An outbreak of septic arthritis among least 41 individuals in New Jersey appears to be linked to treatments at a single outpatient clinic in the state, where each of the patients may have received an injection for osteoarthritis in March 2017.
In the latest issue of the U.S. Centers for Disease Control (CDC)’s Morbidity and Mortality Weekly Report, researchers indicate that an intra-articular injection for osteoarthritic knee pain provided at a private New Jersey outpatient practice may be responsible for the septic arthritis outbreak.
The New Jersey Department of Health (NJDOH) was initially notified about three cases of septic arthritis in March, but at least 41 confirmed instances have now been identified. Nearly 75% of the patients, 30 of the 41, have required surgery following the septic arthritis diagnosis, which drains infected fluid to relieve inflammation and pain.
An investigation is underway by the NJDOH, local health department and New Jersey board of Medical Examiners.
The clinic opted to voluntarily close their practice after reports of knee pain and swelling were filed. There were 250 patient visits during the timeframe when the septic arthritis problems occurred. All patients who were infected were scheduled over three consecutive clinic days, with no apparent clustering by appointment time. The same physician performed all the injections during the three days.
Septic arthritis, also called infectious arthritis, is caused by bacteria or fungus spreading through the bloodstream, or from an open wound or opening from a surgical procedure or puncture. The infection causes inflammation and pain in the affected joint. Symptoms include chills, fatigue, weakness, fever, inability to move the joint or limb affected, pain, and swelling.
The investigation into the outbreak identified multiple breaches of prevention practices at the clinic, including inadequate hygiene and inappropriate use of multiple-dose containers.
Healthcare staff also did not have access to a sink to wash their hands, or to antibacterial liquid, in medication preparation or treatment areas. Staff commonly prepared treatment syringes four days in advance of the treatment. A single dose should be administered within 1 hour of preparation. Additionally, physicians did not wear face masks during the procedure and did not use sterile gloves.
Nearly 40 percent of the patients who had septic arthritis had positive bacterial cultures which included organisms commonly found in the mouth. Bacterial cultures included Streptococcus, Actinomyces, Haemophilus, and Neisseria species. Two patients tested positive for Staphylococcus aureus bacteria in the blood.
Symptom onset ranged from 0 to 65 days after injections. However, 38 patients, the majority of those affected, developed symptoms within 48 hours of having the procedure.
No additional septic arthritis cases were identified after infection prevention recommendations were implemented at the clinic.