Abstract
This retrospective
study explored the association between osteoarthrosis and bacterial-induced
joint erythema-swelling and evaluated antimicrobial nursing interventions in 60
patients with osteoarthrosis. Patients were divided into bacterial
erythema-swelling group (n=28, with positive bacterial culture and joint
redness/swelling) and non-bacterial erythema-swelling group (n=32, with
erythema-swelling but negative cultures), with each group split into
intervention (bacterial: n=15; non-bacterial: n=17) and control (bacterial:
n=13; non-bacterial: n=15) subgroups. Intervention subgroups received
antimicrobial nursing (bacterial-targeted disinfection, erythema-swelling
monitoring, antimicrobial stewardship), while controls received routine care.
Primary outcomes included correlation between osteoarthrosis severity
(Kellgren-Lawrence grade) and bacterial-induced erythema-swelling duration and
post-intervention resolution rate at 3 weeks. Secondary outcomes included
C-reactive protein (CRP) levels, joint temperature difference (°C) and
recurrence rate at 2 months. Results showed significant positive correlation
between Kellgren-Lawrence grade and erythema-swelling duration in bacterial
group (r=0.74, p<0.01). Intervention subgroups had higher resolution rate
(bacterial: 80.0% vs 38.5%; non-bacterial: 76.5% vs 46.7%, p<0.05).
Antimicrobial nursing effectively resolves bacterial-induced joint
erythema-swelling in osteoarthrosis patients, particularly those with severe
disease.
Keywords: Osteoarthrosis; Erythema-swelling; Antimicrobial
stewardship; Kellgren-lawrence grade
Introduction
Bacterial-induced joint
erythema-swelling is a distinct subtype of inflammatory presentation in
osteoarthrosis, accounting for 30-40% of acute flares in severe cases1. Pathogens like Staphylococcus aureus and
Streptococcus spp. colonize damaged joint tissues, triggering neutrophilic
infiltration and cytokine release that manifest as redness, warmth and swelling2. This condition accelerates cartilage degradation and
increases joint deformity risk, yet lacks targeted nursing protocols3. This study investigates the osteoarthrosis-bacterial
erythema-swelling association and evaluates antimicrobial interventions.
Methods
Study design and
participants
Retrospective analysis of 60 patients with
radiographically confirmed osteoarthrosis (knee: 45 cases, hip: 15 cases).
Inclusion criteria: age 50-85 years; Kellgren-Lawrence grade I-IV; acute joint
erythema-swelling (≥2/3 criteria: redness, warmth, swelling, pain). Bacterial
group defined as positive joint fluid/tissue culture (≥10³ CFU/mL);
non-bacterial group as negative cultures with sterile inflammation. Exclusion
criteria: crystal arthropathy, septic arthritis and recent intra-articular
injections.
Grouping & interventions
Control subgroups: Routine care (cold
therapy, pain management).
Intervention subgroups:
Added antimicrobial interventions:
• Bacterial-targeted disinfection: Chlorhexidine 2% skin decontamination (3x/day) and aseptic dressing changes for weeping joints.
• Erythema-swelling monitoring: Daily tracking of redness diameter, swelling circumference and temperature (infrared thermometer).
• Antimicrobial stewardship: Timely specimen collection for culture, antibiotic administration education and adherence monitoring.
• Joint protection: Immobilization with sterile splints during acute phase, gradual mobilization as symptoms resolve.
Outcome measures
• Primary: Correlation between Kellgren-Lawrence grade and initial erythema-swelling duration; 3-week resolution rate (≥70% symptom reduction).
• Secondary: CRP (mg/L), joint temperature difference (affected vs contralateral), 2-month recurrence rate.
Statistical analysis
SPSS 26.0 used for
Pearson correlation, χ² tests and independent t-tests. p<0.05 was
significant.
Results
Osteoarthrosis-bacterial erythema-swelling
relationship and baseline data
Significant positive
correlation between Kellgren-Lawrence grade and erythema-swelling duration in
bacterial group (r=0.74, p<0.01). Bacterial group had higher initial
inflammatory markers (Table 1).
Table 1: Baseline
Characteristics
|
Characteristics |
Bacterial Erythema-Swelling Group (n=28) |
Non-Bacterial Erythema-Swelling Group (n=32) |
p-value |
|
Age (years, x̄±s) |
66.8±9.1 |
64.2±8.3 |
0.27 |
|
Male gender, n(%) |
16(57.1) |
18(56.3) |
0.94 |
|
Affected joint (knee/hip) |
21(75.0)/7(25.0) |
24(75.0)/8(25.0) |
0.98 |
|
Kellgren-Lawrence grade (x̄±s) |
3.4±0.8 |
2.2±0.7 |
<0.001 |
|
Staphylococcus aureus positive, n(%) |
17(60.7) |
0(0.0) |
<0.001 |
|
Initial erythema duration (days, x̄±s) |
8.7±3.2 |
5.3±2.1 |
<0.001 |
|
Initial CRP (mg/L, x̄±s) |
68.5±21.3 |
32.6±14.5 |
<0.001 |
|
Joint temperature difference (°C, x̄±s) |
2.8±0.9 |
1.5±0.6 |
<0.001 |
|
Group |
Intervention |
Control |
p-value |
|
Bacterial Group (n=28) |
12/15(80.0%) |
5/13(38.5%) |
0.019 |
|
Non-Bacterial Group (n=32) |
13/17(76.5%) |
7/15(46.7%) |
0.043 |
Secondary outcomes
Intervention subgroups
demonstrated significant improvements in all secondary measures (Table 3).
Table 3: Secondary Outcomes at
3 Weeks and 2 Months
|
Outcome |
Bacterial Group |
Non-Bacterial Group |
p-value (intervention effect) |
|
CRP (mg/L, x̄±s) |
Intervention:18.2±7.5 |
Intervention:15.3±6.8 |
<0.001 |
|
Control:42.6±12.8 |
Control:25.7±9.4 |
- |
|
|
Temperature difference (°C) |
Intervention:0.8±0.4 |
Intervention:0.6±0.3 |
<0.001 |
|
Control:1.9±0.7 |
Control:1.2±0.5 |
- |
|
|
2-Month recurrence rate |
Intervention:13.3% |
Intervention:11.8% |
0.031 |
|
Control:53.8% |
Control:40.0% |
- |
Discussion
This study confirms
severe osteoarthrosis correlates with prolonged bacterial-induced
erythema-swelling, as damaged cartilage and synovium provide a nidus for
bacterial persistence4. The 54.5% higher Kellgren-Lawrence grade in
bacterial group aligns with evidence that bacterial lipopolysaccharides
upregulate matrix metalloproteinases, worsening joint damage5.
Antimicrobial
nursing resolved symptoms primarily through targeted disinfection, which
reduced bacterial load by 60% in weeping joints6. Daily monitoring
enabled early escalation, while stewardship ensured appropriate antibiotic use-critical
for preventing resistance in recurrent cases7. Notably,
non-bacterial group intervention benefits suggest antimicrobial measures
address subclinical colonization8.
Limitations include
reliance on culture results (misses fastidious organisms) and small sample
size. Future studies should use PCR for bacterial detection.
Conclusion
Osteoarthrosis severity strongly
correlates with duration of bacterial-induced joint erythema-swelling.
Antimicrobial nursing interventions effectively resolve symptoms, reduce
inflammation and prevent recurrence. These strategies are essential for
managing bacterial-driven flares in osteoarthrosis.
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