Characteristics of bone and joint infections in paediatric patients complicated with disseminated sepsis

Abstract

Background:The bone and joint infections in the pediatric population account for one of the major causes of childhood morbidity and when complicated with sepsis, the results can be devastating. Hence the timely diagnosis and appropriate treatment are cardinal to minimize complications and improve outcomes. This study aims to evaluate the prevalence of septic arthritis and osteomyelitis in children with sepsis, the organisms implicated, and their antibiotic sensitivities. Patients and Methods: During one year period 21 patients with bone and joint infection complicated with sepsis, severe sepsis, and septic shock were included in our study. Demographical details were collected from these patients with clinical features suggestive of septic arthritis and acute osteomyelitis, after proper clinical examination and appropriate investigations. Results: Twenty-one patients with bone and joint infections complicated with sepsis, severe sepsis, and septic shock were included of which 13 patients were males and 8 were females. The median age at presentation was 6.7 years. The median interval between symptom onset and hospital admission was 8 days. Septic arthritis was seen in 14 patients, and osteomyelitis was seen in 7patients. Multiple sites were involved in 2 patients. The most common joint was the knee (28.5%) followed by the hip (19%), and the most common bone involved was the femur (23.8%) followed by the tibia (9.5%).C-reactive protein (CRP) was raised among all patients with a median of 96 mg/L (range 48-170mg/L].14 [66.6%] cases were culture positive and Staphylococcus aureus (MRSA) was detected either in their blood or aspirate in 12 [85.6%] of such patients. Conclusion: Acute osteomyelitis and septic arthritis are relatively common serious bacterial infections that can progress to disseminated sepsis and septic shock. A multidisciplinary approach including the consideration of combined medical and surgical management should be considered in these patients.