Pneumococcal Septic Arthritis among Adults, France, 2010-2018

Abstract

Streptococcus pneumoniae infection is considered an uncommon cause of arthritis in adults. To determine the clinical and microbiological characteristics of pneumococcal septic arthritis, we retrospectively studied a large series of cases among adult patients during the 2010-2018 conjugate vaccine era in France. We identified 110 patients (56 women, 54 men; mean age 65 years), and cases included 82 native joint infections and 28 prosthetic joint infections. Most commonly affected were the knee (50/110) and hip (25/110). Concomitant pneumococcal infections were found in 37.2% (38/102) and bacteremia in 57.3% (55/96) of patients, and underlying conditions were noted for 81.4% (83/102). Mortality rate was 9.4% (8/85). The proportion of strains not susceptible to penicillin was 29.1% (32/110). Of the 55 serotyped strains, 31 (56.4%) were covered by standard pneumococcal vaccines; however, several nonvaccine serotypes (mainly 23B, 24F, and 15A) had emerged, for which susceptibility to β-lactams was low.

Keywords: France; Streptococcus pneumoniae; adult; antimicrobial resistance; bacteria; joint infection; septic arthritis; vaccines.

Figure 1

Trends in the frequency of pneumococcal septic arthritis cases among adults as a percentage of all invasive pneumococcal disease cases, by year, France, 2010–2018. Blue line indicates actual values; red line indicates overall trend.

Figure 2

Distribution of pneumococcal joint infections in adults with pneumococcal septic arthritis, by joint and by sex, France, 2010–2018. A) Native joint infections (n = 82); B) prosthetic joint infections (n = 28).

Figure 3

Streptococcus pneumoniae serotype distribution and β-lactam susceptibility in adults with septic arthritis, France, 2010–2018. Boxes indicate serotype distribution within different vaccines. ANSP, amoxicillin-nonsusceptible pneumococcus; CNSP, (third-generation) cephalosporin–nonsusceptible pneumococcus; PCV13,13-valent pneumococcal conjugate vaccine; PNSP, penicillin-nonsusceptible pneumococcus; PPV23, 23-valent pneumococcal polysaccharide vaccine; PSP, penicillin (β-lactam)–susceptible pneumococcus.