Changes in nongonococcal septic arthritis: Drug abuse and methicillin‐resistant staphylococcus aureus

Septic arthritis continues to be a major medical problem for metropolitan hospitals. Previous studies have defined risk factors, joint distribution, and the most common organisms implicated in this condition (1-4). Recently, we became aware of a pattern of septic arthritis that differed significantly from that previously reported. Over a 2-year period, a retrospective analysis of septic arthritis revealed the emergence of a new pattern of antibiotic resistance among the bacteria populating a well-defined subgroup of patients. Patients and methods. Wayne County General Hospital, a 270-bed general hospital in suburban Detroit, has continuously served indigent citizens of the inner city of Detroit and the population of the surrounding area since the turn of the century. A review of the hospital’s records for the 2-year period, January 1, 1981 through December 31, 1982, showed 46 patients with a discharge diagnosis of septic arthritis, excluding all cases of Neisseria gonorrhea. These patients’ medical records, including their bacteriology laboratory data, were reviewed for inclusion in the study. Criteria for inclusion were: presentation with an acutely painful, tender, or swollen joint and positive synovial fluid bacterial cultures. Of the 46 medical