JS, SL supervision and writing-reviewing; MR were contributors to the writing of the All authors read and approved the finale manuscript. Fundin g: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate: The study was approved by the Investigational Review Board of University Hospital Regensburg. Consent for publication: Not Applicable. Competing interests: The authors declare that they have no competing interests References Elsissy JG, Liu JN, Wilton PJ et al. 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Lancet Infect Dis 2020; 20 :341–49. Earwood JS, Walker TR, Sue GJC. Septic Arthritis: Diagnosis and Treatment. Am Fam Physician 2021; 104 :589–97. Horowitz DL, Katzap E, Horowitz S et al. Approach to septic arthritis. Am Fam Physician 2011; 84 :653–60. Nossent J, Raymond W, Keen H et al. Non-gonococcal septic arthritis of native joints in Western Australia. A longitudinal population-based study of frequency, risk factors and outcome. Int J Rheum Dis 2021; 24 :1386–93. Yeh H-T, Liau S-K, Niu K-Y et al. Clinical Characteristics and In-Hospital Outcomes in Dialysis Patients with Septic Arthritis. Medicina (Kaunas) 2022; 58 . Singh JA, Yu S. Septic Arthritis in Emergency Departments in the US: A National Study of Health Care Utilization and Time Trends. Arthritis Care Res (Hoboken) 2018; 70 :320–26. Ross JJ. Septic Arthritis of Native Joints. Infect Dis Clin North Am 2017; 31 :203–18. Lieber SB, Fowler ML, Zhu C et al. Clinical characteristics and outcomes in polyarticular septic arthritis. Joint Bone Spine 2018; 85 :469–73. Cipriano A, Santos FV, Dias R et al. Adult Native Joint Septic Arthritis: A Nine-Year Retrospective Analysis in a Portuguese University Hospital. Acta Med Port 2021; 34 :826–32. Holzmeister A, Frazzetta J, Yuan FFN et al. Evaluation for septic arthritis of the native adult knee is aided by multivariable assessment. Am J Emerg Med 2021; 46 :614–18. Babalola OR, Babalola AA, Alatishe KA. Approaches to Septic Arthritis of the Knee Post Anterior Cruciate Ligament Reconstruction. Curr Rev Musculoskelet Med 2023; 16 :274–83. Davis CM, Zamora RA. Surgical Options and Approaches for Septic Arthritis of the Native Hip and Knee Joint. J Arthroplasty 2020; 35 :S14-S18. Chabaud A, Tetard M, Descamps S et al. Early rehabilitation management strategy for septic arthritis of the knee. Infect Dis Now 2022; 52 :170–74. Jaffe D, Costales T, Jauregui JJ et al. Current surgical practice for septic arthritis of the knee in the United States. J Orthop 2021; 25 :88–92. Mabille C, El Samad Y, Joseph C et al. Medical versus surgical treatment in native hip and knee septic arthritis. Infect Dis Now 2021; 51 :164–69. Ravindran V, Logan I, Bourke BE. Medical vs surgical treatment for the native joint in septic arthritis: a 6-year, single UK academic centre experience. Rheumatology (Oxford) 2009; 48 :1320–22. Flores-Robles BJ, Jiménez Palop M, Sanabria Sanchinel AA et al. Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis: A Single Spanish Center's 8-Year Experience. J Clin Rheumatol 2019; 25 :4–8. Malhas A, Satta G, Peter K et al. Assessment of the management of septic arthritis in accordance with UK guidelines. J Infect 2008; 57 :496–97. Böhler C, Dragana M, Puchner S et al. Treatment of septic arthritis of the knee: a comparison between arthroscopy and arthrotomy. Knee Surg Sports Traumatol Arthrosc 2016; 24 :3147–54. Aïm F, Delambre J, Bauer T et al. Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthop Traumatol Surg Res 2015; 101 :61–64. Wirtz DC, Marth M, Miltner O et al. Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 2001; 25 :239–41. Sharff KA, Richards EP, Townes JM. Clinical management of septic arthritis. Curr Rheumatol Rep 2013; 15 :332. Miller JM, Binnicker MJ, Campbell S et al. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. Clin Infect Dis 2018; 67 :e1-e94. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 18 Mar, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 08 Oct, 2024 Reviews received at journal 25 Sep, 2024 Reviews received at journal 11 Sep, 2024 Reviewers agreed at journal 27 Aug, 2024 Reviews received at journal 29 Jul, 2024 Reviewers agreed at journal 10 Jul, 2024 Reviewers agreed at journal 03 Jul, 2024 Reviewers invited by journal 15 Apr, 2024 Editor assigned by journal 27 Feb, 2024 Editor invited by journal 26 Feb, 2024 Submission checks completed at journal 26 Feb, 2024 First submitted to journal 20 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3973771","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":275393571,"identity":"87866965-f63e-4f7f-8a95-97e633b2e31d","order_by":0,"name":"Melanie Schindler","email":"","orcid":"","institution":"University Hospital Regensburg","correspondingAuthor":false,"prefix":"","firstName":"Melanie","middleName":"","lastName":"Schindler","suffix":""},{"id":275393572,"identity":"54dd52ae-9538-47df-9864-3aa51c6b4baf","order_by":1,"name":"Lorenz Huber","email":"","orcid":"","institution":"University Hospital Regensburg","correspondingAuthor":false,"prefix":"","firstName":"Lorenz","middleName":"","lastName":"Huber","suffix":""},{"id":275393573,"identity":"acc9456c-852b-48b1-aaf9-03ead298f73e","order_by":2,"name":"Nike Walter","email":"","orcid":"","institution":"University Hospital Regensburg","correspondingAuthor":false,"prefix":"","firstName":"Nike","middleName":"","lastName":"Walter","suffix":""},{"id":275393574,"identity":"accf7a13-0782-4ad2-ad39-f7734e4e9d15","order_by":3,"name":"Josina Straub","email":"","orcid":"","institution":"University Hospital Regensburg","correspondingAuthor":false,"prefix":"","firstName":"Josina","middleName":"","lastName":"Straub","suffix":""},{"id":275393575,"identity":"bf491cc1-78cc-4c20-9d43-b3702ecbd36b","order_by":4,"name":"Siegmund Lang","email":"","orcid":"","institution":"University Hospital 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Regensburg","correspondingAuthor":false,"prefix":"","firstName":"Volker","middleName":"","lastName":"Alt","suffix":""},{"id":275393579,"identity":"7ffc54d2-2cd4-4a97-91ad-c169b805cf86","order_by":8,"name":"Markus Rupp","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA2klEQVRIiWNgGAWjYBACgwMMzDA24wOGA0DqAAEtlkhamA2I0mKPpIVNgigtZsfPPjbm+cOQb3C791g1z5l7DHzHGwhoOZNunMzbxmC54c65tNs8N4oZJM8QsMbsQBrzYd4GBgODGzlmt3k+JDAY3EjAr8Xg/DPmw0CHgbUUg7Xcf0BAy4005mQeNogWZp4bIFvw6wAqeMZsOLdNwkDyzrlkyTlnEngkzxB0WBqzxJs/NgZ8t3sPfnhzLEGO7/gBAtZAgAQQ8YBZPESph+oiRfEoGAWjYBSMKAAA7ZJH1K3Ka4YAAAAASUVORK5CYII=","orcid":"","institution":"University Hospital Regensburg","correspondingAuthor":true,"prefix":"","firstName":"Markus","middleName":"","lastName":"Rupp","suffix":""}],"badges":[],"createdAt":"2024-02-20 20:14:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3973771/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3973771/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-024-10316-0","type":"published","date":"2025-03-18T15:58:21+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":51834422,"identity":"a30c78e6-2132-4487-bcb0-faba9f3c0b1a","added_by":"auto","created_at":"2024-02-29 20:12:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":613541,"visible":true,"origin":"","legend":"\u003cp\u003eKaplan- Meier probability plots of mortality related to age ≥65, arterial hypertension, chronic heart failure, chronic renal disease, steroid and immunosuppression use\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3973771/v1/3751706f4ed7df37956673bd.jpg"},{"id":51834421,"identity":"60a76e01-6da2-4547-b9b4-0da079c8cad2","added_by":"auto","created_at":"2024-02-29 20:12:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":163287,"visible":true,"origin":"","legend":"\u003cp\u003eMortality odds ratio for epidemiological and environmental factors\u003c/p\u003e","description":"","filename":"2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3973771/v1/4a1bf3b42fd18bf707f37805.jpg"},{"id":51834701,"identity":"1f01a501-8815-4df8-bc21-75c96b98322e","added_by":"auto","created_at":"2024-02-29 20:20:52","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":156955,"visible":true,"origin":"","legend":"\u003cp\u003eMortality odds ratio for affected joints\u003c/p\u003e","description":"","filename":"3.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3973771/v1/fbc5f8f7851326c81b05ad1f.jpg"},{"id":51834419,"identity":"9ef25c4b-3c9a-4535-841f-c8988742052e","added_by":"auto","created_at":"2024-02-29 20:12:52","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":260625,"visible":true,"origin":"","legend":"\u003cp\u003eMortality odds ratio for comorbidities\u003c/p\u003e","description":"","filename":"4.jpg","url":"https://assets-eu.researchsquare.com/files/rs-3973771/v1/a1bbf6cee520feb3412f7b5b.jpg"},{"id":79120699,"identity":"65849cab-653c-406f-8e3b-14adb3a97fb6","added_by":"auto","created_at":"2025-03-24 16:11:06","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2086871,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3973771/v1/5886ad07-76b6-4d49-ac36-d7b25865c27f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Survival and Risk Factor Analysis in Patients with Septic Arthritis: A Retrospective Study of 192 Cases","fulltext":[{"header":"Background","content":"\u003cp\u003eSeptic arthritis (SA), an infection infiltrating joints, is commonly caused by bacterial invasion [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Septic arthritis typically presents as monoarticular but can also manifest as polyarticular [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Polyarticular involvement is noted in approximately 10\u0026ndash;20% of patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. The knee is more commonly affected compared to other joints [5; 6]. Despite experienced medical care, diagnosing septic arthritis can be challenging. An infection of a native joint can be classified into acute (\u0026lt;\u0026thinsp;three weeks) and chronic (\u0026gt;\u0026thinsp;three weeks) categories, collectively referred to as septic arthritis [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImmediate medical attention is essential as it is deemed a surgical emergency, requiring prompt assessment, diagnosis, and intervention. Timely recognition and treatment of SA play a crucial role in significantly reducing the risk of complications and mortality [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Conversely, delayed or insufficient treatment of septic arthritis may result in permanent joint damage, leading to subsequent disability, ultimately, mortality as the most severe consequence [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. If an infection is confirmed or suspected, an early arthroscopic joint irrigation and joint debridement in terms of synovectomy should be performed [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSA is a relatively uncommon condition, with reported incidences ranging from four to twelve cases per 100,000 person-years (PY) [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The highest frequencies occur among individuals aged 55 years and older [6; 12]. Addressing the treatment of elderly patients, who are particularly vulnerable to these infections, is becoming increasingly important due to demographic development and the growing prevalence of comorbidities in an aging population [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe severity of septic arthritis is underscored by reported one-year mortality rates ranging from 11\u0026ndash;19% [5; 14; 15]. Intriguingly, in contrast to diagnoses such as spondylodiscitis or major amputations, SA demonstrates comparatively lower mortality rates [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Additionally, a substantial proportion of SA cases, estimated between 24% and 33%, encounter suboptimal functional outcomes [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].This joint infection is associated with a spectrum of established risk factors, including rheumatoid arthritis, diabetes mellitus, hemodialysis, intravenous drug use, alcohol dependency, intra-articular steroid injections, prior joint surgeries, cutaneous ulcers, and skin infections [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] .This study elucidates the complex spectrum of SA and underscores the importance of early detection and tailored interventions to reduce significant mortality rates and complications. Additionally, it highlights the necessity of comprehensive risk assessment, considering patient-specific factors and microbial spectra, to optimize treatment strategies and improve long-term outcomes.\u003c/p\u003e \u003cp\u003eThe primary objectives of this study were: (1), to scrutinize the mortality rates of individuals affected by SA, stratified based on accompanying comorbidities, and (2), identify potential risk factors contributing to mortality among patients dealing with SA.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis retrospective analysis involved patients aged 18 years or older receiving treatment for SA at a German university hospital. Patients were identified through the International Classification of Diseases (ICD)-10 codes for \"M00.-, septic arthritis\" within the period spanning from January 01, 2011 to December, 31 2021.\u003c/p\u003e \u003cp\u003eTo verify diagnoses, patients' medical records, surgical reports, laboratory findings, and both microbiological and histopathological records were examined. Demographic data including sex, age, and body mass index (BMI) at the time of surgery and specific SA details, such as the affected joint and identified pathogens, were retrospectively assessed via electronic health records. Obesity was defined as a BMI\u0026thinsp;\u0026ge;\u0026thinsp;25 kg/m\u0026sup2;. Comorbidities were evaluated using the Charlson Comorbidity Index (CCI) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. To perform subgroup analyses, we divided the causes of septic arthritis into two categories: community-acquired septic arthritis (CASA) and healthcare-associated septic arthritis (HASA), as defined previously. This concept is adapted from the approach used in studies focusing on vertebral osteomyelitis (VO) [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Healthcare- associated VA (HAVO) was described as the development of symptoms occurring at least one-month post-hospitalization, within six months after hospital discharge, or subsequent to outpatient interventions within the preceding six months [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Specifically, HAVO, typically characterized by bloodstream infections involving low-virulence pathogens, manifests as an insidious disease course with prolonged diagnostic timelines and higher morbidity and mortality rates [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. A minimum follow-up period of 24 months was established, during which all patients were contacted via telephone for clinical review.\u003c/p\u003e \u003cp\u003eIn this study, severe infection or sepsis was identified by meeting the criteria of Systemic Inflammatory Response Syndrome (SIRS). According to this definition, a diagnosis of SIRS was established when a patient met at least two of the following criteria: (1) abnormal body temperature, indicated by a fever exceeding 38.3\u0026deg;C (100.9\u0026deg;F) or hypothermia below 36.0\u0026deg;C (96.8\u0026deg;F); (2) tachycardia, with a heart rate exceeding 90 beats per minute; (3) increased respiratory rate, characterized by over 20 breaths per minute or a decreased partial pressure of carbon dioxide in arterial blood (PaCO2) below 32 mmHg; (4) abnormal white blood cell count, demonstrated by either an elevation (\u0026gt;\u0026thinsp;12,000 cells/mm\u0026sup3;) or a reduction in total white blood cell count (\u0026lt;\u0026thinsp;4,000 cells/mm\u0026sup3;), or the presence of more than 10% immature forms (band forms) in the blood [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStatistical Analysis\u003c/strong\u003e \u003cp\u003eSPSS Statistics version 28.0 (IBM SPSS Inc, Chicago, IL, USA) was used to analyze the data. Descriptive statistics were computed for all variables, demonstrating continuous variables through mean values and standard deviations. Each variable was individually examined to assess its potential role as a risk factor linked to in-hospital mortality among patients diagnosed with VO. The dataset encompassed various patient outcomes, including instances with and without in-hospital deaths.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eTo evaluate recurrence-free survival, Kaplan-Meier analysis was applied using follow-ups as endpoints. The ANOVA test was employed to establish the statistical significance of the relationship between each parameter and in-hospital mortality.\u003c/p\u003e \u003cp\u003eOdds ratios (OR) with lower and upper 95% Confidence Intervals (CI). were calculated for different comorbidities and complications.\u003c/p\u003e \u003cp\u003eThe strength of the statistical connection between exposure to specific factors and in-hospital mortality was using the odds ratio (OR). An OR less than 1.0 suggested a negative association, indicating reduced odds of in-hospital mortality with exposure to that variable. Conversely, an OR greater than 1.0 suggested a positive association, implying higher odds of the defined outcome with exposure.\u003c/p\u003e \u003cp\u003eTo explore the relationship between in-hospital mortality and each variable, a Chi-square test or correlation analysis of independence was executed. The level of statistical significance was established as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical Considerations\u003c/strong\u003e \u003cp\u003e The Ethics Committee at the University Hospital Regensburg granted approval (reference number 20-1681_1-104). This research adhered to the principles outlined in the Declaration of Helsinki, with all participants providing informed consent.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study evaluated 192 patients for SA, included 135 men and 57 women. These participants had an average age of 62.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15 years, ranging from 19 to 90 years. The mean BMI was 28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7 kg/m\u0026sup2;. The mean CCI was recorded as 2.1\u0026thinsp;\u0026plusmn;\u0026thinsp;2. Most patients (50.5%) had an American Society of Anesthesiologists (ASA) score of III, 22.4% had an ASA score of II, 16.7% had an ASA score of IV, 9.9% had an ASA score of I and 0.5% V (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe mean hospital stay was 28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23 days (2-146). Among them, 62 individuals (32.3%) required admission to the Intensive Care Unit (ICU), where they stayed for an average of 14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18 days (1\u0026ndash;84). In the study, half of the patients underwent open operative treatment, while the other 50% received arthroscopic intervention. Sixty-six patients, accounting for 34.4%, had undergone previous surgery on the infected joint. It was observed that 84.4% (n\u0026thinsp;=\u0026thinsp;162) of cases presented with a monoarticular involvement, whereas 15.6% (n\u0026thinsp;=\u0026thinsp;30) exhibited a polyarticular SA.\u003c/p\u003e\n\u003cp\u003e98 cases (51%) were related to the knee. This was followed by 35 cases (18.2%) associated with the shoulder, 26 cases (13.5%) involving the ankle, and 20 cases (10.4%) concerning the hip (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe etiological distribution of SA in the present study revealed diverse origins. The majority of cases were attributed to hematogenous sources, accounting for 62.0% (n\u0026thinsp;=\u0026thinsp;119). Concomitant chronic osteomyelitis was diagnosed, accounting for 7.3% of the cases (n\u0026thinsp;=\u0026thinsp;14) SA occurred in 16 cases following arthroscopy in this joint, whereas SA after previous joint injections accounted for 2.1% (n\u0026thinsp;=\u0026thinsp;4). Implant-related cases categorized represented 7.8% of instances (n\u0026thinsp;=\u0026thinsp;15). Posttraumatic reasons were identified in 9.4% of cases (n\u0026thinsp;=\u0026thinsp;18), with the remaining cases classified under the \"other\" category at 9.4% (n\u0026thinsp;=\u0026thinsp;18).\u003c/p\u003e\n\u003cp\u003ePathogens were identified, with \u003cem\u003eStaphylococcus aureus (S. aureus)\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;60; 31.3%), \u003cem\u003eStaphylococcus epidermidis (S. epidermidis)\u003c/em\u003e (n\u0026thinsp;=\u0026thinsp;11; 5.7%) and other pathogens\u0026acute; (n\u0026thinsp;=\u0026thinsp;11; 5.7%) being the most common. \u003cem\u003eS. aureus\u003c/em\u003e significantly presented more frequently as monoarticular arthritis (46 vs. 14, p\u0026thinsp;=\u0026thinsp;0.047), and the two methicillin-resistant \u003cem\u003eS. aureus (MRSA)\u003c/em\u003e cases exclusively exhibit polyarticular involvement. There was no observed correlation between a specific pathogen and increased mortality rates.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eDemographic data\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAll\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;192\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eDeceased\u003c/p\u003e\n\u003cp\u003en\u0026thinsp;=\u0026thinsp;64\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean Age (a)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e62.0\u0026thinsp;\u0026plusmn;\u0026thinsp;15\u003c/p\u003e\n\u003cp\u003e85 (44.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e69.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13\u003c/p\u003e\n\u003cp\u003e41 (64.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003emale\u003c/p\u003e\n\u003cp\u003efemale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e135 (70.3%)\u003c/p\u003e\n\u003cp\u003e57 (29.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e46 (71.9%)\u003c/p\u003e\n\u003cp\u003e18 (28.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean BMI\u003c/strong\u003e (kg/m\u0026sup2;)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.4\u0026thinsp;\u0026plusmn;\u0026thinsp;7\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean CCI\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.4\u0026thinsp;\u0026plusmn;\u0026thinsp;3\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eASA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eI\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19 (9.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2 (3.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e43 (22.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e5 (7.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIII\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e97 (50.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e41 (64.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 (16.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (25.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean lenght of hospital stay\u003c/strong\u003e (days)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.1\u0026thinsp;\u0026plusmn;\u0026thinsp;26\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMean ICU admission (days)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e14.7\u0026thinsp;\u0026plusmn;\u0026thinsp;18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e12.9\u0026thinsp;\u0026plusmn;\u0026thinsp;17\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLocation of SA\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eKnee\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98 (51%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31 (48.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eShoulder\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e35 (18.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e17 (26.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAnkle\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26 (13.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHip\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20 (10.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (10.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eHand\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (3.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eElbow\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e4 (2.1%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSternoclavicular\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1 (1.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eSkin and subcutaneous tissue infections were the predominant focus in 24.5% of cases. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePrimary infection foci\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eInfection type\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSkin and subcutaneous tissue\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47 (24.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePneumogenic\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30 (15.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eUrinary tract\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e18 (9.4%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eProsthetic joints\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e17 (8.9%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntraabdominal\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e14 (7.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eOral/dental\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e9 (4.7%)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e(1) The 5-year survival of patients with SA\u003c/h2\u003e\n\u003cp\u003eThroughout the study period, 64 patients (33.3%) died. Conversely, the 5-year survival rate was 71.7%. Notably, for 9 individuals (5%), the date of death remains uncertain. The mean duration of follow-up was 54.4\u0026thinsp;\u0026plusmn;\u0026thinsp;42 months, spanning from 0 to 149 months.\u003c/p\u003e\n\u003cp\u003eThe overall mortality was 17.5% at one year, 19.9% at two years and 28.3% at five years. Out of the total sample size of 65 patients (33.9%) died within 30 days (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e(2) Risk factors for the in-hospital mortality of SA patients\u003c/h2\u003e\n\u003cp\u003ePatients who presented with age 65 or older (45.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), arterial hypertension (43.2%; p\u0026thinsp;=\u0026thinsp;0.003), chronic heart failure (13.7%; p\u0026thinsp;=\u0026thinsp;0.001), chronic renal disease (7.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chronic liver disease (10.3%; p\u0026thinsp;=\u0026thinsp;0.013), peripheral vascular disease (11.5%; p\u0026thinsp;=\u0026thinsp;0.026), malignancy (13.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), steroid use (25.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), immunosuppression (10.0%; p\u0026thinsp;=\u0026thinsp;0.003), intraabdominal infection (7.1%; p\u0026thinsp;=\u0026thinsp;0.049), sepsis (24.2%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), septic shock (13.7%; p\u0026thinsp;=\u0026thinsp;0.049) and ICU admission (30.6%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) demonstrated a significant higher rate of mortality than patients without these conditions (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). Otherwise, sex, previous hospitalization, other comorbidities such as diabetes mellitus, rheumatological disease, were not associated with an elevated mortality rate during the follow-up.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eNumber of comorbidities and mortality\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eComorbidities\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003en (%)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e1-year mortality\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e2-year mortality\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e5-year mortality\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eAge\u0026thinsp;\u0026ge;\u0026thinsp;65a\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e81 (44.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e29.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eArterial hypertension\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32 (40.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e24.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic heart failure\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e13 (52.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic renal disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e24 (54.5%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e43.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e45.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e54.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eChronic liver disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (53.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e30.8%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e61.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePeripheral vascular disease\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (47.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e33.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.1%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e42.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eMalignancy\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e15 (60%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e37.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e46.0%%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65.7%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSteroid use\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22 (46.8%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e34.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.2%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eImmunosuppression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e10 (55.6%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e44.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e50.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e55.6%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eIntraabdominal infection\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e6 (46.2%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e38.5%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e47.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSepsis\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e23 (52.3%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e40.9%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e51.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSeptic shock\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16 (64.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e60.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e65.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eICU\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e28 (50.0%)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.4%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e41.3%\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e48.0%\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003e(3) Risk factors for the mortality of SA patients\u003c/h2\u003e\n\u003cp\u003eAge 65 years or older (OR\u0026thinsp;=\u0026thinsp;1.86; 95% CI 1.11 to 3.14; p\u0026thinsp;=\u0026thinsp;0.002) was significantly associated with in-hospital mortality (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Based on the patient records, 81 cases were classified as HASA (42.2%), while 111 cases (57.8%) were categorized as CASA. Neither HASA nor CASA cases demonstrated an increased in-hospital mortality rate (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThe shoulder was the sole joint affected by a risk factor associated with increased mortality, without statistical significance (OR\u0026thinsp;=\u0026thinsp;1.89; 95% CI 0.91 to 3.91; p\u0026thinsp;=\u0026thinsp;0.215) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eChronic renal disease was identified as a risk factor (OR\u0026thinsp;=\u0026thinsp;2.80; 95% CI 1.47 to 5.35; p\u0026thinsp;=\u0026thinsp;0.000), malignancy (OR\u0026thinsp;=\u0026thinsp;3.40; 95% CI 1.47 to 7.85; p\u0026thinsp;=\u0026thinsp;0.006), as well as chronic heart failure (OR\u0026thinsp;=\u0026thinsp;2.62; 95% CI 1.19 to 5.97; p\u0026thinsp;=\u0026thinsp;0.039) (Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eThere was a statistically significant correlation found between mortality and CCI (\u0026rho;=-0.421; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The ASA score of the 64 those who passed away, was significantly elevated, with a mean of 3.11 compared to 2.58 (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003eSepsis (OR\u0026thinsp;=\u0026thinsp;2.48; 95% CI 1.29 to 4.74; p\u0026thinsp;=\u0026thinsp;0.004), septic shock (OR\u0026thinsp;=\u0026thinsp;4.00; 95% CI 1.70 to 9.40; p\u0026thinsp;=\u0026thinsp;0.001) and multiorgan failure (OR\u0026thinsp;=\u0026thinsp;4.75; 95% CI 1.97 to 11.44; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with higher mortality.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present case series demonstrated that SA is linked with a high rate of 30-days mortality and a substantial 5-year mortality rate. Regarding outcomes, the 5-year survival rate was 71.7%, with an overall mortality of 28.3% at five years. Patients with age over 65 years (45.7%), arterial hypertension (43.2%), chronic heart failure (13.7%), chronic renal disease (7.1%), chronic liver disease (10.3%), peripheral vascular disease (11.5%), malignancy (13.7%), steroid use (25.7%), immunosuppression (10.0%), intraabdominal infection (7.1%;), sepsis (24.2%), septic shock (13.7%) and ICU admission (30.6%) had notably higher mortality rates.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e(1) The 5-year survival of patients with SA\u003c/h2\u003e \u003cp\u003eThe overall mortality was 7.1% at one year, 13.7% at two years and 23% at five years. Patients with septic arthritis and concomitant comorbidities were associated with increased mortality. Being 65 years or older (OR\u0026thinsp;=\u0026thinsp;1.86), having chronic kidney disease (OR\u0026thinsp;=\u0026thinsp;2.80) and experiencing congestive heart failure (OR\u0026thinsp;=\u0026thinsp;2.62) were identified as a significant risk factors for a higher risk of earlier mortality. Additionally, the knee joint was the sole joint affected by a risk factor for a higher mortality (OR\u0026thinsp;=\u0026thinsp;2.93).\u003c/p\u003e \u003cp\u003eThe mortality rate found in this study is in line with the rates reported in previous research. Mortality associated with SA has exhibited variability, ranging between 11% and 19%, as indicated by several studies [5; 14; 15; 24]. Notably, a smaller prospective study reported an 11% mortality rate [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Maneiro et al. identified a one-year mortality rate of 16.6% following the diagnosis [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Conversely, Huang et al., in a national cohort study involving 31.491 SA patients, reported mortality rates of 4.3%, 8.6%, and 16.4% at 30 days, 90 days, and one year, respectively [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Another study involving 543 patients revealed a 90-day mortality rate of 5% [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These variations underscore the nuanced nature of mortality outcomes in SA and highlight the importance of contextualizing findings within the broader landscape of existing research. Possible patient factors that vary, as well as microbial spectra and potentially differing healthcare structures may also contribute to these differences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e(2) Risk factors for the in-hospital mortality of SA patients\u003c/h2\u003e \u003cp\u003eIn our cohort study, patients over the age of 65 years exhibited a considerable mortality rate of 45.7% (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), highlighting the vulnerability of this age group. Furthermore, conditions such as arterial hypertension (43.2%; p\u0026thinsp;=\u0026thinsp;0.003), chronic heart failure (13.7%; p\u0026thinsp;=\u0026thinsp;0.001), chronic renal disease (7.1%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chronic liver disease (10.3%; p\u0026thinsp;=\u0026thinsp;0.013), peripheral vascular disease (11.5%; p\u0026thinsp;=\u0026thinsp;0.026), malignancy (13.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), steroid use (25.7%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), immunosuppression (10.0%; p\u0026thinsp;=\u0026thinsp;0.003), intraabdominal infection (7.1%; p\u0026thinsp;=\u0026thinsp;0.049), sepsis (24.2%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), septic shock (13.7%; p\u0026thinsp;=\u0026thinsp;0.049), and ICU admission (30.6%; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) were significantly associated with increased mortality rates compared to patients without these conditions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eConversely, factors such as sex, previous hospitalization, and other comorbidities such as diabetes mellitus and rheumatological disease did not exhibit a statistically significant association with elevated mortality during the follow-up period. Notably, a significant correlation was identified between mortality and the CCI (ρ=-0.421; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), emphasizing the importance of considering overall health status in prognostic assessments. Additionally, the ASA score among the 64 deceased individuals was found to be significantly higher, underscoring its potential as a predictive factor for adverse outcomes. This comprehensive analysis sheds light on the intricate interplay of various clinical parameters and their impact on mortality, providing valuable insights for risk stratification and patient management strategies.\u003c/p\u003e \u003cp\u003eExpanding our understanding of mortality in SA, existing literature indicates a 90-day mortality rate of 7%, escalating to 22%-69% in patients aged 80 and older [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. In other studies comorbidities such as diabetes mellitus, rheumatoid arthritis, bacteremia, and low creatinine clearance are also linked to increased mortality [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Specifically, patients with rheumatoid arthritis experiencing joint flare-ups are identified as particularly high-risk individuals [26; 27].\u003c/p\u003e \u003cp\u003eSignificant prognostic factors identified in the literature include increasing age (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), female sex (p\u0026thinsp;=\u0026thinsp;.046), higher CCI scores (p\u0026thinsp;\u0026lt;\u0026thinsp;.001), and lacking private insurance [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Yeh et al.'s study on 52 dialysis patients with SA revealed tunneled cuffed catheter and fever as predictors of positive blood culture, with tunneled cuffed catheter being a predictor of in-hospital mortality [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. A study examining SA in emergency departments in the United States revealed that the female sex, urban residence, treatment at a metropolitan teaching hospital, and the presence of medical comorbidities including diabetes mellitus, hyperlipidemia, hypertension, chronic obstructive pulmonary disease, coronary heart disease, gout, osteoarthritis, renal failure, and heart failure were associated with an elevated probability of hospitalization [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn line with prior investigations, our study recognized a similar pattern, with the knee emerging as the most frequently affected joint, closely followed by the shoulder. Specifically, 98 cases (51%) were related to the knee. A other study of 491 patients with SA, the knee emerged as the most frequently affected site, constituting 50.1% of cases, followed by the hip (14.4%), other anatomical locations (26.8%), the shoulder (5.5%), and involvement in multiple sites (1.2%) [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These findings align with current literature, emphasizing the significant prevalence of knee involvement [28; 31\u0026ndash;33]. The richness of literature on native knee arthritis supports our findings, as it is recognized as the most commonly affected joint [1; 34\u0026ndash;38].\u003c/p\u003e \u003cp\u003eSupporting the typical presentation, our study affirmed the predominant pattern of intra-articular infection, primarily characterized by monoarticular involvement. In alignment with established literature, our investigation also identified a congruent pattern, with approximately 20% of cases exhibiting participation in multiple joints, denoted as oligoarticular [9; 27].\u003c/p\u003e \u003cp\u003eIn managing SA cases, our study employed arthroscopic or open surgical lavage in each case of SA. Several studies have conducted comparisons between operative intervention and medical therapy [\u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In one study, patients received empirical intravenous therapy with cloxacillin and ceftriaxone based on culture results, with treatment adjusted according to microbial sensitivity [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] .Meanwhile, another study assessed treatment failure after 7 days, with surgical treatment defined as a need for a second surgery [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Notably, in contrast to a study of Mabille et al about knee and hip arthritis [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], our observed median duration of hospitalization was a little bit higher, specifically 28.3\u0026thinsp;\u0026plusmn;\u0026thinsp;23 days, with extremes ranging from 2 to 146 days. Mabille et al. found that the median duration of hospitalization was significantly higher in the surgical group compared to the medical group (33.5 vs. 21 days) [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. This difference was primarily attributed to post-intervention follow-up, particularly the extended rehabilitation period in a rehabilitation center within the surgical group. These findings confirm data published by Ravindran et al., emphasizing the impact of surgical intervention on post-treatment care and rehabilitation needs [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Timely intervention is imperative, encompassing the initiation of antibiotics alongside surgical lavage and debridement [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Arthroscopic methodologies have demonstrated comparable efficacy to conventional open techniques, offering the supplementary advantages of shorter hospitalization periods and enhanced postoperative recuperation [1; 6; 36; 43\u0026ndash;45]. The decision to utilize an arthroscopic approach is based on the discretion of the treating physician, with additional advantages including minimally invasive procedures, wound healing, functional outcomes, and reduced blood loss.\u003c/p\u003e \u003cp\u003eThe etiology of SA often presents a diagnostic challenge, with a significant proportion of cases lacking an identified causative bacterial organism. However, when a pathogenic organism is identified, \u003cem\u003eS. aureus\u003c/em\u003e emerges as the most prevalent, constituting 53% of the cases [9; 28; 29; 32; 36; 39]. In our study, consistent with existing literature, \u003cem\u003eS. aureus\u003c/em\u003e was the predominant pathogen identified, comprising 31.3% of cases. These pathogens in SA are associated with elevated mortality rates and profound joint dysfunction [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Furthermore, \u003cem\u003eS. aureus\u003c/em\u003e infections exhibit higher rates of cellulitis, abscess formation, and increased morbidity, leading to interventions such as fusion, amputation, or prosthetic joint replacement. Notably, drug-resistant strains, including \u003cem\u003eMRSA\u003c/em\u003e, are becoming more prevalent, especially in intravenous (IV) drug users, with vancomycin-resistant strains observed in patients with recurrent healthcare-associated infections [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOther studies identified MRSA infections were frequently associated with oligoarticular arthritis, while group B streptococci were more prevalent in cases of oligoarticular arthritis compared to monoarticular septic arthritis [27; 47]. In our study, the three \u003cem\u003eMRSA\u003c/em\u003e cases demonstrated oligoarticular arthritis. Moreover, \u003cem\u003estreptococci\u003c/em\u003e cases exhibited a predominance in monoarticular cases (7 vs. 3), and a significant pattern was observed in \u003cem\u003eS. aureus\u003c/em\u003e cases.\u003c/p\u003e \u003cp\u003eUnderstanding the microbial landscape of SA is crucial for tailoring effective treatment strategies, particularly in the context of emerging drug-resistant strains and the varied clinical manifestations associated with different pathogens. Further research is warranted to explore the evolving epidemiology of SA pathogens and their implications for patient outcomes.\u003c/p\u003e \u003cp\u003eCertain limitations should be acknowledged when interpreting the findings of this study. It is a single-center retrospective design, conducted in a German university hospital, may restrict the generalizability of findings to diverse populations. There is a potential for inherent selection bias as the study exclusively involves patients from an academic medical center, which could influence the observed severity and comorbidity profiles. The sample size of 192 patients, while relatively large compared to other studies, may still constrain the statistical robustness and broader generalizability of the findings. Diagnostic challenges in identifying SA, despite efforts to ensure accuracy, could lead to misclassifications or underdiagnoses. Dependence on electronic health records introduces the potential for data gaps or incompleteness, thereby influencing the precision of comorbidity assessments. The minimum follow-up period of 24 months may not adequately capture long-term outcomes, and statistical methods, while robust, lack specific details.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eA vulnerable patient group demonstrated a notably elevated mortality rate. Understanding the intricate interplay of factors contributing to mortality is paramount. Analyzing the specific risk factors unique to each patient, such as existing health conditions, is crucial in effectively addressing and treating SA. Our results emphasize the critical need for careful monitoring, particularly among SA patients with chronic organ diseases, prompt identification and handling of sepsis. These measures collectively aim to improve the chances of survival for this vulnerable group of patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eNot Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e: MS developed the conceptualization, methodology, data curation, software, and writing original draft preparation; LH performed much of the data entry and analysis NW, SB, DZ, JS, SL supervision and writing-reviewing; MR were contributors to the writing of the All authors read and approved the finale manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFundin\u003c/strong\u003eg: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials:\u003c/strong\u003e The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e The study was approved by the Investigational Review Board of University Hospital Regensburg.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e Not Applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eElsissy JG, Liu JN, Wilton PJ\u003cem\u003e et al.\u003c/em\u003e Bacterial Septic Arthritis of the Adult Native Knee Joint: A Review. \u003cem\u003eJBJS Rev\u003c/em\u003e 2020;\u003cstrong\u003e8\u003c/strong\u003e:e0059.\u003c/li\u003e\n\u003cli\u003eMargaretten ME, Kohlwes J, Moore D\u003cem\u003e et al.\u003c/em\u003e Does this adult patient have septic arthritis? \u003cem\u003eJAMA\u003c/em\u003e 2007;\u003cstrong\u003e297\u003c/strong\u003e:1478\u0026ndash;88.\u003c/li\u003e\n\u003cli\u003eMathews CJ, Kingsley G, Field M\u003cem\u003e et al.\u003c/em\u003e Management of septic arthritis: a systematic review. \u003cem\u003ePostgraduate Medical Journal\u003c/em\u003e 2008;\u003cstrong\u003e84\u003c/strong\u003e:265\u0026ndash;70.\u003c/li\u003e\n\u003cli\u003eGarc\u0026iacute;a-Arias M, Balsa A, Mola EM. 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Clinical management of septic arthritis. \u003cem\u003eCurr Rheumatol Rep\u003c/em\u003e 2013;\u003cstrong\u003e15\u003c/strong\u003e:332.\u003c/li\u003e\n\u003cli\u003eMiller JM, Binnicker MJ, Campbell S\u003cem\u003e et al.\u003c/em\u003e A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology. \u003cem\u003eClin Infect Dis\u003c/em\u003e 2018;\u003cstrong\u003e67\u003c/strong\u003e:e1-e94.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"septic arthritis, mortality, comorbidities, complication","lastPublishedDoi":"10.21203/rs.3.rs-3973771/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3973771/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSeptic arthritis (SA) poses a complex clinical puzzle and is associated with significant levels of morbidity and mortality. The objective of this study was (1) to explore overall mortality rates and (2) analyze and identify possible factors that might contribute to the risk of death in patients afflicted with SA.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective study focused on patients suffering from SA who received treatment at a German university hospital between January 01, 2011 to December, 31 2021. Identification of patients was carried out through International Classification of Diseases (ICD)-10 diagnosis codes specifically related to SA, denoted as \"M00.-\". The study analyzed the overall mortality rate as well as comorbidities, and pathogens as potential risk factors. Kaplan\u0026ndash;Meier probability plots and odds ratios (OR) for mortality were calculated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIn a cohort of 192 patients suffering from SA, 64 patients (33.3%) passed away during a mean follow-up time of 54.4\u0026thinsp;\u0026plusmn;\u0026thinsp;42 months. The overall mortality was 17.5% at one year, 19.9% at two years and 28.3% at five years. Patients being 65 years or older (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), arterial hypertension (p\u0026thinsp;=\u0026thinsp;0.003), congestive heart failure (p\u0026thinsp;=\u0026thinsp;0.001), chronic renal disease (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), chronic liver disease (p\u0026thinsp;=\u0026thinsp;0.013), peripheral vascular disease (p\u0026thinsp;=\u0026thinsp;0.026), malignancy (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), steroid use (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), immunosuppression (p\u0026thinsp;=\u0026thinsp;0.003) and intraabdominal infection (p\u0026thinsp;=\u0026thinsp;0.049) demonstrated a significant higher rate of mortality. Comorbidities were found to be associated with mortality. Chronic renal disease (OR\u0026thinsp;=\u0026thinsp;2.80; p\u0026thinsp;=\u0026thinsp;0.000), malignancy (OR\u0026thinsp;=\u0026thinsp;3.40; p\u0026thinsp;=\u0026thinsp;0.006) and chronic heart failure (OR\u0026thinsp;=\u0026thinsp;2.62; p\u0026thinsp;=\u0026thinsp;0.039).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe vulnerable patient group demonstrated a notably elevated mortality rate. Understanding the intricate interplay of factors contributing to mortality is paramount. Prompt evaluation and addressing of individualized risk factors in the early stages could offer significant advantages in effectively managing and treating SA, thereby lowering the chances of mortality. These results underscore the critical need for vigilant monitoring of SA patients who have pre-existing chronic organ conditions, timely recognition, and prompt intervention for sepsis.\u003c/p\u003e","manuscriptTitle":"Survival and Risk Factor Analysis in Patients with Septic Arthritis: A Retrospective Study of 192 Cases","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-29 20:12:47","doi":"10.21203/rs.3.rs-3973771/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-08T06:53:09+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-25T18:45:17+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-11T10:51:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"180587170332839588641944006782516036976","date":"2024-08-27T04:51:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-07-29T15:27:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"235210947977450085734664361762399180263","date":"2024-07-10T08:50:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"189104888007398343678761266573432014424","date":"2024-07-03T14:52:38+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-04-15T15:58:19+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-27T07:36:37+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-27T04:13:50+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-27T04:04:38+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-02-20T20:09:30+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7ecf858d-2541-4469-b93d-1757421ab152","owner":[],"postedDate":"February 29th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-24T16:07:19+00:00","versionOfRecord":{"articleIdentity":"rs-3973771","link":"https://doi.org/10.1186/s12879-024-10316-0","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-03-18 15:58:21","publishedOnDateReadable":"March 18th, 2025"},"versionCreatedAt":"2024-02-29 20:12:47","video":"","vorDoi":"10.1186/s12879-024-10316-0","vorDoiUrl":"https://doi.org/10.1186/s12879-024-10316-0","workflowStages":[]},"version":"v1","identity":"rs-3973771","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3973771","identity":"rs-3973771","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}