Background: Native joint infections (JI) and pyogenic spondylodiscitis (PS) are severe bone and joint infections (BJI). JI and PS incidence has been rising in developed countries for the last decades, ranging from 2 to 25 cases per 100 000 inhabitants (inhbts) and 2.4 to 14.4 cases per 100 000 inhbts respectively. To date, there is few data on JI and PS in Latin America and the Caribbean (LAC) despite the rising burden of those diseases. Martinique, a French region in the Caribbean Sea, has a healthcare system equivalent to that of continental France, providing free access to health facilities for all citizen. Moreover, the University Hospital Center of Martinique (CHUM) is a consortium of 3 hospitals and is the only healthcare facility accredited for managing native BJI on the island. All these characteristics make Martinique an ideal location to carry out an exhaustive epidemiology of BJI in the Caribbean.

Objectives: We aim to evaluate the incidence of native JI and PS in Martinique from 2017 to 2020, their clinical feature and associated morbidity and mortality.

Methods: We conducted a cross-sectional study between 2017 and 2020, using the CHUM’s Programme de Médicalisation des Systèmes d’Information (PMSI) database. Identification of hospital stays related to JI and PS was performed using ICD-10 codes: M869, M463, M008. A review of the medical reports concerning each identified hospital stays was conducted to validate patients meeting JI and PS criteria. All patients aged over 15 years and meeting JI and PS criteria were included in the study. Data collection included: gender, age, comorbidities (cardiovascular, cancer, immunosuppressive therapies), sites of BJI, clinical features of BJI, pathogen identification, requirement for surgery, neurological impairment in patients presenting with PS, intensive care unit (ICU) admission and in-hospital mortality. Estimates of the Martinican population from 2017 to 2020 by both sex and age group were provided by the Institut National de la Statistique et des Études Économiques (INSEE).

Results: Out of 782 stays identified from PMSI databases, 177 patients were included after removing duplicates and cross-checking diagnoses on medical records. Mean age at BJI diagnosis was 58.6 ± 7.6 years and 67.0 ± 17.8 years (p<0.01) for male and female respectively. Between 2017 and 2020, the overall annual incidence of native SA varied from 12.1/100 000 population to 10.5/100 000 population. The overall incidence of native PS remained stable around 7.1/100 000 population. The male-female ratio was 1.6:1 in both septic arthritis and spondylodiscitis in 2017. in 2020, it increased to 1.9:1 in native SA and to 3:1 in native PS. Age based annual incidence of native JI and PS are presented in Figures 1 and 2. Annual incidence of native JI was higher in patients over 75 years of age in 2017. In 2020, the highest incidence of native JI was reported in patients aged from 60 to 74 years. Between 2017 and 2020, incidence of native JI decreased in all age group except for the 60–74 age group, rising from 13.8/100 000 in 2017 to 20.2/100 000 in 2020 i.e. a 46.5% increase. Annual incidence of native PS remained higher in patients over 75 years of age from 2017 to 2020. Between 2017 and 2020 patients aged from 60 to 74 years exhibited the highest increase of PS incidence rising from 7.68 to 13.03/100 000 (+69.6%). Between 2017 and 2020, 22 patients (12.4%) required ICU management and overall mortality rate decreased from 9.43% to 8.33%. Mortality was significantly higher in patients with a history of diabetes (p=0.0016), hypertension (p<0.001) or chronic inflammatory rheumatism (p<0.01).Hypertension, chronic inflammatory rheumatism and endocarditis were more frequent in patient requiring ICU care (p=0.042, p=0.014, p= 0.042 respectively).Staphylococcus was the most common identified pathogen, occurring in 82 patients (48.0%) with over representation of Staphylococcus aureus (70 cases).

Figure 1.

Age based incidence of native joint infections from 2017 to 2020.

Figure 2.

Age based incidence of native pyogenic spondylodiscitis from 2017 to 2020.

Conclusion: This is the first epidemiological study on native JI and PS with exhaustive data in LAC. We report annual incidences of JI and PS comparable to those reported in the literature and we highlight a consistent rising incidence of BJI in patients aged from 60 to 74 years. Morbi-mortality and pathogens profiles of Martinican BJI were comparable to those reported in the literature, mostly in Europe, USA and Asia.

REFERENCES: [1] He et al., Front. Cell. Infect. Microbiol., 2023.

[2] Florestano et al., Rev. Chilena. Infectol., 2014.

[3] Gotuzzo et al., Ann. Rheum. Dis, 1987.

Acknowledgements: NIL.

Disclosure of Interests: None declared.

© The Authors 2025. This abstract is an open access article published in Annals of Rheumatic Diseases under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ ). Neither EULAR nor the publisher make any representation as to the accuracy of the content. The authors are solely responsible for the content in their abstract including accuracy of the facts, statements, results, conclusion, citing resources etc.