Sternoarticualr pyoarthrosis due to gram-negative bacilli. Report of eight cases

Abstract

Of 8 patients with gram-negative bacillary sternoarticular pyoarthrosis, 7 were long-term i.v. heroin abusers. Clinical onset was insidious and a long delay (1 mo. or more) in seeking hospitalization was usually noted. Anterior chest discomfort and painful, restricted homolateral shoulder motion were the chief complaints. Fever and monoarticular arthritis were universally present. Open synovial biopsy examination was frequently required for etiologic diagnosis. Pseudomonas aeruginosa was the most common pathogen isolated. [Acinetobacter anitratus and Bacteroides fragilis were isolated from 1 case each.] Roentgenographic evidence of associated osteomyelitis was usually seen, but tomography was often necessary to delineate this lesion. Intraoperatively, associated osteomyelitis of the clavicular head and/or sternum was present in all 8 cases and a perisynovial and/or retrosternal abscess was found in 5 patients. Early surgical exploration and prolonged antimicrobial therapy [gentamicin and/or carbenicillin for the Pseudomonas cases, tetracycline for the Acinetobacter case and clindamycin for the Bacteroides case] yielded excellent results.