Bacterial joint infections in England and Wales: analysis of bacterial isolates over a four year period

Data from 1158 cases of septic arthritis reported to the Public HealthLaboratory Service (PHLS) Communicable Disease Control Centre (CDSC) fromEngland and Wales over a 4 yr period (January 1990 December 1993) arepresented. Reports where a bacterial organism was isolated from synovialfluid, or where an organism was isolated from blood cultures where adiagnosis of septic arthritis was reported, were examined. Reports ofinfection were more common in children (12.7% of infections were in theunder 10 age group) and the elderly (54.7% aged 60 or over), and werehigher in males in all age groups except in the elderly. The most commoncausative organisms remain staphylococcal and streptococcal species,comprising 40.6% (470) and 28% (324) of cases, respectively. The mostcommon streptococci seen were Streptococcus pneumoniae and Lancefield groupA beta-haemolytic Streptococcus organisms, 60.8% (197/324), although groupB, C and G organisms accounted for 33.6% of streptococcal isolates(109/324). Haemophilus influenzae septic arthritis is not exclusive tochildren as 23.2% (16- 69) of cases occurred over the age of 15. A total of48% (635) of isolates were identified from both synovial fluid and bloodcultures, 32.6% (378) from joint fluid alone and 12.5% (146) from bloodcultures. Although this study excludes cases of septic arthritis where noorganism was isolated, it presents important bacteriological informationfrom a large number of isolates from England and Wales over a 4 yr period.Risk factors identified include a joint prosthesis, jointdisease/connective tissue disorder. immunosuppression and diabetes.