Background. Pneumococcal bone and joint infection is a rare disease. No recent series are available since the vaccination coverage is encouraged. We present clinical and biological characteristics and outcome of a cohort of 62 cases of pneumococcal bone and joint infection.
Methods. We report a retrospective, multicenter study in France and Switzerland in 7 reference centers for complex osteoarticular infections. Case was defined by suggestive clinical and radiological signs and microbiological identification requiring at least one isolate of Streptococcus pneumonia in deep sample (bone and joint and/or blood culture). Informations were collected with a standard data questionnaire.
Results. We present 62 cases, mean age: 65.1 years old (29-93) and sex ratio of 0.5.
Twenty-seven patients (43.5%) presented risk factors: immunosuppressive therapy (n = 12), diabetes mellitus (n = 11), alcoholism (n = 10), asplenia (n = 5). One vaccinated patient had an infection with 6A serotype not included in the vaccine. Localizations were peripheral joints (n = 51), vertebral osteomyelitis (n = 13) and both for 4 cases. Orthopaedic prosthesis was involved in 25 (40.3%) patients. Another concomitant localization was diagnosed in 23 patients: pneumonia (n = 16), meningitis (n = 3), sinusitis (n = 2), otitis (n = 2), endocarditis (n = 1). Fourty seven patients had acute symptoms (<1 month). Upon diagnosis 45 patients (72.6%) were febrile, mean CRP level was 233.7 mg/L (6.4-609). Blood cultures were positive in 38 cases. Antibiotic treatment included Amoxicilline for 32 patients, rifampicin for 21 patients and anti pneumococcal fluoroquinolone for 13. All prosthetic joint infections required surgery. Four (6.0%) treatment failures were diagnosed: 2 early deaths due to acute sepsis, 1 recurrence probably due to poor compliance and 1 chronic infection with a prosthetic joint infection. The outcome is excellent when sepsis is controlled, but its prevention could be easily improved in most of cases by vaccination.
Conclusion. Pneumococcal bone and joint infections is a rare but severe infection in adults. Clinical spectrum is wide and often acute with a previous or concomitant deep airways infection.
Disclosures. All authors: No reported disclosures.