PURPOSE Septic arthritis caused by Mycoplasma is rare. The diagnosis and effective treatment of mycoplasmal septic arthritis remains a serious problem for clinicians. The aim of this systematic review was to document the available evidence on the diagnosis and treatment methods for mycoplasmal septic arthritis and to provide guidance for clinicians. METHODS The PubMed, EMBASE, and Cochrane Library databases were searched in December 2018.The searches were limited to the English language. Article screening and data extraction and compilation were conducted by two independent reviewers. All the included studies were assessed using the Methodological Index for Non-randomized Studies (MINORS) tool. RESULTS There was a total of 33 articles including 34 cases of mycoplasmal septic arthritis and eight of them were periprosthetic joint infection (PJI). Twenty-four patients (70.6%) were immunocompromised, and the synovial fluid white blood cell (WBC) count was significantly lower in the immunocompromised group than in the immunocompetent group (48,527 × 106/L vs. 100,640 × 106/L; P = 0.009). The traditional culture method took longer, and the positivity rate was lower than that of nucleic acid testing (50% vs. 100%; P = 0.016). Only 19.2% (5/26) of patients treated with empiric antibiotics were relieved of symptoms, while 82.4% (28/34) of patients achieved satisfactory results after being treated with antibiotics against Mycoplasma. CONCLUSION The possibility of mycoplasmal septic arthritis should be considered if patients with joint infections have a history of immunocompromised, repeated negative cultures, and poor empiric antibiotic treatment results. The rational use of nucleic acid testing technologies can help in the clinical diagnosis and treatment of mycoplasmal septic arthritis.

中文翻译：

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支原体化脓性关节炎的诊断和治疗：系统评价。

目的支原体引起的败血性关节炎很罕见。支原体化脓性关节炎的诊断和有效治疗仍然是临床医生面临的严重问题。该系统评价的目的是记录有关支原体败血症性关节炎的诊断和治疗方法的可用证据，并为临床医生提供指导。方法于2018年12月对PubMed，EMBASE和Cochrane图书馆数据库进行了搜索，搜索仅限于英语。文章筛选以及数据提取和编辑由两名独立的审阅者进行。使用非随机研究方法索引（MINORS）工具评估所有纳入的研究。结果共有33篇文章，其中包括34例支原体化脓性关节炎，其中8例为假体周围感染。免疫受损的有24名患者（70.6％），并且免疫受损组的滑液白细胞（WBC）计数显着低于免疫功能组（48,527×106 / L与100,640×106 / L; P = 0.009）。传统培养方法花费的时间更长，且阳性率低于核酸检测的阳性率（50％对100％； P = 0.016）。经验性抗生素治疗的患者中只有19.2％（5/26）的症状得到缓解，而抗支原体抗生素治疗的患者中有82.4％（28/34）的患者获得了满意的结果。结论如果关节感染患者具有免疫功能低下的病史，反复的阴性培养和经验性的抗生素治疗效果差，则应考虑支原体化脓性关节炎的可能性。