We report a case of
septic arthritis due to Enterococcus species and review 18 additional cases reported in the literature from 1966 through 1993 for which clinical or treatment data were available. In 11 of the 19 cases, prosthetic joints were affected (9 knees, 2 hips) and in 8 cases, native joints were affected. Of those patients with prosthetic joint
infections, 6 had preexisting
osteoarthritis and 3 had
rheumatoid arthritis; only one patient with native joint
infection had a recognized (although unspecified), preexisting joint abnormality.
Pain,
fever (temperature, > 37 degrees C), and tenderness were the most common clinical findings in patients with native joint
infections. The microbiological diagnosis was made by culture of synovial fluid or synovial tissue (16 of 19), blood (1 of 19), or an unstated specimen (2 of 19).
Polymicrobial infection was present in 6 (32%) of 19 patients. Of fourteen patients treated with either a parenteral
penicillin (11 of 19) or a
glycopeptide (3 of 19), 11 made an uncomplicated recovery. An
aminoglycoside was also used to treat 7 of these 14 patients (4 of these 7 had prosthetic joints). All 11 prosthetic joint
infections were ultimately clinically cured; for most of these patients, the original
prosthesis was removed. For two patients with native joint
infections,
amputation of the infected limb was necessary to cure the
infection.