Septic arthritis in children: Updated epidemiologic, microbiologic, clinical and therapeutic correlations

Abstract

Background: Septic arthritis (SA) is an infection characterized by significant epidemiologic and microbiologic differences between developed and developing regions and between age groups. Objectives: To determine the epidemiologic, clinical, microbiologic and therapeutic aspects of pediatric SA in Southern Israel. Methods: A retrospective case-series study based on the records of children <16 years of age admitted with SA at Soroka Medical Center, Beer-Sheva, during 2006e2013. Results: 189 patients were enrolled. There were 119 (63%) Bedouin and 70 (37%) Jewish children. The knee (39.7%), hip (28%) and ankle (13.8%) were the most commonly involved joints. Blood and/or synovial fluid cultures were positive in 48 (25.4%) patients. Overall SA incidence among children <16 years and <5 years was 11.7 and 25.4/100,000, respectively, without changes throughout the study period. SA incidence among Bedouin children was higher than among Jewish children (15.4 vs. 8.3/100,000 cases). Staphylococcus aureus was the most commonly isolated pathogen (18,19.5% of all patients), followed by Kingella kingae (10, 5.3%)e(37.5% and 20.8% among culture-positive patients, respectively). The number of children with culture-positive SA that required surgery was higher than those with culturepositive SA treated conservatively (P < 0.001). Hospitalization was longer in children treated surgically than in those treated conservatively (P < 0.001).Conclusion: This study is the largest single-center series on pediatric SA published in the last five years and provided an updated picture on incidence and the microbiologic, clinical and

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

“…The average length of hospital stay (LOS) (5.8 days) in our study is in agreement with US data [ 26 ], but is shorter than the reported 9.2 days in the Israeli study [ 10 ]. The rather short LOS is somewhat surprising but in keeping with recommendations that short intravenous antibiotic regimens followed by oral therapy are not inferior to long term intravenous therapy with regards to long-term outcomes [ 37 , 38 ].…”

“…While a study from Norway reported an AIR of 5 per 100,000 based on 12 cases over a 1-year period, a recent long-term study based on the Kids’ Inpatients Database (KID) in the USA reported a stable AIR of 5.5 over two decades, which is in agreement with the AIR of 5.6 in non-Indigenous patients in WA. In contrast, the high AIR in Indigenous children (which make up approximately 6% of the total population aged < 16 years) support findings by Okuzo et al [ 11 ] and recent data from Israel [ 10 ] which demonstrated significantly higher rates in disadvantaged children and illustrate the importance of ethnicity and socioeconomic status in the incidence and hospitalization rates of SA. As in other studies, there was no large change in SA incidence over time [ 10 , 26 ], suggesting a limited effect of changes in medical practice, such as the increased use of immune suppression and invasive joint procedures for children [ 12 ].…”

“…In contrast, the high AIR in Indigenous children (which make up approximately 6% of the total population aged < 16 years) support findings by Okuzo et al [ 11 ] and recent data from Israel [ 10 ] which demonstrated significantly higher rates in disadvantaged children and illustrate the importance of ethnicity and socioeconomic status in the incidence and hospitalization rates of SA. As in other studies, there was no large change in SA incidence over time [ 10 , 26 ], suggesting a limited effect of changes in medical practice, such as the increased use of immune suppression and invasive joint procedures for children [ 12 ]. While the incidence of SA was higher in winter and autumn in Norway [ 28 ], we found no seasonal effect on SA incidence in the Mediterranean and tropical climate of WA.…”

“…The AIR of paediatric SA in WA falls within the reported incidence range from 4 to 12 per 100,000 [10,[25][26][27]. While a study from Norway reported an AIR of 5 per 100,000 based on 12 cases over a 1-year period, a recent long-term study based on the Kids' Inpatients Database (KID) in the USA reported a stable AIR of 5.5 over two decades, which is in agreement with the AIR of 5.6 in non-Indigenous patients in WA.…”

“…SA is considered to be a medical emergency as it can lead to the rapid destruction of joints with the potential for poor functional outcomes [5][6][7][8][9]. Reports on the incidence of SA in children are sparse, with studies from the USA reporting an annual incidence rate (AIR) of 4 per 100,000 person-years, while a recent study from Israel reported an AIR of 11.7 per 100,000 person-years [10,11]. SA incidence in adults has been rising over the last 25 years due to a combination of multi-comorbidity, iatrogenic complications and increasing use of immunomodulating therapies [12][13][14][15].…”