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Peer-reviewedCC BYJournal of Infection

Epidemiology and outcomes of Group A streptococcal and non-Group A streptococcal septic arthritis in French children between 2010 and 2023, a national cohort analysis, and case-control study

  • Manon Pigeolet1
  • Edouard Haumont2
  • Jade Burnouf-Lim3
  • Pierre R. Smeesters
  • Alina Badina3
  1. 1Department of Pediatric orthopaedics, Hôpital Necker – Enfants Malades, Paris, France; Division of Foot and Ankle Surgery, Massachusetts General Hospital, Harvard Medical School, Boston MA, USA; Correspondence to: 149 Rue de Sèvres, Paris 76015, France.
  2. 2Department of Pediatric orthopaedics, Hôpital Necker – Enfants Malades, Paris, France; Department of Orthopaedic Surgery, CHU de Charleroi-Chimay, Lodelinsart, Belgium
  3. 3Department of Pediatric orthopaedics, Hôpital Necker – Enfants Malades, Paris, France
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Abstract

Background: Invasive Group A streptococcal (GAS) infections in children are rising across Europe, yet GAS as a cause of septic arthritis (SA) remains poorly characterized. We aimed to describe the incidence trajectory of GAS SA in France, its clinical presentation relative to non-GAS SA, and predictors of sequelae. Methods: A retrospective national multicenter cohort study with nested case-control elements in children aged 3 months to 16 years was undertaken. Cases were culture- or PCR-confirmed GAS SA from 15 tertiary pediatric orthopaedic centres in France; controls were non-GAS SA patients. Crude and age-standardized incidence rates were calculated for the period 2010–2023. Multivariable logistic regression with cluster-robust standard errors identified predictors of GAS aetiology and of functional sequelae at 30-day follow-up. Findings: 137 GAS SA cases and 321 controls were included. GAS SA incidence rose steadily from 2010 onwards. The crude national incidence rate for 2021–2023 was 0.311 per 100,000 children under 15 years (95% CI 0.24–0.39), approximately 34 cases annually. GAS aetiology was independently associated with age 2–8 years, antalgic joint positioning (OR 3.94, 95% CI 1.61–9.67), elevated CRP (OR 1.14 per 10 mg/L, 95% CI 1.09–1.18), and concurrent skin or soft tissue infection, (OR 4.68, 95% CI 1.29–16.98, p=0.02). Presenting with a SA in a large joint decreases the risk of GAS being the causative organism (OR 0.50, 95% CI 0.26–0.94, p=0.03). Sequelae occurred in 24.8% of GAS SA, comparable to S. aureus SA (41.7%). Predictors of sequelae included longer symptom duration (OR 1.08 per day, 95% CI 1.03–1.12), concurrent osteomyelitis (OR 4.47, 95% CI 2.16–9.27), reintervention (OR 3.64, 95% CI 1.79–7.42), concurrent skin infection (OR 3.80, 95% CI 1.46–9.88), and pre-hospital antibiotics (OR 2.37, 95% CI 1.29–4.33). Interpretation: GAS SA is an emerging paediatric pathogen with a distinct clinical profile and sequelae burden comparable to S. aureus SA. Delayed treatment is a key modifiable predictor of poor outcomes; early recognition by orthopaedic surgeons, paediatricians, and primary care providers is essential.

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Cite

BibTeXRIS
BibTeX
@article{pigeolet2026epidemiology,
  title = {{Epidemiology and outcomes of Group A streptococcal and non-Group A streptococcal septic arthritis in French children between 2010 and 2023, a national cohort analysis, and case-control study}},
  author = {Manon Pigeolet and Edouard Haumont and Jade Burnouf-Lim and Pierre R. Smeesters and Alina Badina},
  journal = {Journal of Infection},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jinf.2026.106847},
  url = {https://doi.org/10.1016/j.jinf.2026.106847},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Epidemiology and outcomes of Group A streptococcal and non-Group A streptococcal septic arthritis in French children between 2010 and 2023, a national cohort analysis, and case-control study
AU  - Manon Pigeolet
AU  - Edouard Haumont
AU  - Jade Burnouf-Lim
AU  - Pierre R. Smeesters
AU  - Alina Badina
PY  - 2026
DA  - 2026/10/23
JO  - Journal of Infection
DO  - 10.1016/j.jinf.2026.106847
UR  - https://doi.org/10.1016/j.jinf.2026.106847
AB  - Background: Invasive Group A streptococcal (GAS) infections in children are rising across Europe, yet GAS as a cause of septic arthritis (SA) remains poorly characterized. We aimed to describe the incidence trajectory of GAS SA in France, its clinical presentation relative to non-GAS SA, and predictors of sequelae. Methods: A retrospective national multicenter cohort study with nested case-control elements in children aged 3 months to 16 years was undertaken. Cases were culture- or PCR-confirmed GAS SA from 15 tertiary pediatric orthopaedic centres in France; controls were non-GAS SA patients. Crude and age-standardized incidence rates were calculated for the period 2010–2023. Multivariable logistic regression with cluster-robust standard errors identified predictors of GAS aetiology and of functional sequelae at 30-day follow-up. Findings: 137 GAS SA cases and 321 controls were included. GAS SA incidence rose steadily from 2010 onwards. The crude national incidence rate for 2021–2023 was 0.311 per 100,000 children under 15 years (95% CI 0.24–0.39), approximately 34 cases annually. GAS aetiology was independently associated with age 2–8 years, antalgic joint positioning (OR 3.94, 95% CI 1.61–9.67), elevated CRP (OR 1.14 per 10 mg/L, 95% CI 1.09–1.18), and concurrent skin or soft tissue infection, (OR 4.68, 95% CI 1.29–16.98, p=0.02). Presenting with a SA in a large joint decreases the risk of GAS being the causative organism (OR 0.50, 95% CI 0.26–0.94, p=0.03). Sequelae occurred in 24.8% of GAS SA, comparable to S. aureus SA (41.7%). Predictors of sequelae included longer symptom duration (OR 1.08 per day, 95% CI 1.03–1.12), concurrent osteomyelitis (OR 4.47, 95% CI 2.16–9.27), reintervention (OR 3.64, 95% CI 1.79–7.42), concurrent skin infection (OR 3.80, 95% CI 1.46–9.88), and pre-hospital antibiotics (OR 2.37, 95% CI 1.29–4.33). Interpretation: GAS SA is an emerging paediatric pathogen with a distinct clinical profile and sequelae burden comparable to S. aureus SA. Delayed treatment is a key modifiable predictor of poor outcomes; early recognition by orthopaedic surgeons, paediatricians, and primary care providers is essential.
SN  - 1532-2742
ER  -