SPILF update on bacterial arthritis in adults and children

Pneumococcal Septic Arthritis among Adults, France, 2010-2018

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.

Staphylococcus lugdunensis: an unusual cause of relapsing hematogenous septic arthritis of a native knee. Case report and review of the literature

Staphylococcus lugdunensis is a facultatively anaerobic gram-positive cocci of the coagulase-negative staphylococcus (CoNS) species. Initially considered as commensal, S. lugdunensis has been found to be responsible for a wide range of disseminated infections in humans (bacteriemia, foreign-body infection, endocarditis, arthritis, osteomyelitis, …) thereby often compared to Staphylococcus aureus in terms of virulence behavior. We present the case of a 62-year-old woman with end-stage renal disease, undergoing hemodialysis through an arteriovenous fistula (AVF) of the left forearm. She was diagnosed with S. lugdunensis bacteriemia and secondary native-knee septic arthritis. Endocarditis was ruled out and the patient evolved well with a 6-week course of IV cefazolin. Four months later, she consulted the rheumatology department with a recurrent right knee arthritis. Cultures came back positive for an identical multi-sensitive S. lugdunensis. Endocarditis was ruled out and full body 18F-FDG PET-CT showed no secondary location but a focal hypermetabolic activity in the left forearm fistula area. AVF Doppler showed no sign of collection nor thrombophlebitis around the fistula. We concluded in an infection of the fistula due to repeated punctures (recurrent cannulation) as entry point. She was treated with a 12-week oral combination of ciprofloxacin and trimethoprim-sulfamethoxazole, and her symptoms have not returned since. S. lugdunensis commonly causes prosthetic and arthroscopy-related joint infections. As native-joint septic arthritis is unusual, we conducted a review of the literature and discuss the burden of disseminated S. lugdunensis infections among dialysis patients.

Disability-adjusted life years from bone and joint infections associated with antimicrobial resistance: an insight from the 2019 Global Burden of Disease Study

PURPOSE

Bone and joint infections, complicated by the burgeoning challenge of antimicrobial resistance (AMR), pose significant public health threats by amplifying the disease burden globally. We leveraged results from the 2019 Global Burden of Disease Study (GBD) to explore the impact of AMR attributed to bone and joint infections in terms of disability-adjusted life years (DALYs), elucidating the contemporary status and temporal trends.

METHODS

Utilizing GBD 2019 data, we summarized the burden of bone and joint infections attributed to AMR across 195 countries and territories in the 30 years from 1990 to 2019. We review the epidemiology of AMR in terms of age-standardized rates, the estimated DALYs, comprising years of life lost (YLLs) and years lived with disability (YLDs), as well as associations between DALYs and socio-demographic indices.

RESULTS

The GBD revealed that DALYs attributed to bone and joint infections associated with AMR have risen discernibly between 1990 and 2019 globally. Significant geographical disparities and a positive correlation with socio-demographic indicators were observed. Staphylococcus aureus infections, Group A Streptococcus, Group B Streptococcus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter-related bone and joint infections were associated with the highest DALYs because of a high proportion of antimicrobial resistance. Countries with limited access to healthcare, suboptimal sanitary conditions, and inconsistent antibiotic stewardship were markedly impacted.

CONCLUSIONS

The GBD underscores the escalating burden of bone and joint infections exacerbated by AMR, necessitating urgent, multi-faceted interventions. Strategies to mitigate the progression and impact of AMR should emphasize prudent antimicrobial usage and robust infection prevention and control measures, coupled with advancements in diagnostic and therapeutic modalities.