Risk Factors and Clinical Features of Septic Arthritis in Children: a Systematic Review and Meta-Analysis

Abstract

Background: Septic arthritis is a bacterial infection of the joint space that can cause permanent disability or death in children if not treated promptly. We conducted a systematic review and meta-analysis of studies published from 1980 to December 2022 to synthesize the evidence on risk factors and clinical features of septic arthritis in children. Methods: We searched PubMed, Embase, and Cochrane Library databases using the terms “septic arthritis”, “children”, “risk factors”, and “clinical features”. We included prospective cohort studies or randomized trials that reported on these outcomes. We assessed the quality of the included studies using the Cochrane risk of bias tool or the Newcastle-Ottawa scale. We pooled the results using random-effects models and calculated odds ratios (ORs) or mean differences (MDs) with 95% confidence intervals (CIs). Results: We included 42 studies with a total of 6,120 children. Risk factors for septic arthritis included age younger than 3 years (OR 2.54, 95% CI 1.87-3.46), male sex (OR 1.32, 95% CI 1.14-1.53), previous joint problems or surgery (OR 2.19, 95% CI 1.50-3.20), immunodeficiency (OR 2.76, 95% CI 1.86-4.10), and recent infection or injury (OR 2.45, 95% CI 1.72- 3.49). Clinical features varied but commonly included fever (OR 5.67, 95% CI 3.66-8.79), joint pain (OR 9.23, 95% CI 5.97-14.28), swelling (OR 8.41, 95% CI 5.44-13.01), and reduced movement (OR 10.12, 95% CI 6.55-15.65). The knee was the most frequently affected joint (40%), followed by the hip (28%) and ankle (11%). Staphylococcus aureus was the most common cause of infection (40%), followed by Streptococcus pyogenes (12%) and Kingella kingae (11%). Conclusions: This review provides a comprehensive summary of risk factors and clinical features of septic arthritis in children, which can facilitate early diagnosis and treatment to prevent joint damage and systemic complications.