Septic arthritis (peds): Difference between revisions
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Revision as of 21:44, 4 July 2011
Background
- Most often in pts <3yo
- MSSA and MRSA are most common causes in all age groups
- Pts w/ SCD, RA and IBD at increased risk
Diagnosis
- Neonates
- Do not appear ill
- Only 50% have fever
- Older infants, toddlers, children
- Fever (>101.3), localizing signs
- Labs
- CRP >20
- WBC >12K
Work-Up
- Labs
- CBC, Blood cx, ESR, CRP, Throat cx
- Arthrocentesis
- Cell count, GS, glucose, cx
DDx
- Trauma
- Septic arthritis
- Acute Rheumatic Fever
- Reactive Arthritis (Poststreptococcal)
- Gonococcal arthritis
- Lyme disease
- Sickle cell crisis
- Henoch-Schonlein Purpura (HSP)
- Legg Calve Perthes Disease
- Slipped Capital Femoral Epiphysis (SCFE)
- Osteomyelitis
- Juvenile Idiopathic Arthritis
- Transient (Toxic) Synovitis (Hip)
- Hemophilia
- Osgood Schlatter Disease
Treatment
- Joint drainage
- IV Abx
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
Source
Tintinalli