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.