Streptococcus agalactiae bone and joint infection: a multicentre observational study 2014-23

Streptococcus is the second genus involved in bone and joint infections (BJIs) after Staphylococcus. Streptococcus agalactiae is the predominant Streptococcus species implicated in BJIs. However, unlike Staphylococcus-related BJIs, we lack epidemiological data on S. agalactiae BJIs. We aimed to describe its distinctive features compared with other streptococci.

This multicentre retrospective observational study included all microbiologically confirmed streptococcal BJI in adults between 2014 and 2023 from six referral centres for complex BJIs in France. Characteristics of S. agalactiae BJIs were compared to other streptococcal BJIs to identify risk factors for S. agalactiae infection. From this study, 143 S. agalactiae strains were characterised and compared by CRISPR1 typing method.

1454 patients were included, with a median age of 67 years and 65% male. S. agalactiae was the predominant streptococcal species involved 423/1454(29%). The most prevalent comorbidities identified were obesity (378/1454;26%) and diabetes mellitus (343/1454;24%). Prosthetic joint infections (PJIs) were the most common (653/1454;45%), although diabetic foot osteitis was less prevalent overall, it was significantly more associated with S. agalactiae infections (48/423;11% versus 70/1031;7%, p=0.05). S. agalactiae BJIs were more frequently lower-limb infections and chronic infections (240/423;57% versus 502/1031;49%, p=0.04). Half of the cohort had a polymicrobial infection and were slightly more frequent with S. agalactiae BJIs (235/423;56% versus 498/1031;48%, p=0.1). These results were consistent with a sensitivity analysis excluding diabetic foot related osteitis. Logistic regression analysis identified arteriopathy (OR: 4.16; IC95:1.64-11.24, p=0.003), and obesity (OR: 2.57; IC95: 1.41-4.78, p=0.002) as specific risk factors for S. agalactiae BJIs. Molecular study revealed three main clonal complexes (CC) involved in BJI strains: CC1 (58/143;41%), CC23 (36/143;25%) and CC10 (22/143;15%).

S. agalactiae emerges as a prominent and distinct pathogen in complex streptococcal BJIs, with specific risk factors such as arteriopathy and obesity, and more chronic infections.