Author
Catherine J Mathews
Bio: Catherine J Mathews is an academic researcher. The author has contributed to research in topics: Septic arthritis & Arthritis. The author has an hindex of 5, co-authored 8 publications receiving 978 citations.
Papers
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TL;DR: The changing epidemiology of septic arthritis of native joints in adults, encompassing the increasing frequency of the disorder and its evolving antibiotic resistance is reviewed, including the advent of novel and antibiotic-resistant causative microorganisms and within the current climate of increased immunosuppression.
492 citations
TL;DR: No investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor, and key unanswered questions remain surrounding the medical and surgical management of the infected joint.
Abstract: Objective: To evaluate the existing evidence on the diagnosis and management of septic arthritis in native joints.
Design: Systematic review.
Data sources: Cochrane Library, Medline, Embase, National Electronic Library for Health, reference lists, national experts.
Review methods: Systematic review of the literature with evaluation of the methodological quality of the selected papers using defined criteria set out by the Clinical Effectiveness and Evaluation Unit of the Royal College of Physicians.
Results: 3291 citations were initially identified. Of these, 189 full text articles were identified for potential selection. Following review of these full text articles, 80 articles were found to fulfil the inclusion criteria and were included in the final list. Conclusions were drawn on the diagnosis, investigation and management of septic arthritis.
Discussion: Little good quality evidence exists to guide the diagnosis and management of septic arthritis. Overall, no investigation is more reliable in the diagnosis of septic arthritis than the opinion of an experienced doctor. Aspiration and culture of synovial fluid is crucial to the diagnosis, but measurement of cell count is unhelpful. Antibiotics are clearly required for a prolonged period, but there are no data to indicate by which route or for how long. Key unanswered questions remain surrounding the medical and surgical management of the infected joint.
234 citations
TL;DR: These guidelines focus on the diagnosis and management of septic arthritis, which is the most serious type of hot swollen joint and has wide differential diagnosis.
Abstract: The clinical presentation of a hot swollen joint is common and has wide differential diagnosis. The most serious is septic arthritis, with a case fatality of 11%. Delayed or inadequate treatment leads to joint damage. These guidelines focus on the diagnosis and management of septic arthritis. Hot swollen joints commonly have other underlying diagnoses, including crystal arthritis, reactive arthritis and a monoarticular presentation of polyarthritis.
218 citations
TL;DR: There is a striking paucity of high-quality evidence upon which to base guidelines on the management of the hot-swollen joint, and the diagnosis of septic arthritis rests on the opinion of a clinician experienced in the assessment of musculoskeletal disease.
Abstract: Purpose of reviewTo propose and discuss an evidence-based algorithm for the diagnosis and treatment of bacterial septic arthritis. Also, to review the recent literature on emerging management strategies and discuss the potential impact of these developments on clinical practice.Recent findingsEviden
172 citations
TL;DR: The results of this work suggest the basis for potential targets for adjunctive immunotherapy, and changing patterns in microbial etiology and sensitivities are reviewed, and predictions made surrounding emerging causative organisms.
Abstract: Septic arthritis is a disease with a high morbidity and mortality. Antimicrobial therapy is not always sufficient to prevent joint damage and overwhelming sepsis. This review examines the progress that has been made in understanding the molecular mechanisms underlying joint sepsis. The results of this work suggest the basis for potential targets for adjunctive immunotherapy. Changing patterns in microbial etiology and sensitivities are also reviewed, and predictions made surrounding emerging causative organisms.
7 citations
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TL;DR: These guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system infections.
Abstract: Evidence-based guidelines for the management of patients with methicillin-resistant Staphylococcus aureus (MRSA) infections were prepared by an Expert Panel of the Infectious Diseases Society of America (IDSA). The guidelines are intended for use by health care providers who care for adult and pediatric patients with MRSA infections. The guidelines discuss the management of a variety of clinical syndromes associated with MRSA disease, including skin and soft tissue infections (SSTI), bacteremia and endocarditis, pneumonia, bone and joint infections, and central nervous system (CNS) infections. Recommendations are provided regarding vancomycin dosing and monitoring, management of infections due to MRSA strains with reduced susceptibility to vancomycin, and vancomycin treatment failures.
3,370 citations
TL;DR: This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of S. aureus as a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections.
Abstract: Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.
3,054 citations
01 Oct 2012
TL;DR: This work will provide an overview of the mechanisms and factors involved in bacterial adhesion, the techniques that are currently being used studying bacterial-material interactions as well as provide insight into future directions in the field.
Abstract: Staphylococcus comprises up to two-thirds of all pathogens in orthopedic implant infections and they are the principal causative agents of two major types of infection affecting bone: septic arthritis and osteomyelitis, which involve the inflammatory destruction of joint and bone. Bacterial adhesion is the first and most important step in implant infection. It is a complex process influenced by environmental factors, bacterial properties, material surface properties and by the presence of serum or tissue proteins. Properties of the substrate, such as chemical composition of the material, surface charge, hydrophobicity, surface roughness and the presence of specific proteins at the surface, are all thought to be important in the initial cell attachment process. The biofilm mode of growth of infecting bacteria on an implant surface protects the organisms from the host immune system and antibiotic therapy. The research for novel therapeutic strategies is incited by the emergence of antibiotic-resistant bacteria. This work will provide an overview of the mechanisms and factors involved in bacterial adhesion, the techniques that are currently being used studying bacterial-material interactions as well as provide insight into future directions in the field.
569 citations
TL;DR: The changing epidemiology of septic arthritis of native joints in adults, encompassing the increasing frequency of the disorder and its evolving antibiotic resistance is reviewed, including the advent of novel and antibiotic-resistant causative microorganisms and within the current climate of increased immunosuppression.
492 citations
Johns Hopkins University School of Medicine1, University of Toronto2, Hannover Medical School3, Case Western Reserve University4, University College Dublin5, Duke University6, Freeman Hospital7, University of Alabama at Birmingham8, Cleveland Clinic Lerner College of Medicine9, Eastern Virginia Medical School10, Stanford University11, Harvard University12, University of Pittsburgh13
TL;DR: These standard definitions of infections in VAD patients are created by adapting and expanding on existing standardized definitions, which are based on the pathophysiology of equivalent infectious processes in prosthetic devices, such as cardiac prosthetic valve infections, intravascular catheter-related infections, and prosthetic joint infections.
Abstract: In 2009, the International Society for Heart and Lung Transplantation (ISHLT) recognized the importance of infectionrelated morbidity and mortality in patients using ventricular assist devices (VADs) and the growing need for a consensusbased expert opinion to provide standard definitions of infections in these patients. The aim of these standard definitions is to improve clinical-investigator communication, allowing meaningful comparison in practice and outcomes between different centers and different VAD devices. In 2010, a core group of experts, including infectious diseases specialists, cardiologists, pathologists, radiologists, and cardiothoracic surgeons, formed an ISHLT Infectious Diseases Working Group to develop agreed criteria for definitions of infections in VAD patients. These definitions have been created by adapting and expanding on existing standardized definitions, which are based on the pathophysiology of equivalent infectious processes in prosthetic devices, such as cardiac prosthetic valve infections, intravascular catheter-related infections, and prosthetic joint infections. These definitions have been divided into 3 sections: VAD-specific infections, VAD-related infections, and non-VAD infections. Owing to the constant shortage of donor organs, new allocation systems, and improved medical therapies for congestive cardiac failure, the overwhelming trend in cardiac transplantation has been toward listing principally the most critically ill patients, that is, those requiring inpatient inotropic therapy for mechanical circulatory support (MCS). The ventricular assist device (VAD) has an expanding role in the management of these patients, both as a bridge to transplantation and as a destination therapy (ie, alternative to transplantation). According to United Network of Organ Sharing (UNOS) registry data, 9,000 transplant candidates have undergone MCS since 1999, comprising 33% of all listed patients and 75% of all listed inpatients. 1
303 citations