Kantonsspital St.Gallen
login

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

Helene Lotz, Carol Strahm, Vilijam Zdravkovic, Bernhard Jost & Werner Albrich

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.
   
citation Lotz H, Strahm C, Zdravkovic V, Jost B, Albrich W. Septic arthritis due to streptococci and enterococci in native joints: a 13 year retrospective study. Infection 2019; 47:761-770.
   
type journal paper/review (English)
date of publishing 30-03-2019
journal title Infection (47/5)
ISSN electronic 1439-0973
pages 761-770
PubMed 30929143
DOI 10.1007/s15010-019-01301-w