The Clinical Usefulness of Polymerase Chain Reaction as a Supplemental Diagnostic Tool in the Evaluation and the Treatment of Children With Septic Arthritis

Carter, Kristen; Doern, Christopher D.; Jo, Chan Hee; Copley, Lawson A.

doi:10.1097/bpo.0000000000000411

Cited by 52 publications

(48 citation statements)

References 27 publications

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“…Williams et al 11 used PCR for pathogen detection and reported K. kingae as the most frequently isolated pathogen (27 cases, 39.7% of all synovial fluid pathogens, while routine cultures identified K. kingae in only 2 synovial fluid samples). Two additional studies 14,16 used both conventional cultures and PCR methods of detection and reported K. kingae growth in 10% and 14% of cases. The rates of positivity of synovial fluid cultures in the 7 studies mentioned were in the range of 23.8e63%.…”

Section: Discussionmentioning

confidence: 99%

“…Two additional studies reported that the use of PCR increases considerably the chances of bacterial identification in SA. 14,16 We consider surgery in the management of SA as complementary to antibiotics and not as an alternative to antibiotics and postulate that pus has to be drained and the joints have to be washed. In deep located joints like hip and shoulder, effective drainage is achieved by formal arthrotomy while arthroscopy represents an alternative.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Cohen

Katz

Rahamim

et al. 2020

Pediatrics & Neonatology

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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

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Cohen

Katz

Rahamim

et al. 2020

Pediatrics & Neonatology

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“…In approximately 18-70 % cases, no organisms can be identified (culture negative septic arthritis) [7,10]. The possible explanations for culture negative results are mistaken diagnosis; small bacterial load in sample; requirement of more sensitive diagnostic methods or samples obtained after initiation of antibiotics.…”

Section: Epidemiology and Causative Organismsmentioning

confidence: 97%

Bone and Joint Infections in Children: Septic Arthritis

Agarwal

Aggarwal

2015

Indian J Pediatr

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The pathological invasion of a joint and subsequent inflammation is known as septic arthritis. The knee and hip are the most frequently involved joints. Staphylococcus aureus is the most common cause of septic arthritis in children. An acute onset of illness with an inflamed painful joint and restricted movements and inability to use joint (pseudoparalysis) clinically indicates septic arthritis. The diagnosis is difficult in a neonate or young child where refusal to feed, crying, discomfort during change of diaper (if hip is involved) or attempted joint movement may be the only findings. Fever and other systemic signs may also be absent in neonates. Septic arthritis is diagnosed clinically, supported by appropriate radiological and laboratory investigations. The peripheral blood white cell count is frequently raised with a predominance of polymorphonuclear cells. The acute phase reactants such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) are often markedly raised. Ultrasonography and MRI are preferred investigations in pediatric septic arthritis. Determination of infecting organism in septic arthritis is the key to the correct antibiotic choice, treatment duration and overall management. Joint aspirate and/or blood culture should be obtained before starting antibiotic treatment. Several effective antibiotic regimes are available for managing septic arthritis in children. Presence of large collections, thick pus, joint loculations and pus evacuating into surrounding soft tissues are main indications for surgical drainage. Joint aspiration can be a practical alternative in case the lesion is diagnosed early, with uncomplicated presentations and superficial joints.

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“…Gram stain and culture may become negative shortly after initiation of antimicrobial therapy whereas bacterial rDNA persists and may be detected by molecular methods several weeks later (17). Addition of 16S rDNA PCR to routine processing of joint specimens increases diagnostic yield over culture alone in paediatric septic arthritis (18).…”

Section: Discussionmentioning

confidence: 99%

Neisseria meningitidis serogroup C sepsis and septic arthritis in an HIV-positive man

et al. 2017

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SummaryA patient with well-controlled HIV-1 infection presented with fever and rigors, a widespread maculopapular rash, and severe generalised arthralgia. Sepsis of unknown aetiology was diagnosed, and treatment with broadspectrum antimicrobials commenced. Following initial clinical improvement a right knee septic arthritis developed. Microscopy and culture of the joint aspirate was negative for organisms but 16S rDNA PCR identified Neisseria meningitidis DNA, subsequently verified as capsular genogroup C, thus confirming a diagnosis of disseminated meningococcal sepsis with secondary septic arthritis.

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The Clinical Usefulness of Polymerase Chain Reaction as a Supplemental Diagnostic Tool in the Evaluation and the Treatment of Children With Septic Arthritis

Abstract: PCR provides supplemental information for diagnostic confirmation through an increased rate of detection of bacteria. The timing of results and the inability to provide antibiotic sensitivity are factors that limit its clinical usefulness currently.

Cited by 52 publications

References 27 publications

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

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

Bone and Joint Infections in Children: Septic Arthritis

Neisseria meningitidis serogroup C sepsis and septic arthritis in an HIV-positive man

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