Article Text

ACUTE SEPTIC ARTHRITIS: A FOUR YEAR RETROSPECTIVE STUDY
  1. A Mascarenhas1,
  2. P M Kjollerstrom1,
  3. S Deuchande3,
  4. M C Neves2
  1. 1Department of Paediatrics, Hospital Dona Estefânia, Lisbon, Portugal
  2. 2Department of Paediatric Orthopedics, Hospital Dona Estefânia, Lisbon, Portugal
  3. 3Department of Paediatrics, Hospital São Francisco Xavier, Lisbon, Portugal

Abstract

Aims Evaluation of the demographic, clinical, laboratory and evolutional characteristics of septic arthritis in the pediatric population in a reference pediatric hospital.

Methods Case review of children admitted with the diagnosis of septic arthritis between January 1st 2004 and December 31st 2007.

Results From a total of 46 patients, 60.9% were male. Age at diagnosis ranged from newborn to 15 years old (mean 4.51). Mean in-hospital stay was 15.7 days. Symptoms were referred on average 12.3 days prior to admission (median 4 days). Fever was present in 78.3%; 97.8% had pain, reduced motility and inflammatory signs of the affected joint. The lower limbs were most commonly affected (95.7%; hip 45.7%). 23.9% referred with previous trauma or cutaneous infections. Seventeen (37%) had taken NSAIDs the week before. Blood or synovial fluid cultures were positive in 41.3% of patients. Staphylococcus aureus was the most common pathogen (19.6%, one isolate was methicillin resistant). Most patients received flucloxacillin (87%) and gentamicin (73.9%). Only 3 patients revealed sequelae on follow up evaluation.

Conclusions The successful management of pyogenic arthritis depends on timely decompression of the joint space and institution of appropriate antibiotic therapy. Compared to other studies we have longer in-hospital stays and longer parenteral antibiotic courses but our sequelae incidence is lower than usually reported. NSAIDs use was probably a risk factor. Staphylococcus aureus remains the most common isolated micro-organism with a small incidence of community-acquired methicillin resistance.

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