Septic arthritis (peds)

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Background

  • Most often in patients < 3yo
  • MSSA and MRSA are most common causes in all age groups
  • Patients with sickle cell disease, rheumatoid arthritis, and inflammatory bowel disease are at increased risk

Evaluation

  • Neonates
    • Do not appear ill
    • Only 50% have fever
  • Older infants, toddlers, children
    • Fever (>101.3), localizing signs
  • Labs
    • CRP >20
    • WBC >12K

Kocher Criteria

  • One point each
    • Non-weight bearing on affected side
    • ESR >40mm/hr
    • Fever
    • WBC >12,000
  • Probability by points[1]
    • 1 of 4 - 3%
    • 2 of 4 - 40%
    • 3 of 4 - 93%
    • 4 of 4 - 99%

Work-Up

  • Labs
    • CBC, ESR, CRP, , blood/throat cultures
  • Arthrocentesis
    • Cell count, gram stain, glucose, cultures

Differential Diagnosis

Treatment

  1. Joint drainage/wash out
  2. IV antibiotics
Age Suspected Organism Antibiotics
Newborn (0–2 mo) Staphylococcus aureus Vancomycin, 10 milligrams/kg every 6–8 h
or 
Clindamycin, 10 milligrams/kg every 6–8 h
Group B Streptococcus Ampicillin, 50–100 milligrams/kg every 6 h
and 
Cefotaxime, 50 milligrams/kg every 6–8 h
or 
[[Ceftriaxone]], 50 milligrams/kg every 12 h
Gram-negative bacilli Cefotaxime, 50 milligrams/kg every 8 h
Neisseria gonorrhoeae  Cefotaxime, 50 milligrams/kg every 8 h
Unknown Vancomycin or clindamycin and cefotaxime or ceftriaxone (dosing as above)
Infant (2–36 mo) S. aureus Vancomycin or clindamycin (dosing as above)
Streptococcus species Clindamycin/cefotaxime/ceftriaxone (dosing as above)
Gram-Negative bacilli Cefotaxime or ceftriaxone (dosing as above)
Haemophilus influenzae  Cefotaxime or ceftriaxone (dosing as above)
Unknown Vancomycin or clindamycin and cefotaxime or ceftriaxone
Child (>36 mo) S. aureus Vancomycin or clindamycin
Streptococcus species  Clindamycin/cefotaxime/ceftriaxone
Gram-negative bacilli Cefotaxime or ceftriaxone
N. gonorrhoeae Cefotaxime or ceftriaxone
Unknown Vancomycin or clindamycin and cefotaxime or ceftriaxone

Disposition

Admit

See Also

References

  1. Kocher, MS, et al. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999; 81 (12):1662–70.