POS1158 THE SPECTRUM OF NON-TUBERCULOUS OSTEOARTICULAR INFECTIONS IN A RHEUMATOLOGY DEPARTMENT DURING THE YEARS 2010-2020: A RETROSPECTIVE STUDY OF 102 CONSECUTIVE CASES IN A SINGLE CENTER
Authors: M. Chammakhi, C. Bendahmane, F. Kemiche, I. Cerf-Payrastre, E. Pertuiset
Journal: Annals of the Rheumatic Diseases (2021)

Background: osteoarticular infections (OAI) are characterized by a large variety of sites, causative microorganisms, source and route of infection, risk factors and also by the fact that several medical specialties are involved in diagnosis and treatment. These characteristics are subject to changes over the time. Objectives: to describe the spectrum of non-tuberculous OAI in the absence of OA material, including native septic arthritis (SA) and non-postoperative SA or infectious spondylodiscitis (SPDI) during the years 2010-2020. This includes demographics, comorbidities, site of infection, causative microorganisms, source of infection, diagnosis, treatment procedures and mortality. Methods: medical records of patients aged 18 years old or above who were diagnosed with a non-tuberculous OAI in the Department of rheumatology of our hospital during the 2010-2020 period were selected and retrospectively reviewed. OAI with the following characteristics were excluded: SA on prosthetic joints, postoperative SA or SPDI, osteomyelitis, brucellosis, Lyme disease. Only proven cases where included on the basis of an isolated pathologic organism at the site of infection and/or in the blood (with typical clinical, biological and imaging features). Results: There were 102 consecutive patients (males 62%), aged 62.5±16.8 years, with an IMC of 25.1±5.2. Peripheral SA where observed in 52 cases, SPDI in 33 cases, non-peripheral SA in 10 cases (sacroiliitis 5, pubic symphysitis 2, sternoclavicular 2, posterior interapophyseal 1); in 7 patients, there was an association of SPDI and peripheral SA. At least two non-contiguous sites were involved in 22 patients (21.5%). The sites of the positive sample where: osteoarticular (synovial fluid, vertebral biopsy) in 47 cases; blood in 28 cases; both of them in 27 cases. In the 102 cases, 105 microorganisms grew in culture including one Candida glabrata. The following bacteria where responsible in the other cases: 42 Staphylococcus aureus (including 3 cases of methicillin resistant); 7 coagulase-negative Staphylococcus spp.; 6 Group A Streptococcus ; 12 group B Streptococcus agalactiae ; 8 groups C/G Streptococcus ; 3 group D Streptococcus gallolyticus ; 2 Streptococcus pneumoniae ; 1 Neisseria gonorrhea ; 8 enterobacteria; 3 Enterococcus faecalis; 3 Pseudomonas aeruginosa ; 3 Haemophilus ; 6 others species (2 Parvimonas micra , 1 aerococcus urinae , 1 Nesseiria bacilliformis , 1 bacteroides fragilis , 1 campylobacter fetus ). The most frequent host risk factors were: diabetes (21%), inflammatory/auto-immune disease (10%; including 3 rheumatoid arthritis), chronic renal insufficiency (CC&lt;30 ml/mn) (6%), active cancer with local or general extension (6%), immunodeficiency state (SCID revealed by OAI in 2 cases). Three patients where on biological therapy. The source of infection was known in 76 cases: skin infection in 27; urinary tract infection in 17; joint injection in 7 cases ; dental infection in 6 cases; infected vascular material in 6 cases; abdominal infection in 5 cases; genital infection in 3 cases; ENT infection in 3 cases; pulmonary disease 2 cases. Mean duration of symptoms ranged from 13 days for peripheral SA to 39 days for SPDI. Fever (≥38°C) was present in 52% of cases. Mean CRP was 182±128 mg/l. Blood cultures where positive in 55.5%. There was only one case of infectious endocarditis. All patients were treated with antibiotics with a mean duration of 10.2±5.6 weeks. Orthopedic surgery was proceeded in 67% of peripheral septic arthritis and in 10% of the other OAI. Six patients where admitted in the intensive care unit; 4 patients died (4.3%). Mean length of hospitalization was 28.6±15 days. Conclusion: in the years 2010-2020, non-tuberculous OAI represents a regular cause of hospitalization in rheumatology. Iatrogenic origin accounts for 13% of cases and urinary tract infection for 17%. Staphylococcus species are involved in only 48% of cases and Streptococcal species in 30%. Disclosure of Interests: None declared.