Clinical features and aetiology of septic arthritis in northern Israel

Objective. To assess the clinical features and determine the pathogens responsible for septic arthritis in patients admitted to two community hospitals in the Haifa district in northern Israel over a 17-yr period. Methods. A retrospective study of the hospital records of patients with septic arthritis admitted to Carmel Medical Center and Bnai Zion Medical Center in Haifa between 1987 and 2003. Results. Of 150 cases identified by discharge summary diagnostic codes, only 110 patients met criteria for the case definition of septic arthritis, and these form the basis of this report. Their mean age was 37.2 yr. Of the patients, 10.4% were recent immigrants, most of them from the former Soviet Union and from Ethiopia. Primary joint disease was reported in 21.8% of the cases, osteoarthritis being most prevalent (8.1%). Of the infected joints, 8.1% were prosthetic. Staphylococcus aureus was the most common pathogen isolated, making up 40% of all positive cultures. Streptococcal and Gram-negative bacilli were both identified in 14%. Eight patients had tuberculous arthritis (9%). Another pathogen, unusual in developed countries, was Brucella species, which was identified in 11% of the cases. Two-thirds of the patients underwent surgical joint drainage while the rest were treated solely with antibiotics. Conclusions. The present study highlights the importance of characterizing the profile of species causing septic arthritis in specific regions, taking into account ethnic, genetic and environmental factors. In our survey population, tuberculous arthritis is a growing problem, mainly due to recent immigration waves, and brucella is an endemic and common pathogen. It is important to keep a high level of suspicion for these latter two bacteria, as they require special and unique care.