Difference between revisions of "Septic arthritis of the hip (peds)"
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==Background== | ==Background== | ||
| + | *hematogenous spread or local inf. | ||
| + | * wt. bearing joints most common | ||
| + | * knee (40-50%) | ||
| + | * hip (20- 25%) | ||
| + | * staph, S. Pneumo, group A strep | ||
| + | * in neonates also Groub B strep % gram neg. | ||
| − | + | ==Diagnosis== | |
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| − | == Diagnosis == | ||
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Age - 6 mo to 8 yrs | Age - 6 mo to 8 yrs | ||
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Xrays - possible effusion | Xrays - possible effusion | ||
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- get Bld Cxs (40-50% grow out) | - get Bld Cxs (40-50% grow out) | ||
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- CT may be useful to look for abscess, UTZ for effusion. | - CT may be useful to look for abscess, UTZ for effusion. | ||
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'''Kocher Criteria''' | '''Kocher Criteria''' | ||
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1. ESR > 40 | 1. ESR > 40 | ||
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4. Fever | 4. Fever | ||
| − | 1/4 criteria met --> 3% have septic joint | + | *1/4 criteria met --> 3% have septic joint |
| − | + | *2/4 --> 40% | |
| − | 2/4 --> 40% | + | *3/4 --> 93% |
| − | + | *4/4 --> 99% | |
| − | 3/4 --> 93% | ||
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| − | 4/4 --> 99% | ||
==Treatment== | ==Treatment== | ||
| − | + | # drainage | |
| − | + | # Oxacillin, Nafcillin or Clinda in pen all | |
| − | + | # cover H. inf as needed w/ 3rd gen ceph. | |
| − | + | # IV abx for 10-14 days before po | |
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| − | ceph. | ||
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==See Also== | ==See Also== | ||
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Peds: Hip Pain | Peds: Hip Pain | ||
| − | + | **Septic Joint*** | |
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| − | ** | ||
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*usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older). | *usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older). | ||
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*Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx | *Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx | ||
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[[Category:Peds]] | [[Category:Peds]] | ||
| + | [[Category:Ortho]] | ||
Revision as of 21:38, 22 June 2011
Contents
Background
- hematogenous spread or local inf.
- wt. bearing joints most common
- knee (40-50%)
- hip (20- 25%)
- staph, S. Pneumo, group A strep
- in neonates also Groub B strep % gram neg.
Diagnosis
Age - 6 mo to 8 yrs
Pres - Pain, Pseudoparalysis
Labs - ESR > 20 after 1-2 d, WBC >
Xrays - possible effusion
- may present w/ referred knee or thigh pain
- usually hold jt in flexion, ext rotat & slt abduction.
- get Bld Cxs (40-50% grow out)
- Xrays useful to exclude other cause of joint pain (AP & Frog leg)
- CT may be useful to look for abscess, UTZ for effusion.
Kocher Criteria 1. ESR > 40
2. WBC > 12
3. Refusal or inability to weight bear on affected joint
4. Fever
- 1/4 criteria met --> 3% have septic joint
- 2/4 --> 40%
- 3/4 --> 93%
- 4/4 --> 99%
Treatment
- drainage
- Oxacillin, Nafcillin or Clinda in pen all
- cover H. inf as needed w/ 3rd gen ceph.
- IV abx for 10-14 days before po
See Also
Peds: Hip Pain
- Septic Joint***
- usu acute, same mech as OM, usu similar org w/ s. aureus most common (think gc if older).
- Rx= aspirate sufficient for all xcept hip, must go to OR/IR w/ hip b/c incr pressure can cause avn of hip! o/w tap okay, usu OR if reaccumulates. send for (in order) 1) cx 2) count 3) gs.
- CBC >15 in 50%, ESR >60mm/hr in >90% of cases, CRP >20mg/L in 94%, Bcx 50%, fluid usu >50,000 WBC
(in gc arthritis: +blood cx: ~0%, +fluid cx/gs: 25-50%, urethral/rectal/throat swab may incr cx yield)
- xr for septic hip usu w/ joint space wide of >1-2 mm vs other side
- Rx= neonate ox & gent, 2mo-5yr cefotax & ox, 5y-12y ox (vanco?), >12 ox & ctx