Methicillin-Resistant Staphylococcus aureus Arthritis in Adults: Case Report and Review of the Literature

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis has emerged over the past 25 years as an increasingly prevalent and serious infection. We sought to characterize the clinical features of MRSA septic arthritis in adult patients. Methods: We report a case of community-acquired fatal MRSA septic arthritis of the hip and analyze the clinical features of 56 additional adult patients with native-joint MRSA septic arthritis identified through a systematic literature review. Results: Among 56 previously reported cases of MRSA native-joint septic arthritis, 42 were men, 14 had polyarticular infections, 5 were previously healthy individuals with community-acquired infections, and 8 had a fatal outcome. The most frequent predisposing factor was a preexisting rheumatologic condition. The knees and shoulders were most commonly affected. Conclusions: MRSA native-joint septic arthritis is a predominantly male disease that is usually nosocomial in origin but can occur rarely in health care naive patients. A preexisting rheumatic disease is the most common predisposition. Community-acquired MRSA septic arthritis can be fatal. Cultures should be performed promptly, to identify potential antibiotic resistance. Patients presenting with both community-acquired and nosocomial septic arthritis should receive initial antibiotic treatment that includes coverage for MRSA. (C) 2012 Elsevier Inc. All rights reserved. Semin Arthritis Rheum 41:604-610