Microbiological profile of septic arthritis in Pakistani population – A prospective study

Objective: The objective of this study is to observe the positive rate of aspirated synovial fluid culture, bacterial isolation and their antibiotic susceptibility against commonly used drugs in a microbiology laboratory. Material and Methods: During a period of 6 months, 398 synovial fluid samples were analyzed using VITEK-MS for identification and tested for antibiotic susceptibility following standard recommendations. Results: Only 22% (89) of the samples showed aerobic bacterial growth while 77.6% (309) were negative. The primary pathogen, Staphylococcus aureus (49.4%), exhibited resistance to Cefoxitin (56%), Co-trimoxazole (17.1%), and Clindamycin (13.6%). Escherichia coli and Pseudomonas species (10% each) were the other significant contributors. Concerningly, gram negative exhibited resistance to Ceftriaxone (68%) and Meropenem (20%), indicating a rise in antimicrobial resistance (AMR) in the community. Other less frequently isolated bacteria included Coagulase negative staphylococcus, Streptococcus pneumoniae, Streptococcus pyogenes, Burkholderia species, Acinetobacter and Enterobacter species. Females (57.3%) in our community were more affected than males (42.6%). Elderly patients, more than 60 years of age, are more affected (25%) than any other age group. Conclusion: The increasing prevalence of MRSA, ESBL, and CRE poses challenges in treatment, leading to higher mortality and morbidity. Early diagnosis through PCR or culture and sensitivity, targeted or combination therapy, and implementation of an "Antibiotic Stewardship Program" can help reduce morbidity and AMR.