A combination of surgical and medical treatment is normally required for patients with
septic arthritis.
Antibiotics selected for use on these patients are normally based on tissue culture results. However, in sub-acute and chronic
septic arthritis cases, the results of the culture are usually negative as a result of prior treatment. The present study will investigate the incidence of culture-negative
septic arthritis and the outcomes based on the use of first-line
drug antibiotics for the treatment of sub-acute and chronic
septic arthritis. For the present study, the authors retrospectively reviewed medical records of surgically treated
septic arthritis cases over the past 10 years at Siriraj Hospital. The patient culture results, the
antibiotics used, and the results of treatment were all recorded and analyzed. One hundredfifty-three
septic arthritis patients were reviewed. Sixty-two patients were classified as having been diagnosed with either sub-acute or chronic
septic arthritis. Thirty-six of 62 patients (58.1%) had a negative culture result. In the culture-positive patients, 42.3% had Streptococcus, 26.9% had Staphylococcus aureus, 11.5% had other gram positive bacteria, 15.4% had gram-negative bacteria, and 3.8% had tuberculus
infection. In the culture-negative sub-acute and chronic group (36 of 62), 23 patients received
Cefazolin, nine patients received
Cloxacillin, and four patients received
Clindamycin. Successful results were 69.9%, 66.7% and 75%, respectively. The present study reflects that the incidence ofculture-negative, sub-acute and chronic
septic arthritis is approximately 58.1%. The first-line class of
antibiotics remains the appropriate
antibiotic choice for these patients because they are still effective for treatment of
septic arthritis in up to 70% of all cases.