Septic arthritis (peds)

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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

  1. Reactive or toxic synovitis
  2. Trauma
  3. Septic arthritis
  4. Acute rheumatic fever
  5. Poststreptococcal reactive arthritis
  6. Gonococcal arthritis
  7. Lyme disease
  8. Sickle cell crisis
  9. Henoch-Schönlein purpura
  10. Legg-Calvé-Perthes disease
  11. Slipped capital femoral epiphysis
  12. Osteomyelitis
  13. Juvenile rheumatic arthritis
  14. Transient synovitis
  15. Hemophilia
  16. Osgood-Schlatter disease

Treatment

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

See Also

Source

Tintinalli