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Septic arthritis due to streptococci and enterococci in native joints: a 13 year retrospective study

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Abstract

Objectives

Streptococcal species are the second most common cause of native joint septic arthritis (SA). However, there are few systematic data about streptococcal SA.

Methods

The medical records of adults with SA caused by streptococci, pneumococci, and enterococci at our tertiary care centre between 2003 and 2015 were reviewed.

Results

71 patients (34% female) with 83 affected joints were included. Median age was 62 years. A single joint was involved in 62 patients (87%). One or more comorbidities were present in 58 patients (82%). 16 patients (23%) had a concomitant soft-tissue infection overlying the affected joint. The hematogenous route was the dominating pathogenesis (42/71, 59%). 9 (13%) patients were diagnosed with endocarditis. The knee was the most commonly affected joint (27/83, 33%) followed by shoulder (13/83, 16%). ß-haemolytic streptococci were most commonly identified (37/71, 52%) followed by polymicrobial infections (12/71, 17%). Surgical interventions included arthroscopic irrigation and debridement in 31 (44%), arthrotomy in 23 (32%), and amputation in five patients (7%). Median duration of antimicrobial therapy was 42 days. Antibiotic treatment without any surgical intervention was performed in 5 (7%) patients. Outcome was good in 55 (89%) patients; mortality was 13% with four of nine deaths attributed to joint infection. Age and pathogen group independently predicted poor outcome in recursive partitioning analysis.

Conclusions

Streptococcal SA was mostly due to ß-haemolytic streptococci in older and polymorbid patients. Old age, anginosus group streptococci, enterococci, and polymicrobial infections predicted poor outcome, while antibiotic treatment duration can likely be shortened.

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Author notes

  1. Helene Lotz and Carol Strahm have contributed equally to this work.

Authors and Affiliations

  1. Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Helene Lotz, Carol Strahm & Werner C. Albrich

  2. Department of Orthopaedics and Traumatology, Cantonal Hospital St. Gallen, Rorschacherstrasse 95, 9007, St. Gallen, Switzerland

    Vilijam Zdravkovic & Bernhard Jost

Authors
  1. Helene Lotz
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  2. Carol Strahm
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  3. Vilijam Zdravkovic
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  4. Bernhard Jost
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  5. Werner C. Albrich
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Contributions

The conception and design of the study: HL, CS, and WCA; acquisition of data: HL and CS; analysis of data: HL, CS, and VZ; interpretation of data: all authors; drafting the article: HL, CS, and WCA; critical revision of the article: all authors; final approval of the version to be submitted: all authors.

Corresponding author

Correspondence to Carol Strahm.

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Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

The study was approved by the local Ethics Committee (EKSG 15/161).

Informed consent

Due to the retrospective nature of the study, an informed consent was waived.

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Lotz, H., Strahm, C., Zdravkovic, V. et al. Septic arthritis due to streptococci and enterococci in native joints: a 13 year retrospective study. Infection 47, 761–770 (2019). https://doi.org/10.1007/s15010-019-01301-w

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  • DOI: https://doi.org/10.1007/s15010-019-01301-w

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