Longitudinal incidence of native septic arthritis in France: a 13-year analysis of the National Health Data System Database

OBJECTIVES: Septic arthritis (SA) is relatively rare, but potentially life-threatening with a reported mortality rate of about 6 to 10%. The aim of the study is to assess SA epidemiological changes over time in France. METHODS: Adults with native SA admitted to hospital were retrospectively selected from the French nationwide hospital database (SNDS) between 2009 and 2022. Patients with prosthesis joint infection were excluded. Incidence and mortality rates of SA were estimated longitudinally. Risk factors of SA were assessed after 10:1 matching with controls. RESULTS: From 2009 to 2022, a total of 109.160 SA episodes were identified. SA was more common in men (65%) with a mean age of 62 years. The most commonly coded bacteria were staphylococci (48%). The incidence rate of native SA increased from 13 in 2009 to 16.2 per 100,000 adults per year in 2022. Main risk factors of SA were rheumatoid arthritis (OR 4.7 [95%CI: 4.5-4.9]), addiction other than on tobacco or alcohol (OR 4.5 [95%CI: 4.3-4.8]), complicated diabetes (OR 4.4 [95%CI: 4.3-4.5]), and dialysis (OR 4.0 [95%CI: 3.8-4.3]). The all-cause mortality rates of SA at 1, 6 and 12 months were 3.2%, 8.4% and 11.4%, respectively, and remained stable during the period. CONCLUSION: In this nationwide study, we confirmed a slight increase in the incidence of native SA in adults between 2009 and 2022. With high and stable mortality associated with comorbidities, native septic arthritis remains a serious disease.