Clinical Features and Outcomes of Children with Culture-Negative Septic Arthritis

Spyridakis, Evangelos; Gerber, Jeffrey S.; Schriver, Emily; Grundmeier, Robert W.; Porsch, Eric A.; Geme, Joseph W. St.; Downes, Kevin J.

doi:10.1093/jpids/piy034

Cited by 34 publications

(33 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The overall rate of positive cultures in this study was 41.5%, which is in line with other studies that do not solely rely on the presence of a positive culture to diagnose SA [ 31 ]. Given the fact that cultures often remain negative [ 32 – 35 ], this should also not deter physicians from instituting therapy for presumed SA in a compatible clinical picture as this may lead to poor outcomes [ 1 ]. While an increasing role for Kingella infections has been described in culture-negative paediatric SA [ 31 , 36 ], we were unable to investigate the role of this relatively new agent as there is no Kingella -specific diagnostic code in discharge summaries.…”

Section: Discussionmentioning

confidence: 99%

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

et al. 2021

View full text Add to dashboard Cite

Objective To describe the incidence, risk factors and long-term outcomes in children hospitalised with septic arthritis (SA) in Western Australia (WA). Methods We extracted state-wide longitudinally linked administrative health data for patients aged < 16 years with a first diagnostic code of 711.X (ICD9-CM) and M00.X (ICD10-AM) in WA in the period 1990–2010. Annual incidence rates (AIR) per 100,000 with 95% confidence intervals (CIs), prior conditions during a median lookback period of 63.2 [interquartile range (IQR) 19.8–117.1] months and outcomes, including standardised mortality rates (SMR), during a median follow-up of 10 years are reported. Results A total of 891 patients [62% male, median age 6.4 (IQR 1.9–10.6) years with 34% aged < 3 years] were admitted for SA during the observation period. The overall AIR (per 100,000) was 9.85 (95% CI 4.79–14.41), and was higher in Indigenous Australians [34.9 vs. 5.5 (non-Indigenous), p < 0.001] and in males [11.9 vs. 7 (females), p < 0.01]; AIR showed no temporal or seasonal variation. Knees (43.9%), hips (34.6%) and ankles (13.3%) were most frequently affected, with Staphylococci predominant (49%) in patients with positive cultures (41.5%). Prior infection(s) (40.4%) and respiratory disease (7%) were the main pre-existing morbidities. Median hospital stay was 4.0 (IQR 2–8) days, with 1.9% requiring admission to the intensive care unit and 10.4% requiring readmission within 30 days. During follow-up, 26 patients (3.1%) developed osteomyelitis, nine patients were diagnosed with osteoarthrosis (1.1%) and five patients (0.6%) underwent joint replacement. Female patients developed other serious infections more often than male patients (40.5 vs. 27.1%, p < 0.01), as well as other comorbidities (Charlson Comorbidity Index > 0: 34.6 vs. 27.2%, p = 0.02), including diabetes (4.2 vs. 0%; p = 0.001), cardiovascular events (4.2 vs 1.4%, p = 0.002) and chronic arthritis (1 vs. 0%, p = 0.05). The crude mortality rate was low (0.3%), with 99.4% survival at 180 months and no increase in the SMR. Conclusions The incidence of SA in children in WA did not change over the 20-year observation period. SA did not lead to excess mortality, but bone and joint complications developed in 5% of patients. The high propensity to comorbid conditions in this young cohort suggests an underlying role of comorbidity in SA development. Supplementary Information The online version contains supplementary material available at 10.1007/s40744-021-00307-x.

show abstract

Section: Discussionmentioning

confidence: 99%

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

et al. 2021

View full text Add to dashboard Cite

show abstract

“…The correlation is strongest in ankylosing spondylitis. Reactive arthritis following enteric or urogenital infection has a relationship that varies anywhere from below 50% to 85% [7,8].…”

Section: Discussionmentioning

confidence: 99%

Chronic seronegative spondyloarthropathy following acute Mycoplasma pneumoniae infection in a human leukocyte antigen B27-positive patient: a case report

et al. 2020

View full text Add to dashboard Cite

Background We report a case of a 30-year-old patient who presented with acute Mycoplasma pneumoniae infection that was complicated by reactive arthritis and asymmetric proximal myopathy and progressed to chronic spondyloarthropathy. Reactive arthritis and sacroiliitis are unusual extrapulmonary manifestations of M. pneumoniae infection, which is a common condition. Case presentation A 30-year-old Greek previously healthy man presented to our emergency department with fever, progressively worsening bilateral lower limb weakness, and asymmetric oligoarthritis. Our diagnosis was based on a positive polymerase chain reaction test for M. pneumoniae using blood and cerebrospinal fluid and magnetic resonance imaging findings that suggested sacroiliitis. Our patient was also found to be human leukocyte antigen B27 positive. His infection was successfully treated with a 14-day course of doxycycline; the arthritis was treated with naproxen and corticosteroids. His arthritis, which restricted his mobility, improved progressively, and he was discharged without any neurological symptoms. Conclusions In our case, an acute M. pneumoniae infection eventually progressed to chronic spondyloarthropathy. In our patient, M. pneumoniae infection may represent a random event, or it might be a necessary factor for the development of reactive arthritis, asymmetric proximal myopathy, and sacroiliitis, always in combination with the appropriate genetic background. Extrapulmonary manifestations of M. pneumoniae may occur even in the complete absence of respiratory symptoms, and the diagnosis of unusual complications, such as reactive arthritis, requires high clinical suspicion and extensive investigation.

show abstract

“…The common clinical presentation of transient synovitis of the hip, which is thought to be triggered by a systemic viral infection[23,24], presents similarly to septic arthritis. Additionally, pediatric patients have a high incidence of “culture negative” septic arthritis which makes diagnosis difficult[25]. Given the technical skill and advanced imaging needed to obtain a diagnostic hip aspiration, there would be tremendous benefit if the SMS proved to be an effective rule-out test in this population.…”

Section: Discussionmentioning

confidence: 99%

Pilot study of a novel serum mRNA gene panel for diagnosis of acute septic arthritis

Schultz¹,

Sweeney²,

DeBaun³

et al. 2019

WJO

View full text Add to dashboard Cite

BACKGROUNDSeptic arthritis is an orthopedic emergency requiring immediate surgical intervention. Current diagnostic standard of care is an invasive joint aspiration. Aspirations provide information about the inflammatory cells in the sample within a few hours, but there is often ambiguity about whether the source is infectious (e.g. bacterial) or non-infectious (e.g. gout). Cultures can take days to result, so decisions about surgery are often made with incomplete data. Novel diagnostics are thus needed. The “Sepsis MetaScore” (SMS) is an 11-mRNA host immune blood signature that can distinguish between infectious and non-infectious acute inflammation. It has been validated in multiple cohorts across heterogeneous clinical settings.AIMTo study whether the SMS holds diagnostic validity in determining the etiology of acute arthritis.METHODSWe conducted a blinded, prospective, non-interventional clinical study of the SMS. All patients undergoing work-up for a septic primary joint were enrolled. Patients proceeded through the normal standard-of-care pathway, including joint aspiration and inflammatory labs [white blood cell (WBC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP)]. Venous blood was also drawn into PAX gene RNA-stabilizing tubes and mRNAs were measured using Nano String nCounter™. SMS was calculated blinded to clinical results.RESULTSA total of 20 samples were included, of which 11 were infected based on aspiration or intra-operative cultures. The SMS had an area under the ROC curve (AUROC) of 0.87 for separating infectious from non-infectious conditions. For comparison, the AUROCs for ESR = 0.58, CRP = 0.6, and WBC = 0.59. At 100% sensitivity for infection, the specificity of the SMS was 40%, meaning nearly half of non-septic patients could have been ruled out for further intervention.CONCLUSIONIn this pilot study, SMS showed a high level of diagnostic accuracy in predicting septic joints compared to other diagnostic biomarkers. This quick blood test could be an important tool for early, accurate identification of acute septic joints and need for emergent surgery, improving clinical care and healthcare spending.

show abstract

Clinical Features and Outcomes of Children with Culture-Negative Septic Arthritis

Cited by 34 publications

References 27 publications

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

Septic Arthritis in Children: A Longitudinal Population-Based Study in Western Australia

Chronic seronegative spondyloarthropathy following acute Mycoplasma pneumoniae infection in a human leukocyte antigen B27-positive patient: a case report

Pilot study of a novel serum mRNA gene panel for diagnosis of acute septic arthritis

Contact Info

Product

Resources

About