A Study Of Septic Arthritis At Kenyatta National Hospital (Kenya) (a Five-year Retrospective/prospective Study)

Abstract

A study of septic arthritis at Kenyatta National Hospital was done in two stages:- First, a retrospective study was carried out by reviewing files of patients, then a prospective study of patients was done. The retrospective study was of patients seen between July 1980 and July 1984. The prospective study was of patients seen between July 1984 and July 1985. A total of 87 patients were studied. Of these, 42 were retrospective cases and 45 prospective cases. The data was obtained from the hospital records, wards and orthopaedic clinic. Septic arthritis was found to be common in children below the age of 5 years who accounted for 37% of the total number of patients studied. Male to female ratio was noted to be 21: 8. 45 per cent of the patients studied presented with a history of trauma with or without evidence of trauma. The knee joint was the most commonly affected joint accounting for 35 per cent of all the affected joints. The commonest bacterial strains isolated from the synovial fluid aspirated from the affected joints were: - staphyloccocus aureus accounting for 35%, gram negative organisms of which klebsiella species comprised 12%, salmonella species comprised 11% and proteus species 11% of all the bacterial strains isolated. Most staphylococcal strains isolated were sensitive to erythromycin, septrin, aminoglycosides and minocycline and very few strains were sensitive to ampicillin and penicillin G. Most gram negative organisms isolated were sensitive to am ikac in and gentamycin and sensitivity to kanamycin was found to be inferior to that of either gentamycin or amikacin. Good immediate results were noted in 840/0of patients by arthrocentesis and specific antibiotics while in those treated by arthrotomy or surgical toilet and specific antibiotics, good immediate results occurred in 580/0of the patients. A word of caution here is that most patients subjected to surgery were those with advanced disease in whom joint destruction had set in, or those with infected traumatic wounds, and these factors affected the immediate outcome of the treatment instituted. It is recommended that attempt should be made to arrive at early diagnosis before joint destruction ensues and specific antibiotics of correct dosage and for long enough duration be given together with adequate drainage and splintage or traction.