One-Third of Patients Require Re-debridment: Predictors of Failure After Single Surgery for Native Joint Bacterial Arthritis – Retrospective cohort study

Among adults with suspected bacterial arthritis of a native joint, this study aimed to determine: (1) the failure rate after a single surgical debridement (arthroscopic or open); (2) clinical predictors associated with failure of a single surgical debridement; and (3) factors associated with positive synovial fluid cultures in patients suspected of bacterial arthritis. Data from 117 adults, involving 137 native joints (52% knee), who underwent at least one surgical debridement for suspected bacterial arthritis at our institution between 2011 and 2021 were included with at least 3 months of follow-up. The failure of a single surgical treatment was defined as the need for at least one additional debridement within three months to control infection. Bivariate analyses and multivariable logistic regression were performed to identify potential risk factors for failure of the initial surgical debridement and to assess factors associated with positive synovial fluid cultures. Among the 137 native joints (subjected to surgical debridement for suspected bacterial arthritis), 44 (32%) required at least one additional debridement to control infection. Multivariable logistic regression identified positive synovial fluid culture as the only independent predictor of treatment failure (OR 5.5; 95% CI, 2.25-13.4; p<0.001). In a subsequent multivariable analysis, preoperative serum CRP levels greater than 203 mg/L (OR 3.94; 95% CI, 1.67–9.27; p=0.002) and purulent joint fluid appearance (OR 9.49; 95% CI, 3.82–23.6; p<0.001) were independently associated with positive synovial fluid cultures. About one in three patients who have undergone surgical debridement for suspected bacterial arthritis of a native joint requires at least one additional debridement; whereas in the case of positive synovial cultures about half (45%) undergo at least one additional debridement. Pre-operative serum CRP above 203 mg/L and purulent joint fluid are associated with having positive synovial fluid cultures.