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Orthopaedic infections in children 2

SEPTIC ARTHRITIS

  • In children septic arthritis can occur at any age but 50% of cases occur in children under 5years and 30% of cases occur in children under 2years
  • Hip most commonly affected in infants, and knee in older children
  • 10% of cases will have more than 1 joint affected

Route of spread

  1. Haematogenous
  2. Spread from metaphyseal osteomyelitis where the metaphysis is intra-articular
  3. Spread from contiguous soft tissue infection
  4. Direct inoculation

Causative organism

Under 2 years

2-16 years

16-30 years

over 30 years

S.aureus

S.aureus

S.aureus

S.aureus

E.coli

Strep. Pyogenes

Strep. pyogenes

Streptococci (A,B,C,G,pneumon)

Group B Strep

Streptococci (C,G)

N.gonorrhoea

Haemophilus

Haemophilus

 

Since the introduction of the HiB vaccine the incidence of haemophilus infections has dropped dramatically (Personal correspondence from Stepping Hill Hospital microbiology department)

Investigations

  • FBC, ESR, CRP
  • USS for detection of hip effusion
  • XR may show subluxation or dislocation

Diagnostic aspiration

Send sample for

  • Gram stain and microscopy
  • Septic arthritis strongly suspected if the WCC is >50,000mm-3 with 90% PMN, even if the cultures are negative
  • Culture

Differential diagnosis

Child

  • Irritable hip (transient synovitis)
  • Acute rheumatic fever
  • Henoch-Schonlein purpura

Adult

  • Gout
  • Pseudogout
  • Acute RA/OA
  • Acute
  • monarthropy

Treatment

  • IV antibiotics broad spectrum aimed at best guess first then adjusted according to microbiology results
  • Length of treatment (minimum)
    • IV 2 weeks
    • Oral child 2-4 weeks¬†
    • Adult 4-6 weeks


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