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Comparative Analysis of Methicillin-Susceptible Staphylococcus aureus and Streptococcal Native Joint Septic

Jungok Kim¹, Eun-Jeong Joo², Ki-Ho Park³

¹Division of Infectious Diseases, Department of Medicine, Chungnam National University School of Medicine, Dae-Jeon 35015, Republic of Korea.

Antibiotics (Basel, Switzerland)

|July 27, 2026

Abstract:

Background/Objectives: This study aimed to evaluate and compare the clinical characteristics and outcomes of patients with methicillin-susceptible Staphylococcus aureus (MSSA) and streptococcal native joint septic arthritis (NJSA). Methods: This retrospective multicenter study included adult patients with NJSA from three tertiary care hospitals between 2004 and 2023. Patients were categorized into three groups based on bacterial virulence and differences among streptococcal species: MSSA, non-viridans streptococci, and viridans streptococci. Results: A total of 213 NJSA cases were identified, comprising 164 MSSA, 35 non-viridans streptococcal, and 14 viridans streptococcal cases. Non-viridans streptococcal NJSA exhibited significantly more acute clinical features associated with systemic inflammation, including frequent fever, leukocytosis, thrombocytopenia, elevated C-reactive protein levels, higher total bilirubin levels, and acute kidney injury, compared to MSSA and viridans streptococcal NJSA. The clinical presentations were similar between the MSSA and viridans streptococcal groups. The non-viridans streptococcal group showed a higher incidence of concomitant bacteremia, but a lower proportion of positive joint culture results. Treatment approaches were consistent across the groups, except for a shorter duration of antibiotic therapy in the viridans group. Treatment failure rates were comparable: 9.8% for MSSA, 14.3% for non-viridans streptococci, and 21.4% for viridans streptococci. Conclusions: This study highlights the heterogeneous nature of streptococcal NJSA, with non-viridans streptococci presenting more aggressive clinical manifestations despite similar treatment responses across groups. These findings challenge conventional views on streptococci as a less virulent pathogen than MSSA and emphasize the need for diagnostic and management strategies tailored to the unique pathogenic traits of these bacteria.

Insights

Non-viridans streptococci cause more severe native joint septic arthritis than MSSA, despite similar treatment outcomes. This challenges the view of streptococci as less virulent, requiring tailored management strategies.

Area of Science:

Infectious Diseases
Microbiology
Rheumatology

Background:

Septic arthritis is a serious joint infection.
Methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci are common pathogens.
Understanding differences in their clinical presentation is crucial for management.

Purpose of the Study:

To compare clinical characteristics and outcomes of MSSA and streptococcal native joint septic arthritis (NJSA).
To evaluate virulence differences between MSSA and various streptococcal species in NJSA.

Main Methods:

Retrospective multicenter study of 213 adult NJSA cases (2004-2023).
Patients categorized into MSSA, non-viridans streptococci, and viridans streptococci groups.
Clinical features, laboratory data, and treatment outcomes were analyzed.

Main Results:

Non-viridans streptococcal NJSA showed more systemic inflammation (fever, leukocytosis, AKI) than MSSA and viridans streptococci.
MSSA and viridans streptococcal NJSA had similar presentations.
Treatment failure rates were comparable across groups (9.8%-21.4%).

Conclusions:

Streptococcal NJSA is heterogeneous, with non-viridans streptococci exhibiting more aggressive features.
Non-viridans streptococci may be more virulent than previously thought.
Tailored diagnostic and management strategies are needed for different NJSA pathogens.

Read full analysis

Keywords:

Staphylococcus aureus bone and joint infections native joint septic arthritis septic arthritis streptococci

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