Outcomes of Adjunctive Therapy with Open Arthrotomy for Patients with Septic Arthritis Due to Melioidosis: A Retrospective Study

Sorawit Chittrakarn Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Pisud Siripaitoon Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Narongdet Kositpantawong Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Siripen Kanchanasuwan Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Duangkamol Aiewruengsurat Allergy and Rheumatology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Piyawat Bintachitt Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand

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Boonsri Charoenmak Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Monchana Jullangkoon Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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Sarunyou Chusri Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand;

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ABSTRACT.

Melioidosis is a potentially fatal infection caused by the bacterium Burkholderia pseudomallei. Septic arthritis caused by this infection is uncommon and difficult to treat. The role of adjunctive open arthrotomy in this type of infection has not yet been elucidated. We conducted a retrospective study of patients with microbiologically confirmed melioidosis between January 2002 and December 2022. Patients with a clinical condition of septic arthritis and positive cultures for B. pseudomallei were included. Comparisons were made between patients who received adjunctive therapy with open arthrotomy with conventional standard treatment and those who did not in terms of clinical outcomes and hospital expenditures. Of the 478 patients diagnosed with melioidosis microbiological confirmation, 81 patients had septic arthritis, accounting for 17% of cases. Among these patients, only 36 (44%) underwent adjunctive therapy with open arthrotomy. The 14-day and 30-day in-hospital mortality and length of hospital stays of patients who underwent adjunctive therapy with open arthrotomy were more favorable than those of patients who did not receive adjunctive therapy with open arthrotomy; however, the difference was not statistically significant. Patients who underwent adjunctive therapy with open arthrotomy had lower hospital expenditures (antimicrobial and non-antimicrobial costs) than those who did not undergo open arthrotomy. Adjunctive therapy with open arthrotomy for patients with septic arthritis due to melioidosis was associated with favorable clinical outcomes and significantly lower hospital expenditures.

Author Notes

Disclosures: This study was approved by the Ethics Committee of the Faculty of Medicine, Prince of Songkla University (certification number: REC.66-349-14-1). The requirement for informed consent from participants or representatives was waived owing to the retrospective nature of the study, and the data were fully anonymized before analysis and presentation.

Authors’ addresses: Sorawit Chittrakarn, Pisud Siripaitoon, Narongdet Kositpantawong, Siripen Kanchanasuwan, Boonsri Charoenmak, Monchana Jullangkoon, and Sarunyou Chusri, Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand, E-mails: sorawit.c@psu.ac.th, grippen45@gmail.com, poom_032@yahoo.com, kaymed29@yahoo.com, cboonsrii@medicine.psu.ac.th, nana_jittung@hotmail.com, and sarunyouchusri@hotmail.com. Duangkamol Aiewruengsurat, Allergy and Rheumatology Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand, E-mail: dklangkamol@yahoo.com. Piyawat Bintachitt, Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand, E-mail: piyabintap@hotmail.com.

Address correspondence to Sarunyou Chusri, Infectious Disease Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand. E-mail: Sarunyouchusri@hotmail.com
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