Abstract
In our study, septic arthritis due to Staphylococcus aureus and Streptococcal species was more common in the elderly. This contrasts with Lyme arthritis which has a higher incidence in younger patients. The majority of joint infections were in the elderly, with a median age of 65 (range 14-95) for Staphylococcus aureus and 70 for Streptococcal species. The age range of Methicillin-resistant Staphylococcus aureus (MRSA) septic arthritis was 27-95 (median 72) with 39/53 (73.6%) above age 60. The age range of Streptococcal arthritis patients was 36-86 (median 70). There were more males with septic arthritis for both Staphylococcus aureus (86/134) 64% and streptococci (12/22) 55%. The most frequently involved joint was the knee, 49.3% for S. aureus followed by hip (23.9%), elbow (14.3%), shoulder (14%), wrist (1.5%), ankle (0.75%) and sternoclavicular (0.75%). The knee was affected in 81% of Streptococcal infections, with the rest equally divided between the hip, elbow, acromioclavicular and ankle joints. The history of prior joint replacement in patients with septic arthritis was 21/28 (80%) for MRSA, 36/102 (35.3%) for methicillin-susceptible Staphylococcus aureus (MSSA) and 9/21 (43%) for streptococcal arthritis suggestive of healthcare-associated infections. Our results suggest a need for improvements to prevent the entry of pathogens into the surgical site during and after surgery.
Highlights
We have previously reported a higher incidence of infections associated with Pasteurella multocida and Stenotrophomonas maltophilia in older patients [1, 2]
Our results suggest a need for improvements to prevent the entry of pathogens into the surgical site during and after surgery
We reviewed the reports of approximately 7000 Staphylococcus aureus culture-positive patients in 10 hospitals of our network consisting of 9 hospitals in Eastern Pennsylvania and 1 in adjacent Warren County, New Jersey, USA for a period of 3 years ending in October 2019 and found 134 cases of S. aureus septic arthritis (86 males and 48 females), ages ranging from 14-95 with a median age 65
Summary
We have previously reported a higher incidence of infections associated with Pasteurella multocida and Stenotrophomonas maltophilia in older patients [1, 2]. We present our findings from a large series of S. aureus and streptococcal infections where joint infections were more common in the elderly. Septic arthritis is a pyogenic infection of synovial joints. In a recent study from India, S. aureus was the most common cause of septic arthritis. The number of elderly and those with prior joint surgery were strikingly smaller than our study, with no species identification of streptococci isolated [7]. In a 12-year study from Thailand, group B Streptococcus was the most common cause of septic arthritis with a significant association with upper extremity joints, oligopolyarthritis, tenosynovitis and rainy season. Our findings were remarkably different, with the majority of streptococcal septic arthritis affecting a single knee and significantly associated with prior joint surgery [8]
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