J D Luhmann1, S J Luhmann. 1. Department of Pediatrics, Washington University School of Medicine, St. Louis 63110-1077, USA. luhmann_j@kidsA1.wustl.edu
Abstract
OBJECTIVE: To establish the etiology of septic arthritis in children after implementation of HIB immunization guidelines. METHODS: A retrospective review of all charts with a discharge diagnosis of septic arthritis (ICD-9: 711) from January 1991 to December 1996 at St. Louis Children's Hospital was conducted. RESULTS: Sixty-four patients (male = 58%) were identified, whose median age was 6.0 years. Twenty-one children (33%) were misdiagnosed on initial presentation. An organism was isolated in 38 (59%) of cases. The predominant organisms were Staphylococcus aureus (10 isolates), Group A Streptococcus (4), Enterobacter species (4), Kingella kingae (3), Neisseria meningitides (3), Streptococcus pneumoniae (2), Neisseria gonorrhoeae (2), Candida (2), Staphylococcus epidermidis (2). The only isolate of Haemophilus influenzae type B was in 1992 in an unimmunized 14 month old. CONCLUSIONS: These data confirm Staphylococcus aureus as a frequent pathogen and suggest that H influenzae type B is no longer the predominant isolate in young children with septic arthritis. In addition, early septic arthritis in children is frequently misdiagnosed on initial evaluation.
OBJECTIVE: To establish the etiology of septic arthritis in children after implementation of HIB immunization guidelines. METHODS: A retrospective review of all charts with a discharge diagnosis of septic arthritis (ICD-9: 711) from January 1991 to December 1996 at St. Louis Children's Hospital was conducted. RESULTS: Sixty-four patients (male = 58%) were identified, whose median age was 6.0 years. Twenty-one children (33%) were misdiagnosed on initial presentation. An organism was isolated in 38 (59%) of cases. The predominant organisms were Staphylococcus aureus (10 isolates), Group A Streptococcus (4), Enterobacter species (4), Kingella kingae (3), Neisseria meningitides (3), Streptococcus pneumoniae (2), Neisseria gonorrhoeae (2), Candida (2), Staphylococcus epidermidis (2). The only isolate of Haemophilus influenzae type B was in 1992 in an unimmunized 14 month old. CONCLUSIONS: These data confirm Staphylococcus aureus as a frequent pathogen and suggest that H influenzae type B is no longer the predominant isolate in young children with septic arthritis. In addition, early septic arthritis in children is frequently misdiagnosed on initial evaluation.
Authors: Mikhail Tretiakov; Frank S Cautela; Sarah E Walker; Joanne C Dekis; George A Beyer; Jared M Newman; Neil V Shah; Jenna Borrelli; Sharan T Shah; Anter S Gonzales; Jennifer M Cushman; John P Reilly; Jeffrey M Schwartz; Claude B Scott; Khalid Hesham Journal: J Orthop Date: 2019-01-04