Concurrent Septic Arthritis and Osteomyelitis in Children

Abstract

III.

Clinical and microbiological features of septic arthritis in children: Experience of one Latin American country

“…The high concurrency of osteomyelitis observed in this series is not surprising [5]. Several studies have shown a low bacterial recovery rate around 33-37% [1,2,6], which are much lower than that found in our study where the cultures resulted in a high return rate (70%).…”

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

“…Although there has been dramatic change in the prognosis and disease course in acute osteoarticular infections during the last century, acute osteoarticular infections are still a source of morbidity and even mortality, especially when concurrent septic arthritis and osteomyelitis are initially overlooked [6,10,11]. In our study, the presence of a coexisting joint effusion in the setting of metaphyseal osteomyelitis was found to represent concurrent septic arthritis in a majority of cases (75%) with a P-value of <0.0001.…”

“…Additionally, the neonatal periosteum is thinner and more likely to perforate, spilling infection into the joint and adjacent soft tissues [14]. McCarthy et al [11] quote a rate of 76% and, more recently, Montgomery et al [6] quote a rate of 78% for concurrent septic arthritis in the setting of neonatal osteomyelitis. In our study population, the percent of patients younger than 2 years with coexisting septic arthritis was 44%; however, children in this age group only represented 20% of the overall population.…”

“…Because of the significant impact on morbidity and mortality, Montgomery et al [6] investigated parameters to improve earlier detection of coexisting osteomyelitis in the setting of septic arthritis, in which they coined the term concurrent infections. In contrast to our study, Montgomery et al [6] started with patients with a known diagnosis of septic arthritis and looked for concurrent osteomyelitis.…”

“…In noncomplicated osteomyelitis, management more commonly includes medical rather than surgical treatment. Therefore, knowing whether an effusion is reactive or pyogenic is important to optimize patient care [1,[4][5][6][7].…”