Belkhir L, Rodriguez-Villalobos H, Vandercam B, Marot J C, Cornu O, Lambert M, Yombi J C
Acta Clin Belg. 2014 Jan-Feb;69(1):40-6. doi: 10.1179/0001551213Z.00000000015.
Septic arthritis (SA) is a rheumatological emergency that can lead to rapid joint destruction and irreversible loss of function. The most common pathogen causing SA is Staphylococcus aureus which is responsible for 37-65% of cases. Streptococcus pneumoniae is traditionally described as an uncommon cause of SA of a native joint. The objective of our study was to analyse clinical characteristics, treatment, and outcome of all cases of pneumococcal septic arthritis treated in our institution, and to compare them with other series published in the literature.
We conducted a retrospective study of pneumococcal SA identified among all cases of SA diagnosed in a teaching hospital of one thousand beds between 2004 and 2009. Diagnosis was based on culture of joint liquid or by the presence of pneumococcal bacteraemia and purulent (more than 50 000/mm(3) white blood cells with more than 90% neutrophils) joint fluid aspiration.
Among 266 cases of SA, nine patients (3·3%) were diagnosed as having pneumococcal SA. The median age was 75 years. The main affected joint was the knee (7/9). No patient had more than one joint involved. Four patients suffered from concomitant pneumonia. Joint culture and blood cultures were positive in 7/9 and 5/9, respectively. Median (range) length of stay was 18 days (3-47 days). One patient with associated pneumococcal bacteraemia died 19 days after admission. Seven patients recovered completely.
Streptococcus pneumoniae is now being increasingly recognized as a common agent of SA. This organism is frequently associated with pneumococcal pneumonia or bacteraemia, particularly in patients with advanced age and comorbidities. Direct inoculation of joint fluid into blood culture medium BACTEC system increases the probability of microbiological diagnosis. The prognosis is usually favourable if the disease is promptly recognized and treated (antibiotic therapy combined with joint drainage).
化脓性关节炎（SA）是一种风湿性急症，可导致关节迅速破坏和功能不可逆丧失。引起SA最常见的病原体是金黄色葡萄球菌，其导致37%至65%的病例。传统上，肺炎链球菌被描述为原发性关节SA的罕见病因。我们研究的目的是分析在我们机构治疗的所有肺炎球菌性化脓性关节炎病例的临床特征、治疗及结局，并将其与文献中发表的其他系列进行比较。
我们对2004年至2009年在一家拥有1000张床位的教学医院诊断的所有SA病例中确诊的肺炎球菌性SA进行了回顾性研究。诊断基于关节液培养或存在肺炎球菌菌血症以及脓性（白细胞超过50000/mm³且中性粒细胞超过90%）关节液抽吸。
在266例SA病例中，9例患者（3.3%）被诊断为肺炎球菌性SA。中位年龄为75岁。主要受累关节为膝关节（7/9）。没有患者累及一个以上关节。4例患者并发肺炎。关节培养和血培养分别在7/9和5/9中呈阳性。中位（范围）住院时间为18天（3至47天）。1例伴有肺炎球菌菌血症的患者入院后19天死亡。7例患者完全康复。
肺炎链球菌现在越来越被认为是SA的常见病原体。这种病原体常与肺炎球菌肺炎或菌血症相关，特别是在老年和有合并症的患者中。将关节液直接接种到血培养BACTEC系统中可提高微生物学诊断的概率。如果疾病能及时识别并治疗（抗生素治疗联合关节引流），预后通常良好。
