• Eli Ben-Chetrit, Amit Zamir, Ayman Natsheh, Gideon Nesher, Yonit Wiener-Well, and Gabriel Simon Breuer.
• Infectious Diseases Unit, Department of Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
• Intern Emerg Med. 2020 Jun 1; 15 (4): 655-661.

AbstractSeptic arthritis (SA) is commonly associated with Staphylococcal or Streptococcal infections. Overtime, there has been a global increase in the distribution of antimicrobial resistance within both Gram-positive bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria such as extended-spectrum beta-lactamase (ESBL) positive Enterobacteriacea. The aim of this study was to determine whether this change in epidemiology similarly affected the distribution of resistant pathogens causing SA. The study was conducted at the Shaare Zedek Medical Center in Jerusalem, Israel. All adult patients diagnosed with SA during 2002-2016 were included in the cohort. Antimicrobial resistance trends were examined over three periods: 2002-2009, 2010-2013, and 2014-2016. Of 85 patients with SA, mean age of patients was 66.8 (± 20.3) years, with male predominance (n = 62, 66%). Most SA cases involved native knee joints and more than 85% (n = 80) were acquired in the community. The most common isolates were S. aureus (n = 38, 45%) and beta-hemolytic streptococci (n = 13, 15%). MRSA SA was diagnosed in 8% of all SA cases (n = 7). An increasing, although non-significant trend in MRSA SA was observed during the study period (p = 0.3). Gram-negative infections were uncommon (n = 14). No ESBL-positive or carbapenem-resistant Enterobacteriacea were detected. Over a 15-year study period, no significant increase in resistant pathogens causing SA was observed. In the era of antibiotic stewardship, these results strengthen our practice of administering narrow-spectrum antimicrobials empirically for SA. However, our findings cannot be generalized to regions with higher rates of MRSA in the community.

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