Les arthrites septiques streptococciques de l’adulte : 55 cas et revue de la littérature

Abstract

Objectives. – To evaluate the rate of occurrence and characteristics of streptococcal septic arthritis. Methods . – Retrospective single-center study of patients with bacteriologically documented septic arthritis admitted to a rheumatology department over a 20-year period. Results. – Of 303 cases of septic arthritis, 55 (18%) were due to streptococci and 166 (55%) to S. aureus (55%). As compared to patients with S. aureus arthritis, patients with streptococcal arthritis were more likely to be female (56% vs. 36%, P < 0.006) and older than 60 years of age (71% vs. 58%), less likely to have comorbidities (36% vs. 56%), rheumatoid arthritis (5% vs. 19%, P < 0.01), or diabetes (2% vs. 15%, P < 0.01), and more likely to have cancer (13% vs. 7%). Involved joints and proportions of patients with arthritis in multiple joints were similar in the two groups. Mortality was lower in the group with streptococcal infection (3.6% vs. 7.8%). The streptococci were distributed as follows: Group A ( n = 7), Group B ( n = 12), Group C ( n = 4), Group D ( n = 7), Group F ( n = 1), Group G ( n = 2), nongroupable ( n = 14), nontypable ( n = 1), and S. pneumoniae ( n = 7). Groups A and B and nongroupable strains mainly affected women; Group A selectively involved younger patients and Group B very elderly patients. Comorbidity, most notably cancer, was common in patients with S. pneumoniae or Group D streptococci. The portal of entry was often a skin lesion for Groups A and B and a medical procedure for Group D. Multiple joint involvement was common with Groups A and B and prosthetic joint infection with Groups B and C. Group A and S. pneumoniae were associated with severe systemic symptoms and extraarticular foci of infection, whereas a smoldering course was more common with Groups D and G and with nongroupable strains. Residual joint abnormalities were noted in half the patients, with no differences across groups. Conclusions . – The features of streptococcal septic arthritis vary according to the group of the causative organism and differ from those of S. aureus arthritis.