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Septic arthritis (SA) is among the few true orthopedic emergencies1 and can lead to cartilage damage, permanent disability, and even death.2 Patients with articular abnormalities, diabetes, low socioeconomic status, cutaneous ulcers or skin infections, or injection drug use (IDU) are at increased risk for SA.1 Patients with IDU represent a unique population who may have characteristics and behaviors that predispose them to worse outcomes after SA. Injection drug use increases the risk of morbidity and death from drug overdose as well as the many acute and chronic diseases associated with recurrent hematogenous infections.3
Recent studies have linked the increasing rates of IDU in the United States to the opioid epidemic as more nonmedical users of prescription opioids have transitioned to injectable forms of narcotics.4–6 Concurrent with the increase in IDU has been an increase in the incidence of SA among patients with IDU.7 Nonsterile injection technique is a risk factor for SA because it can introduce skin flora into the blood-stream or tissue via primary inoculation.8,9 Recent studies have noted a shift to more antibiotic-resistant or virulent pathogens, such as methicillin-resistant Staphylococcus aureus (MRSA), among patients with SA.10–12 Septic arthritis caused by resistant organisms is associated with higher rates of complications, reoperation, and death, in addition to higher treatment costs.7,13–15
Studies have reported microbial trends in SA in the IDU population, but results have differed over time and by geographic location.9,10,12,16–20 Rates of MRSA and methicillin-sensitive S aureus (MSSA) are reportedly higher in IDU-associated SA (IDU-SA) compared with non–IDU-associated SA (non–IDU-SA).10,13,16 The differences in the clinical courses of these patients are poorly understood.
In this study, the authors analyzed the differences in preoperative characteristics, microbial characteristics, and postoperative outcomes between patients with IDU-SA and non–IDU-SA groups. They hypothesized that patients with IDU-SA would have higher rates of resistant pathogens, longer hospital stays, higher rates of discharge to a skilled nursing facility or against medical advice, lower rates of follow-up, and higher rates of persistent/secondary infections.
Materials and Methods
This study received institutional review board approval. The authors retrospectively reviewed the medical records of all 208 cases of operatively treated SA confirmed by positive culture between May 2015 and May 2019 at 2 academic urban...