Epidemiology and outcome of septic arthritis in childhood: a 16-year experience and review of literature

Abstract

INTRODUCTION Septic arthritis (SA) is a devastating infection with a high rate of sequelae. The aim of this retrospective study was to determine the epidemiology, clinically significant sequelae and risk factors for developing these sequelae in children admitted to our hospital with SA. METHODS Patients with bacteriologically and/or radiologically confirmed SA from January 1999 to December 2014 were identified from discharge and laboratory records. Data was collected through a retrospective review of the case notes. RESULTS A total of 75 patients (62.7% male) met the inclusion criteria. The median age at presentation was six years (range two weeks to 15 years), and six patients were neonates. Microbiologic aetiology was determined in 40 (53.3%) patients, with Staphylococcus aureus being the most common organism. 68.0% of the patients underwent arthrotomy, and the average hospital stay was 15.3 days. Sequelae of SA were observed in nine patients on follow-up. Univariate and multivariate statistical analyses showed that young age, pyogenic bacterial isolation and concomitant osteomyelitis were significant risk factors for developing sequelae. CONCLUSION Our study demonstrated that young age, pyogenic bacterial isolation and concomitant osteomyelitis are associated with a high risk of sequelae. Timely microbiologic diagnosis by novel polymerase chain reaction methods and the use of magnetic resonance imaging in high-risk children to identify adjacent infection could possibly prevent lifelong disabling sequelae in SA.

Mid-Term Outcomes of Cementless Total Hip Arthroplasty in Adult Patients with Childhood Hip Infection

“…We agree with the view of previous studies that THA must be performed in infected hips that had remained quiescent for more than 10 years to prevent a higher risk of reinfection of previous pyogenic infections after THA [ 1 , 10 ]. Thus, we performed preoperative assessments to exclude evidence of persistent infection.…”

Septic arthritis in childhood: A 24‐year review

“…Previous studies have shown that 10–17% of patients with SA experienced sequelae 4 . Similarly, in this study, six patients (16%) experienced chronic sequelae.…”

“…The associated mild symptoms and limited increase in the levels of acute‐phase reactants create problems, and it is difficult to isolate 5 . Thus, the bacterium can be more easily identified using aerobic blood culture vials or real‐time PCR assays 4 . Notably, patients with unknown pathogens in this study were mostly between 2 and 5 years old ( P < 0.05).…”

“…Previous studies have shown that the rate of positive findings on synovial fluid cultures ranges from 38.7 to 63.0%. 1,4 Negative cultures might have been ascribed to prior antibiotic therapy or the inhibitory effect of pus on bacteria. 1 Similarly, in the present study, the rate of positive synovial fluid cultures was 43%.…”

Septic Arthritis of Neonates: Descriptive Study of a Neonatal Intensive Care Unit Nosocomial Outbreak

“…Nosocomial infections are mostly due to gram negative organisms [ 5 ]. In a retrospective review by Jeyanthi et al that included six neonates, methicillin resistant Staphylococcus aureus was the predominant organism [ 6 ]. In the neonatal and the broader paediatric group, Klebsiella pneumoniae , Staphylococcus aureus and Escherichia coli are the commonest organisms.…”