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Is Septic Wrist Overdiagnosed and Overtreated?
Ying C. Ku, BS; Mazen Al-Malak, MD; Ryan Khalaf, BS; Diane Jo, MA; Lianne Mulvihill, BA; Jacob Lammers, DO; R'ay S Fodor, BS; Jose Reyes, BS; Brian A. Figueroa, MD; Antonio Rampazzo, MD, PhD; Bahar Bassiri Gharb, MD, PhD.
Department of Plastic and Reconstructive Surgery, Cleveland Clinic Foundation
2023-02-01
Presenter: Ying Ku
Affidavit:
The submission is original work and has not been previously presented at any major meetings.
Director Name: Bahar Bassiri Gharb
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: Hand
Background: The existing diagnostic criteria for septic wrist are non-specific and patients with non-infectious etiologies risk undergoing unnecessary surgeries. This study aimed to investigate evidence of bacterial infection in patients who underwent open drainage of the joint.
Methods: A retrospective review of 117 patients with a presumed diagnosis of septic wrist who underwent open drainage at our institution was performed. Evidence of bacterial infection was determined as a positive Gram stain/culture result from arthrocentesis or open drainage. Bivariate analyses were conducted to identify correlations of bacterial infection with comorbidities (autoimmune diseases, immunosuppression, inflammatory arthritis, IV drug use), imaging results, synovial fluid analysis, blood culture, inflammatory markers (ESR, CRP, WBC), and antibiotics administration.
Results: Forty-three females and 74 males with an average age of 57.3ą17.7 were included. Median follow-up was 1.3[3] months. Thirty-six patients (30.8%) demonstrated no evidence of bacterial infection per Gram stain/culture. Of these, 10 patients received alternative diagnoses post-surgery. Eleven (44%) out of the remaining 26 patients had no purulent material identified during the operation. No antibiotics administration prior to the procedures (p=0.01), negative synovial crystals (p=0.02), and positive blood culture (p=0.002) were associated with evidence of bacterial infection. No associations were identified between evidence of bacterial infection and each comorbid condition (p=0.1-0.32), synovial WBC (p=0.72), imaging (p=0.2), and each inflammatory marker (p=0.19-0.99). Complete recovery was noted in 30 patients at 2[2.3] months.
Conclusion: A high percentage of patients that underwent open drainage exhibited negative evidence of bacteria, indicating the possibility that septic wrist is over-treated.
