Septic Arthritis In Children Research Articles

Arthroscopic treatment of septic arthritis of the knee in children

IntroductionChildhood septic arthritis of the knee is a serious disease that can impair growth and cause serious functional sequelae. There are few data on arthroscopic treatment in children, and series were always less than 20 cases. HypothesisThe objective of this study was to assess clinical and radiographic results of arthroscopic drainage combined with antibiotic therapy for the treatment of childhood septic arthritis of the knee. The hypothesis was that arthroscopic treatment is also effective in children. Materials and methodsA retrospective study, conducted between January 2003 and December 2012, included patients under 15 years of age with septic arthritis of the knee treated by arthroscopic drainage with a minimum of 2 years’ follow-up. ResultsFifty-six patients, with a mean age at surgery of 3.4 years (range, 3 months to 12 years), were included. Staphylococcus aureus was the most common causative organism. Two patients (3.6%) had recurrence, successfully treated by repeat arthroscopic drainage. Mean Lysholm score was 96.9 (range, 70–100) and mean KOOS-Child pain, symptoms, daily life, sports and quality of life scores were respectively 97 (81–100), 95 (75–100), 98 (89–100), 93 (71–100) and 95 (70–100) at a mean 65 months’ follow-up. Ranges of motion were normal. Radiology found no joint damage. Discussion and conclusionArthroscopic drainage combined with antibiotic treatment is a simple and effective treatment for childhood septic arthritis of the knee and is for our reference attitude. It can also be indicated in case of recurrence. Level of evidenceIV, retrospective study.

Dexamethasone Therapy for Septic Arthritis in Children

Dexamethasone Therapy for Septic Arthritis in Children

Dexamethasone Therapy for Septic Arthritis in Children.

Prospective studies of children with septic arthritis report that adding dexamethasone to antibiotic therapy contributes significantly to clinical and laboratory improvement. This study sought to evaluate the effect of this regimen outside of a randomized controlled trial. The sample consisted of children with septic arthritis hospitalized at a tertiary pediatric medical center in 2008 to 2013. Disease course and outcome were compared between children treated with antibiotics alone or with adjuvant dexamethasone, according to the admitting department policy. The cohort included 116 patients, 90 treated with antibiotics alone and 26 treated with antibiotics+dexamethasone. The groups were similar for age, symptom duration before hospitalization, body temperature, acute-phase reactant levels, and rate of positive fluid cultures (21.6% total). Compared with monotherapy, antibiotics+dexamethasone treatment was associated with a shorter duration of fever (mean 2.3 vs 3.9 days, P = .002), more rapid clinical improvement (mean 6.3 vs 10.0 days to no pain/limitation, P < .001), more rapid decrease in C-reactive protein level to <1 mg/dL (mean 5.3 vs 8.4 days, P = .002), shorter duration of parenteral antibiotic treatment (mean 7.1 vs 11.4 days, P < .001), and shorter hospital stay (mean 8.0 vs 10.7 days, P = .004). Recurrent symptoms of fever and joint pain occurred in 4 patients in the antibiotics+dexamethasone group after completion of the steroid course. Children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone.

Bone and Joint Infections in Children: Septic Arthritis.

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.

Osteomyelitis and septic arthritis in children: first data from the EUCLIDS network

Osteomyelitis and septic arthritis in children: first data from the EUCLIDS network

Septic Arthritis in Children: Frequency of Coexisting Unsuspected Osteomyelitis and Implications on Imaging Work-Up and Management

Osteomyelitis and septic arthritis clinically present at any age with overlapping signs and symptoms. The purposes of this study were to evaluate the demographic distribution of septic arthritis and osteomyelitis in children and to explore optimal imaging guidelines for these patients. We performed a retrospective study of children up to 18 years old who were treated for osteomyelitis or septic arthritis between January 2011 and September 2013. All patients underwent MRI without previous intervention. Studies were reviewed to determine the incidence of septic arthritis or superimposed osteomyelitis. The reference diagnosis was based on the combined review by the orthopedic surgeon and infectious disease notes, discharge summary, operative report, and MRI examination. One hundred sixty-two children who underwent 177 MRI examinations were diagnosed with acute musculoskeletal infection. One hundred three patients were included in the septic arthritis category, of whom 70 (68%) had septic arthritis with osteomyelitis. Seventy-four (42.1%) patients had isolated osteomyelitis without septic arthritis. Children under 2 years old were more likely to have septic arthritis (either isolated or with osteomyelitis) than isolated osteomyelitis compared with older children (p = 0.0003). In children who underwent MRI for suspected musculoskeletal infection, septic arthritis was more prevalent in children under the age of 2 years than in older children. However, both septic arthritis and osteomyelitis were found frequently in older children. Musculoskeletal infection imaging workup guidelines for children of all ages should address the frequent association of osteomyelitis and septic arthritis. We recommend that MRI should be used in the evaluation of suspected musculoskeletal infections in children, and the nearest joint should always be included to evaluate the extent of articular disease.

Preoperative antibiotics for septic arthritis in children: delay in diagnosis.

To review the records of 50 children who underwent open joint washout for septic arthritis with (n=25) or without (n=25) preoperative antibiotics. Records of 50 children who underwent open joint washout for presumed septic arthritis with (n=25) or without (n=25) preoperative antibiotics were reviewed. 17 boys and 8 girls aged 3 weeks to 16 years (median, 1.5 years) who were prescribed preoperative antibiotics before joint washout were compared with 12 boys and 13 girls aged one month to 14 years (median, 2 years) who were not. Following arthrotomy and washout, all patients were commenced on high-dose intravenous antibiotics. Patients were followed up for 6 to 18 months until asymptomatic. Patients who were referred from places other than our emergency department were twice as likely to have been prescribed preoperative antibiotics (p=0.0032). Patients prescribed preoperative antibiotics had a longer median (range) time from symptom onset to joint washout (8 [2-23] vs. 4 [1-29] days, p=0.05) and a higher mean erythrocyte sedimentation rate (93.1 vs. 54.3 mm/h, p=0.023) at presentation. Nonetheless, the 2 groups were comparable for weight bearing status, fever, and positive culture, as well as the mean (range) duration of antibiotic treatment (4.9 [4-7] vs. 4.7 [1-8] weeks, p=0.586). Preoperative antibiotics should be avoided in the management of septic arthritis in children. Their prescription delays diagnosis and definitive surgery, and leads to additional washouts and complications. A high index of suspicion and expedite referral to a specialist paediatric orthopaedic unit is needed if septic arthritis is suspected.

Polyarticular Septic Arthritis Caused by Haemophilus influenzae Serotype f in an 8-Month-Old Immunocompetent Infant: A Case Report and Review of the Literature.

Background. The standard use of vaccinations against pathogens has resulted in a decreased incidence of musculoskeletal infections caused by these previously common bacterial pathogens. Consequently, the incidence of infections caused by atypical bacteria is rising. This report presents a case of septic arthritis caused by non-type b H. influenzae in a pediatric patient. Methods. We report a case of an infant with polyarticular septic arthritis caused by H. influenzae serotype f. A literature review was conducted with the inclusion criteria of case reports and studies published between 2004 and 2013 addressing musculoskeletal H. influenzae infections. Results. An 8-month-old female presented with pain and swelling in her right ankle and left elbow. The patient was diagnosed with septic arthritis and underwent incision and drainage. Wound and blood cultures were positive for Haemophilus influenzae serotype f. In addition to treatment with IV antibiotics, the patient underwent immunocompetency studies, which were normal. Subsequent follow-up revealed eradication of the infection. Conclusions. Haemophilus influenzae non-type b may cause serious invasive infections such as sepsis or septic arthritis in children with or without predisposing factors such as immunodeficiency or asplenia. Optimal treatment includes surgical management, culture driven IV antibiotics, and an immunologic workup.

Midterm results of Ilizarov hip reconstruction for late sequelae of childhood septic arthritis.

The management of hip instability as a consequence of septic arthritis in childhood is difficult. Ilizarov hip reconstruction is a double-level femoral osteotomy with the objective of eliminating hip instability, through a proximal valgus–extension–derotation osteotomy and a distal varization–lengthening osteotomy for mechanical axis correction and equalization limb length. Ilizarov hip reconstruction was performed for 16 adult patients with complaints of hip pain, leg-length discrepancy, limping, reduced activity and limited abduction of the hip as a result of childhood septic arthritis. Their ages ranged from 19 to 32 years (mean 23.2 ± 4.2). Ilizarov external fixator was used in all cases. At the time of last follow-up that ranged from 60 to 132 months (mean 85.6 ± 23.5), the Harris hip score (HHS) showed excellent functional outcome in two cases (12.50 %), good in 13 cases (81.25 %) and fair in one case (6.25 %). There was no poor functional outcome in any case. Preoperatively, the mean HHS was 56.18 points, and at the time of last follow-up, it improved to a mean of 84.62 points. Pain subsided in all patients, the Trendelenburg sign became negative in all but three (19 %) patients, no patient had limb-length discrepancy, and the alignment of the extremity was reestablished in all cases. No additional operations were required. Ilizarov hip reconstruction is a valuable and durable solution for the late sequelae of childhood septic arthritis of the hip presenting in adult patients.

Arthrite septique de l’enfant à protéine C-réactive initialement normale : description clinique et biologique

Septic arthritis has to be suspected in children with joint effusion and fever so as to perform joint aspiration, which will confirm the diagnosis by bacteriological methods, and to perform surgical treatment by joint lavage. Since development of current molecular methods, such as real-time PCR, Kingella kingae has become the first microbial agent of osteoarticular infections in young children, whereas Staphylococcus aureus is second. C-reactive protein (CRP) is an aid used to diagnose septic arthritis, but its elevation could be moderate. In a previous study, conducted at our hospital, 10% of children hospitalized for S. aureus or K. kingae septic arthritis had a CRP level<10 mg/L. To determine if diagnosis of septic arthritis could be made by other parameters, we analyzed the clinical and biologic features of these patients and compared them to those of children hospitalized for septic arthritis with initial CRP ≥10 mg/L. Among the 89 children with septic arthritis, 10% (n=9) had initial CRP<10 mg/L (K. kingae, n=5/63 ; S. aureus, n=4/26). Initial temperature and fibrinogen were significantly lower in the CRP<10 mg/L group than in the other (37.3°C vs. 37.9°C, P=0.039 and 4.19 vs. 5.72 g/L, P=0.003, respectively). Age, symptom duration before diagnosis, as well as leukocyte and platelet counts were similar in both groups. Two children (2/89=2.2%) with S. aureus septic arthritis had no fever, CRP elevation, or fibrinogen elevation. In the CRP-negative group, three of four children with S. aureus arthritis and one of five with K. kingae arthritis had a high CRP level (34, 40, 61, and 13 mg/L, respectively) 3 days after surgery and antibiotic treatment. One child with K. kingae septic arthritis and initial CRP<10 mg/L needed a second surgical drainage because of relapse of arthritis. In the S. aureus arthritis group, none of the children with initial CRP<10 mg/L experienced complications, while six of those with initial CRP≥10 mg/L needed a second surgical act or hospitalization in an intensive care unit. While CRP is most often>10 mg/L during septic arthritis in children, it could be negative in up to 20% of patients in different studies. However, a mild inflammatory syndrome or even a CRP<10 mg/L cannot exclude diagnosis of septic arthritis. Therefore, a first episode of monoarthritis in children has to be considered as septic arthritis and treatment should not be delayed.

PO-0218 Audit Of Early Management Of Cases Of Septic Arthritis In Children

Introduction Septic arthritis can occur at any site of the body, but commonly occur in the lower limbs, especially knee and hip joints. It may arise from direct inoculation or spread from contiguous disease, but the most common method is haematogenous spread. We audited cases of septic arthritis in children as it can have serious consequences if mismanaged. Objectives We looked at the management of children presenting with suspected septic arthritis. Method All children who had a discharge code of septic arthritis between 1/01/07 and 29/04/13 were included. A standard proforma was used for data collection which recorded details of symptoms, signs, investigations and treatment Results 39 patients were coded as septic arthritis. On closer look 11 patients were wrongly coded which left with 28 patients to audit. 100% had full joint examinations and an orthopaedic review. 100% had appropriate blood tests including blood culture. 26 patients (93%) had a joint aspiration out of which 12(46%) had an aspirate before giving antibiotics. Staph aureus - 5 (18%) was the most coomon bacteria isolated from the joint aspirate followed by Group A beta-haemolytic strep 2 (7%), Group B Beta haemolytic strep 2 (7%), Coliform bacilli- 2 (7%), Strep mitis and coagulase negative staph- 1 (4%) and Strep pneumonia- 1 (4%). 100% had appropriate empirical antibiotics. The duration of antibiotics was variable but included a combination of intravenous and oral antibiotics. Conclusion The audit highlighted the areas for improvement: Urgent orthopaediac review in all cases Joint aspirate ideally before giving antibiotics A stand-alone guideline for children with septic arthritis.

Epidemiology, Diagnosis, and Treatment of Pericapsular Pyomyositis of the Hip in Children

The yield of synovial fluid cultures in patients meeting clinical criteria for septic hip arthritis remains low. In the presence of positive blood cultures, these patients are diagnosed and treated as "presumed septic arthritis." We hypothesized that some of these patients may instead have an extra-articular infection, such as pericapsular pyomyositis. An IRB-approved prospective study of children with suspected septic hip arthritis at a tertiary care children's hospital over a 2-year time period was conducted. Children were evaluated with a previously published clinical algorithm with the addition of magnetic resonance imaging (MRI). Of the 53 patients presenting with an acutely irritable hip, 32% were found to have pericapsular pyomyositis, whereas 15% were diagnosed with septic arthritis. Although C-reactive protein (CRP, ≥33.1 mg/L) performed well at predicting infection, there were no significant differences in CRP, erythrocyte sedimentation rate, white blood cell count, temperature, or weight-bearing status in children with septic arthritis compared with pericapsular pyomyositis. In addition to MRI, there was a difference in the size of hip effusion on ultrasound, which was significantly smaller in cases of pericapsular pyomyositis. CRP (≥74.3 mg/L) was found to be predictive of need for surgical intervention in children with pericapsular pyomyositis. Correct anatomic diagnosis of the site of infection is essential for the efficient care of the child. Herein, we found that pericapsular pyomyositis is twice as common as septic arthritis in children presenting with an acutely irritable hip. Clinical algorithms are incapable of differentiating these pathologies suggesting that both be considered under the current diagnosis previously referred to as "presumed septic arthritis." Incorrect diagnosis of a septic arthritis in the presence of a pericapsular pyomyositis could potentially lead to unnecessary debridement of the joint in the presence of extra-articular infection, thus contaminating the joint. Conversely, debriding the joint instead of the epicenter of the infection can prolong the infectious process. For these reasons, we conclude that MRI has the potential to improve the clinical care of children by providing a more precise diagnosis. Level II-"Diagnostic" [Development of diagnostic criteria on the basis of consecutive patients (with universally applied reference "gold" standard)].

A59: Dexamethazone Therapy for Septic Arthritis in Children: a Follow Up Study

Background/Purpose:In our previous prospective study we have demonstrated that the administration of Dexamethasone as an adjuvant therapy lead to a significant clinical and laboratory improvement in children with septic arthritis. This therapy has become accepted in some of the pediatric wards at Schneider's medical center. The aim of this study was to evaluate the effect of adding Dexamethasone to antibiotic therapy on the clinical course of septic arthritis in children not under controlled study.Methods:A retrospective study included all children hospitalized with the diagnosis of septic arthritis at Schneider Children's Medical Center from 2008–2013 .Part of the patients were treated with antibiotics alone, whereas others were treated with Dexametasone in addition to antibiotics, according to the policy of the admitting ward.Results:116 medical records were included in our study. Of which, 26 (22.4%) patients were treated with Dexamethasone and antibiotics and 90(77.6%) were treated with antibiotics only. There was no significant difference between the groups in age, duration of symptoms prior to hospitalization, body temperature or levels of acute phase reactants. Bacteria were isolated from 23 patients (20%) without any difference between the two groups. Patients treated with Dexamethasone had a significantly shorter duration of fever (mean 1st day without fever 2.3 vs. 3.9) (p = 0.002), shorter duration of parenteral antibiotic treatment (mean of 7.1 vs. 11.4 days) (p &lt; 0.001) and accelerated clinical improvement (mean 1stday without pain or any limitation in physical examination 6.3 vs. 10 days)(p&lt;0.001).Likewise, C‐reactive protein (CRP) levels declined faster below 1mg/dL in the Dexamethasone group (mean of 5.3 vs. 8.4 days) (p = 0.002) and the hospital stay was significantly shorter (mean of 8 vs. 10.7 days) (p = 0.004). No side effects of treatment were recorded in either group, but in the Dexamethasone group a short rebound of symptoms occurred in 3/26 (11.5%) patients after completing the course of steroids.Conclusion:A short course of Dexamethasone given early, in addition to antibiotics, leads to a significant clinical and laboratory improvement, shortens duration of treatment and accelerates recovery in children with septic arthritis.

Letter to the Editor: Another Look: Is There a Flaw to Current Hip Septic Arthritis Diagnostic Algorithms?

To the editor, I read with interest the article by Uzoigwe in which the author critically assessed the current diagnostic algorithms recommended for differentiating between pediatric septic arthritis and transient synovitis in children [3]. The six evaluated studies show wide variation in the risk posed by each of the clinical (a body temperature ≥ 38.5°C and inability to bear weight) and laboratory (white blood cell count > 12 × 109/L and erythrocyte sedimentation rate [ESR] ≥ 40 mm/hour) criteria included in the predictive scoring. Uzoigwe identified collinearity of the inflammatory predictors, inadequate sample size, and enrollment of an insufficient number of children with septic arthritis, as possible explanations for the incongruent between-studies results [3]. It should be noted, however, that the performance of any criterion for identifying diseased patients not only depends on the intrinsic properties of the investigated variable, but also on the reliability of the gold standard comparator. In the case of septic arthritis, the issue is complicated by the fact that, on average, in 33% (range, 16%–60%) of children with presumptive joint infections, the disease remains bacteriologically unconfirmed [2]. In full agreement with this concept, only 113 of 238 (47.5%) patients deemed to have septic arthritis in the studies reviewed by Uzoigwe grew an irrefutable pathogen in joint aspirates or blood cultures [3]. Therefore, children with symptoms of hip inflammation and synovial fluid (white blood cell count > 50 × 109/L), but no positive isolation of bacteria from a normally sterile site were included in the “septic arthritis” category. In recent years, Kingella kingae, a fastidious gram-negative member of the normal oropharyngeal flora has been recognized as the most common etiology of septic arthritis in children aged 6–36 months [4]. The organism requires inoculation of synovial fluid exudates into blood culture vials or the use of sensitive nucleic acid amplification assays for its detection [4], and it has been demonstrated that when these novel bacteriological methods are not used, many cases of joint infections caused by Kingella kingae will be missed and classified as “culture negative” septic arthritis [1, 4]. Additionally, children with Kingella kingae infections of the skeletal system frequently present with a mild clinical picture, requiring a high index of suspicion: the mean ± standard deviation body temperature is 38.4 ± 0.9°C, mean ESR is 44.1 ± 24.8 mm/hour, 21% of children have a blood white blood cell count < 12 × 109/L, and 23% have less than 50 × 109/L white blood cells in the synovial fluid aspirate, mimicking transient synovitis [1, 4]. Because none of the studies evaluated by Uzoigwe employed blood culture vials nor nucleic acid amplification tests, it is entirely possible that many children with K kingae septic arthritis presenting with mild clinical symptoms, unimpressive laboratory markers of inflammation, and negative cultures, could have been misclassified as cases of “transient synovitis.” Although Uzoigwe is correct in that well-controlled and adequately powered studies are in need to constructing a reliable diagnostic algorithm aimed to differentiate between pediatric joint infection and benign synovitis, use of improved bacteriological methods is also crucial for defining a more accurate gold standard for pediatric septic arthritis.

Twelve-month outcome following septic arthritis in children

There are very few literature data from the last two decades on the rate of complications following septic arthritis in children. This retrospective chart review shows that 10% of children admitted for septic arthritis to our institution suffered from clinically significant complications at 12 months following diagnosis. Forty-four children met our inclusion criteria, of whom 59% were male and 57% were culture positive. The most common causative organism was Staphylococcus aureus (76%), of which only 8% were methicillin-resistant S. aureus. Poor prognostic factors were culture positivity, infancy (<2 years) and male sex. Our rate of dysfunction is lower than most published rates, which have historically been in the range 15 to 49% in developed countries.

Arthroscopic Treatment of Septic Arthritis of the Hip in a Child: A Case Report

Recommended treatment options for acute septic arthritis in children include repeated aspiration, open arthrotomy, and arthroscopic drainage. However, reports of arthroscopic treatment of septic arthritis of the hip in a child are rare. We experienced a case of arthroscopic management of acute septic arthritis of the right hip joint in a three-year-old child using a 30。 , 2.7 mm arthroscope for the ankle joint through manual traction without use of a traction table. The patient had complete range of motion in the right hip joint two weeks after surgery and recurrent infection was not observed at the final follow-up two years postoperatively.

Use of Real-Time Polymerase Chain Reaction for the Diagnosis of Infection and Differentiation Between Gram-Positive and Gram-Negative Septic Arthritis in Children

Diagnosis and identification of the etiological agent of septic arthritis (SA) in children is an important issue, as early treatment based on accurate diagnosis of joint infections can prevent potentially disabling complications. The purpose of this study was to evaluate the efficacy of real-time polymerase chain reaction (PCR) for the diagnosis of SA in children. Twenty children with suspected SA who had joint pain and underwent surgical treatment were enrolled in this study. Their preoperative clinical and laboratory findings were investigated. Tissues obtained during operation were subjected to microbiological culture and real-time PCR, including methicillin-resistant Staphylococcus (MRS)-specific PCR and broad range universal PCR. Infection was confirmed if the result of microbiological culture was positive. Furthermore, abnormal clinical and laboratory findings and improvement in the symptoms and posttreatment data were also defined as the final diagnosis of infection. Out of the 20 patients, 19 were diagnosed with the infection. The remaining patient was postoperatively diagnosed with juvenile idiopathic arthritis. Abnormal preoperative body temperatures, white blood cell counts, C-reactive protein levels, and erythrocyte sedimentation rates were observed in 6, 9, 15, and 12 cases, respectively. The results of microbiological culture, MRS-PCR, and universal PCR were positive in 9, 2, and 15 cases, respectively. Analysis of the melting peak in universal PCR revealed that of the 15 cases, 10 had gram-positive and 5 had gram-negative infections. The sensitivity and specificity for the diagnosis of SA were, respectively, 0.47 and 1.00 in microbiological culture and 0.79 and 1.00 in real-time PCR. Successful diagnosis of infection and differentiation between gram-positive and gram-negative bacteria were achieved using MRS-PCR and universal PCR. Hence, real-time PCR is useful and has greater sensitivity than microbial culture for diagnosing SA in children. Level II diagnostic study investigating a diagnostic test.

Artritis séptica de cadera por Haemophilus influenzae tipo F en la infancia: a propósito de un caso

Septic arthritis of the hip is an acute infection, predominantly of bacterial etiology. Although Staphylococcus aureus is the primary pathogen in any age group, other potentially pathogenic microorganisms exist. We describe the case of an 18-month patient with septic arthritis of the hip with a rare causal agent (Haemophilus influenzae type F) and a good outcome. This case highlights the importance of considering other less common etiologic agents for septic arthritis in children, performing arthrocentesis with synovial fluid culture before starting antibiotic treatment, whenever this is possible. In addition, as in this case, it should be noted that a positive synovial fluid culture for Haemophilus influenzae forces typification of the bacteria in order to rule out or confirm a vaccine failure.

Osteomyelitis and septic arthritis in children

The cause, epidemiology, diagnosis, and treatment of osteoarticular infections have changed considerably in recent years. The current review includes the most up to date literature on pediatric septic arthritis and osteomyelitis. There is controversy over whether osteoarticular infection rates are increasing or decreasing. Changes in epidemiology may be related to improved methods of diagnosis. The pathogens responsible for osteoarticular infections in children have changed with alterations in immunization practices, emergence of resistant bacteria, and changes in patterns of immune modulating diseases and medications in children. Special culture techniques and PCR may help to identify pathogens that are difficult to culture. Surgical debridement is typically required for joint infections and chronic osteomyelitis, whereas acute osteomyelitis can typically be treated with medication alone. Needle aspiration/irrigation alone has been described as an alternative to surgical incision/drainage for septic arthritis, but this practice has not been widely adopted. Intravenous antibiotic therapy for 2-4 days followed by 20 days of oral therapy is effective for treating uncomplicated cases of osteomyelitis, whereas 2-4 days of intravenous antibiotics followed by 10 days of oral therapy is sufficient for septic arthritis. Steroids have shown some improved short-term clinical outcomes in patients with septic arthritis. Up to date knowledge of emerging pathogens, utilization of modern diagnostic techniques and implementation of new shorter treatment regimens can optimize the treatment of pediatric septic arthritis and osteomyelitis.

The diagnostic utility of gram stain microscopy in paediatric septic arthritis – a retrospective case study

The diagnosis of septic arthritis in children remains challenging despite reasonable evidence for the use of laboratory tests in diagnosis. There is also limited data on the diagnostic utility of gram stain microscopy in diagnosis. We therefore aim to establish the diagnostic utility of gram stain and predictive clinical and laboratory features of paediatric septic arthritis.