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Pneumococcal septic arthritis: review of 190 cases
John J Ross1, Charles L Saltzman, Philip Carling
1Division of Infectious Diseases, Saint Elizabeth's Medical Center, Boston, MA 02135, USA. jrossmd@cchcs.org
Abstract:
This article reports 13 cases of pneumococcal septic arthritis and reviews another 177 cases reported since 1965. Of 2407 cases of septic arthritis from large series, 156 (6%) were caused by Streptococcus pneumoniae. Mortality was 19% among adults and 0% among children. Pneumococcal bacteremia was the strongest predictor of mortality. At least 1 knee was involved in 56% of adults. Polyarticular disease (36%) and bacteremia (72%) were more common among adults with septic arthritis caused by S. pneumoniae than among adults with other causative organisms. Only 50% of adults with pneumococcal septic arthritis had another focus of pneumococcal infection, such as pneumonia. Functional outcomes were good in 95% of patients. Uncomplicated pneumococcal septic arthritis can be managed with arthrocentesis and 4 weeks of antibiotic therapy; most cases of pneumococcal prosthetic joint infection can be managed without prosthesis removal. A fatal case of septic arthritis caused by a beta-lactam-resistant strain of S. pneumoniae is also presented.
Insights
Pneumococcal septic arthritis, caused by Streptococcus pneumoniae, affects 6% of septic arthritis cases. While mortality is higher in adults (19%), most patients achieve good functional outcomes with appropriate treatment.
Area of Science:
- Infectious Diseases
- Rheumatology
- Orthopedic Surgery
Background:
- Septic arthritis is a serious joint infection.
- Streptococcus pneumoniae is an important cause of bacterial infections.
Purpose of the Study:
- To report on pneumococcal septic arthritis cases.
- To review the characteristics, management, and outcomes of pneumococcal septic arthritis.
Main Methods:
- Retrospective case series of 13 patients.
- Literature review of 177 previously reported cases.
- Analysis of 2407 cases of septic arthritis from large series.
Main Results:
- 156 (6%) of 2407 septic arthritis cases were pneumococcal.
- Mortality was 19% in adults and 0% in children.
- Pneumococcal bacteremia was the strongest predictor of mortality.
- Knee involvement occurred in 56% of adult cases.
- Polyarticular disease and bacteremia were more common in adults with pneumococcal septic arthritis.
- Good functional outcomes were achieved in 95% of patients.
Conclusions:
- Pneumococcal septic arthritis can be managed effectively with arthrocentesis and antibiotics.
- Prosthetic joint infections may be treated without prosthesis removal.
- Beta-lactam-resistant strains pose a treatment challenge.