Skip to main content

Main menu

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
    • 50th Volume Reprints
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • JRheum Supplements
  • Services

User menu

  • My Cart
  • Log In

Search

  • Advanced search
The Journal of Rheumatology
  • JRheum Supplements
  • Services
  • My Cart
  • Log In
The Journal of Rheumatology

Advanced Search

  • Home
  • Content
    • First Release
    • Current
    • Archives
    • Collections
    • Audiovisual Rheum
    • COVID-19 and Rheumatology
    • 50th Volume Reprints
  • Resources
    • Guide for Authors
    • Submit Manuscript
    • Payment
    • Reviewers
    • Advertisers
    • Classified Ads
    • Reprints and Translations
    • Permissions
    • Meetings
    • FAQ
    • Policies
  • Subscribers
    • Subscription Information
    • Purchase Subscription
    • Your Account
    • Terms and Conditions
  • About Us
    • About Us
    • Editorial Board
    • Letter from the Editor
    • Duncan A. Gordon Award
    • Privacy/GDPR Policy
    • Accessibility
  • Contact Us
  • Follow jrheum on Twitter
  • Visit jrheum on Facebook
  • Follow jrheum on LinkedIn
  • Follow jrheum on YouTube
  • Follow jrheum on Instagram
  • Follow jrheum on RSS
LetterLetter

Septic Oligoarthritis Caused by Klebsiella pneumoniae and Acinetobacter baumannii

MAURICIO F.S. MARCHI and RAFAEL S. GOMES
The Journal of Rheumatology July 2013, 40 (7) 1239-1240; DOI: https://doi.org/10.3899/jrheum.130117
MAURICIO F.S. MARCHI
Fundação Universidade Regional de Blumenau, Department of Medicine, Antônio da Veiga, N. 140, Health Sciences Department, J-105 Blumenau, Santa Catarina 89012-900, Brazil.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
RAFAEL S. GOMES
Fundação Universidade Regional de Blumenau, Department of Medicine, Antônio da Veiga, N. 140, Health Sciences Department, J-105 Blumenau, Santa Catarina 89012-900, Brazil.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: gomesmed2002@ibest.com.br
  • Article
  • Info & Metrics
  • References
  • PDF
  • eLetters
PreviousNext
Loading

To the Editor:

Septic arthritis is an uncommon and potentially fatal emergency associated with significant mortality and morbidity rates, with an incidence in the general population reported to be 2 to 5 per 100,0001. Bacteria may spread directly from adjacent osteomyelitis or from a local soft-tissue infection, diagnostic or therapeutic procedure, or penetrating trauma1. Usually, this condition is caused by S. aureus, which accounts for two-thirds of the cases, whereas septic arthritis caused by Klebsiella pneumoniae or Acinetobacter baumannii are rare conditions seldom reported2,3,4,5. We describe a case of an adult male with oligoarthritis septic arthritis due to extended-spectrum beta-lactamase K. pneumoniae and imipenem-resistent A. baumannii after arthroscopic surgery of the knee. To our knowledge, this is the first report of a patient with septic oligoarthritis simultaneously coinfected by the pathogens K. pneumoniae and A. baumannii.

A 52-year-old man underwent arthroscopic surgery of the right knee because of a meniscal lesion. After 5 months, he developed signs of oligoarthritis in both elbows and on the operated knee. Examination showed all 3 articulations were swollen and hot, with signs of articular effusion, periarticular pain, and partial limitation of movement. Blood count and biochemical markers did not show any relevant characteristics. Erythrocyte sedimentation rate and C-reactive protein levels were elevated (95 mm/h and 236 mg/dl, respectively), and remained high throughout the next 7 months. He underwent open surgery of both elbows and arthrocentesis of the right knee to collect material for culture and analysis of the synovial fluid. He then progressed to a septic state and to acute respiratory failure and received broad-spectrum antibiotics, initially oxacillin and meropenem, with the purpose of covering both gram-positive and −negative germs. The bacterial culture of the synovial fluids and Kirby-Bauer antibiotic testing revealed extended-spectrum beta-lactamase K. pneumoniae in both elbows and imipenem-resistent A. baumannii in the right knee. All the hemocultures were negative. He received a combination of vancomycin and polymyxin B. In consequence of his general condition he was sent to the intensive care unit, where he remained for 45 days. After discharge, he maintained functional capacity of the joints, although he could not fully extend both elbow joints. He did not develop any other complications such as osteomyelitis or pyomyositis.

This case is unusual for several reasons. First, nongonococcal bacterial arthritis usually affects only 1 joint, most commonly the knee, while polyarticular involvement occurs in only 10% to 15% of cases, usually in patients with rheumatoid arthritis, systemic connective tissue disorder, or overwhelming sepsis6,7,8,9. Second, most cases are caused by S. aureus, whereas only 15% of cases are caused by gram-negative bacteria, which are most commonly seen in immunocompromised and elderly patients2,4,10. Third, although K. pneumoniae is a common cause of gram-negative bloodstream infection, septic arthritis caused by this pathogen is a rare condition in adult patients. Even though the mortality rate from septic arthritis caused by K. pneumoniae is relatively low, around 7.1%, early recognition and treatment of the infection is important to reduce complications such as joint destruction3,4. Finally, septic arthritis caused by A. baumannii is hardly ever reported; however, the incidence of nosocomial infections has been increasing, consequently, infections caused by A. baumannii must be treated immediately to prevent nosocomial cross-infection and bacterial spread11. It is a challenging task to treat infections caused by antibiotic-resistant bacteria, and such infections are likely to cause multiple organ failure and death11.

REFERENCES

  1. 1.↵
    1. Kherani RB,
    2. Shojania K
    . Septic arthritis in patients with pre-existing inflammatory arthritis. CMAJ 2007;176:1605–8.
    OpenUrlFREE Full Text
  2. 2.↵
    1. Mathews CJ,
    2. Weston VC,
    3. Jones A,
    4. Field M,
    5. Coakley G
    . Bacterial septic arthritis in adults. Lancet 2010;375:846–55.
    OpenUrlCrossRefPubMed
  3. 3.↵
    1. Kohler JE,
    2. Hutchens MP,
    3. Sadow PM,
    4. Modi BP,
    5. Tavakkolizadeh A,
    6. Gates JD
    . Klebsiella pneumoniae necrotizing fasciitis and septic arthritis: An appearance in the Western hemisphere. Surg Infect 2007;8:227–32.
    OpenUrlCrossRef
  4. 4.↵
    1. Schelenz S,
    2. Bramham K,
    3. Goldsmith D
    . Septic arthritis due to extended spectrum beta lactamase producing Klebsiella pneumoniae. Joint Bone Spine 2007;74:275–8.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Markusse HM,
    2. Timmerman RJ
    . Infectious arthritis caused by Klebsiella. A report of two cases. Clin Rheumatol 1989;8:517–21.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Nade S
    . Septic arthritis. Best Pract Res Clin Rheumatol 2003;17:183–200.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Dubost JJ,
    2. Soubrier M,
    3. Sauvezie B
    . Pyogenic arthritis in adults. Joint Bone Spine 2000;67:11–21.
    OpenUrlPubMed
  8. 8.↵
    1. Carpenter CR,
    2. Schuur JD,
    3. Everett WW,
    4. Pines JM
    . Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med 2011;18:781–96.
    OpenUrlCrossRefPubMed
  9. 9.↵
    1. Goldenberg DL
    . Septic arthritis. Lancet 1998;351:197–202.
    OpenUrlCrossRefPubMed
  10. 10.↵
    1. García-Arias M,
    2. Balsa A,
    3. Mola EM
    . Septic arthritis. Best Pract Res Clin Rheumatol 2011;25:407–21.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Duan X,
    2. Yang L,
    3. Xia P
    . Septic arthritis of the knee caused by antibiotic-resistant Acinetobacter baumannii in a gout patient: A rare case report. Arch Orthop Trauma Surg 2010;130:381–4.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

The Journal of Rheumatology
Vol. 40, Issue 7
1 Jul 2013
  • Table of Contents
  • Table of Contents (PDF)
  • Index by Author
  • Editorial Board (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word about The Journal of Rheumatology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Septic Oligoarthritis Caused by Klebsiella pneumoniae and Acinetobacter baumannii
(Your Name) has forwarded a page to you from The Journal of Rheumatology
(Your Name) thought you would like to see this page from the The Journal of Rheumatology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Septic Oligoarthritis Caused by Klebsiella pneumoniae and Acinetobacter baumannii
MAURICIO F.S. MARCHI, RAFAEL S. GOMES
The Journal of Rheumatology Jul 2013, 40 (7) 1239-1240; DOI: 10.3899/jrheum.130117

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero

 Request Permissions

Share
Septic Oligoarthritis Caused by Klebsiella pneumoniae and Acinetobacter baumannii
MAURICIO F.S. MARCHI, RAFAEL S. GOMES
The Journal of Rheumatology Jul 2013, 40 (7) 1239-1240; DOI: 10.3899/jrheum.130117
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One
Bookmark this article

Jump to section

  • Article
    • REFERENCES
  • Info & Metrics
  • References
  • PDF
  • eLetters

Related Articles

Cited By...

More in this TOC Section

  • IgG4-Related Disease With Testicular Involvement: Association or Coincidence?
  • The Use of Tofacitinib Has a Potential Effect on Improving the Outcomes of Melanoma Differentiation–Associated Gene 5–Related Interstitial Lung Disease
  • Considerable Uncertainty About the Burden of Gout in the Middle East and North Africa Region
Show more Letters

Similar Articles

Content

  • First Release
  • Current
  • Archives
  • Collections
  • Audiovisual Rheum
  • COVID-19 and Rheumatology

Resources

  • Guide for Authors
  • Submit Manuscript
  • Author Payment
  • Reviewers
  • Advertisers
  • Classified Ads
  • Reprints and Translations
  • Permissions
  • Meetings
  • FAQ
  • Policies

Subscribers

  • Subscription Information
  • Purchase Subscription
  • Your Account
  • Terms and Conditions

More

  • About Us
  • Contact Us
  • My Alerts
  • My Folders
  • Privacy/GDPR Policy
  • RSS Feeds
The Journal of Rheumatology
The content of this site is intended for health care professionals.
Copyright © 2022 by The Journal of Rheumatology Publishing Co. Ltd.
Print ISSN: 0315-162X; Online ISSN: 1499-2752
Powered by HighWire