title: Pneumococcal septic arthritis: review of 190 cases.
abstract: This article reports 13 cases of pneumococcal septic arthritis and reviews another 177 cases reported since 1965. Of 2407 cases of septic arthritis from large series, 156 (6%) were caused by Streptococcus pneumoniae. Mortality was 19% among adults and 0% among children. Pneumococcal bacteremia was the strongest predictor of mortality. At least 1 knee was involved in 56% of adults. Polyarticular disease (36%) and bacteremia (72%) were more common among adults with septic arthritis caused by S. pneumoniae than among adults with other causative organisms. Only 50% of adults with pneumococcal septic arthritis had another focus of pneumococcal infection, such as pneumonia. Functional outcomes were good in 95% of patients. Uncomplicated pneumococcal septic arthritis can be managed with arthrocentesis and 4 weeks of antibiotic therapy; most cases of pneumococcal prosthetic joint infection can be managed without prosthesis removal. A fatal case of septic arthritis caused by a beta-lactam-resistant strain of S. pneumoniae is also presented.
authors.affiliation: Division of Infectious Diseases, Saint Elizabeth's Medical Center, Boston, MA 02135, USA. jrossmd@cchcs.org
authors.forename: John J
authors.initials: JJ
authors.lastname: Ross
authors.forename: Charles L
authors.initials: CL
authors.lastname: Saltzman
authors.forename: Philip
authors.initials: P
authors.lastname: Carling
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004351:Drug Resistance; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011008:Pneumococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology* / Q000401:mortality; D015995:Prevalence; D016459:Prosthesis-Related Infections / Q000382:microbiology; D012307:Risk Factors; D013296:Streptococcus pneumoniae; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents