Cluster cases of septic arthritis caused by streptococcus pneumoniae in the era of penicillin resistance

Streptococcus pneumoniae is an uncommon cause of bone and joint infections. Three cases of S. pneumoniae septic arthritis occurred in children over a three-month period at a community hospital. A seven-month-old presented with hip arthritis caused by penicillin susceptible S. pneumoniae (PSSP). He was treated with ceftriaxone. A three-month-old, enrolled in childcare, presented with hip arthritis caused by high level penicillin resistant S. pneumoniae (PRSP). He was treated with clindamycin. A 12-year-old presented with left elbow arthritis caused by PRSP. His risk factor for PRSP was related to recent antibiotic treatment. He was treated with clindamycin. All patients recovered without sequelae. No patient had a history of significant trauma. Implications for an increasing incidence of PRSP include recognition of risk factors, such as childcare attendance and prior antibiotic use. Clindamycin and selected third generation cephalosporins provide adequate empiric coverage for common organisms causing bone and joint infections in children.