Current Concepts in Pediatric Septic Arthritis

Abstract

Septic arthritis continues to present challenges regarding the clinical diagnosis, workup, and definitive management. Urgent management is essential, so treating surgeons must efficiently work through differential diagnoses, identify concomitant infections, and do a timely irrigation and débridement. The incidence of methicillin-resistant Staphylococcus aureus is increasing, typically resulting in a more rapid progression of symptoms with more severe clinical presentation. The diagnostic utility of MRI has resulted in improved detection of concomitant septic arthritis and osteomyelitis, although MRI must not substantially delay definitive management. Early diagnosis followed by urgent irrigation and débridement and antibiotic therapy are essential for satisfactory long-term outcomes. Antibiotics should not be administered until blood cultures and arthrocentesis fluid are obtained, except in rare cases of a septic or toxic patient. Once cultures are obtained, empiric antibiotic therapy should commence and provide coverage for the most likely pathogens, given the patient's age. Laboratory markers, especially C-reactive protein, should be followed until normalization and correlate with resolution of clinical symptoms. Definitive antibiotic selection should be shared with a pediatric infectious disease specialist, who can help guide the duration of treatment.

Pediatric Musculoskeletal Infection Roundtable: Tips and Tricks for Streamlining Care in Common Scenarios

“…Open incisions have been the mainstay of treatment, but recent evidence has shown more orthopaedic surgeons opting for an arthroscopic approach, which may decrease length of hospital stay. 25,26 There is disagreement among our group as to whether a bone biopsy should be routinely performed when treating osteomyelitis without an abscess. When performing a bone biopsy, some experts will only culture routinely for aerobic and/or anaerobic bacteria while others may include culture for fungi or acid-fast bacillus.…”

Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients

“…In the classical paradigm, osteomyelitis usually occurs at the metaphysis. However, due to the unique anatomy in the neonatal long bones, osteomyelitis usually occurs at the epiphysis, resulting in a high probability of septic arthritis [17][18][19][20]. This warrants prompt treatment to avoid catastrophic outcomes, including epiphyseal cartilage destruction, growth disturbances, and functional impairment [16].…”

CORR Insights®: Low Reinfection Rates but a High Rate of Complications in THA for Infection Sequelae in Childhood: A Systematic Review

“…Several recent advances should facilitate an even-better understanding of the impact of childhood septic arthritis on adult arthroplasty, including the use of electronic medical records, improved diagnosis of childhood septic arthritis [3], standardized tools to define PJI in research [7], and advances in arthroplasty techniques in the setting of deformity [5]. These improvements should be leveraged to confirm the results of this systematic review [2] and to redefine the modern complication rate in THA among patients with a history of pediatric septic arthritis.…”