Septic Arthritis in Children: Clinical Update

Abstract

Septic arthritis in children is a medical emergency, needing prompt diagnoses, drainage of the synovial space, and antimicrobial therapy to prevent poor outcomes. The most common mode of transmission is hematogenous dissemination to the synovial joint. Septic arthritis is most commonly seen in boys and mainly affects the weight-bearing joints. The most common bacteria are dependent on age, but across all age groups, Staphylococcus aureus is the most common. To appropriately diagnose and treat septic arthritis, a multidisciplinary approach with microbiology support, radiologists, pediatricians, rheumatologists, infectious disease specialists, and orthopedic surgeons is ideally needed. Septic arthritis in a child, especially of the hip, is a medical emergency and requires urgent orthopedic consultation for surgical drainage and joint space irrigation (Laine, J PediatrOrthop B24(2):95–98, 2015). Prompt initiation of empiric parenteral antibiotics at high doses against Staphylococcus aureus is needed in all age groups. Empiric intravenous therapy against Kingella kingae is recommended in patients 3 months to 5 years of age, as it is becoming the predominant organism in this age group in some settings. A transition to oral therapy is made by clinical/laboratory/microbiological improvement with expected duration of therapy from 2 to 4 weeks. It is essential for patients to have close follow-up to prevent poor outcomes such as limb length discrepancy, hip dislocation, osteoarthritis, avascular necrosis of the femoral head, and ankylosis.