Septic arthritis (peds)

(Redirected from Septic Arthritis (Peds))

This page is for pediatric patients; for adult patients see septic arthritis.

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

Clinical Features

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

Differential Diagnosis

Evaluation

Work-Up

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

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%

Management

  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.

Authors:

Ross Donaldson