Septic arthritis (peds): Difference between revisions
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<span class="Apple-style-span" style="font-size: 19px; font-weight: bold; ">DDx</span> | <span class="Apple-style-span" style="font-size: 19px; font-weight: bold; ">DDx</span> | ||
#Trauma | #Trauma | ||
#Septic arthritis | #Septic arthritis | ||
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#Osteomyelitis | #Osteomyelitis | ||
#[[Juvenile Idiopathic Arthritis]] | #[[Juvenile Idiopathic Arthritis]] | ||
#Transient | #[[Transient (Toxic) Synovitis (Hip)]] | ||
#Hemophilia | #Hemophilia | ||
#[[Osgood Schlatter Disease]] | #[[Osgood Schlatter Disease]] | ||
Revision as of 20:02, 27 June 2011
Background
- Most often in pts <3yo
- MSSA and MRSA are most common causes in all age groups
- Pts w/ SCD, RA and IBD at increased risk
Diagnosis
- Neonates
- Do not appear ill
- Only 50% have fever
- Older infants, toddlers, children
- Fever (>101.3), localizing signs
- Labs
- CRP >20
- WBC >12K
Work-Up
- Labs
- CBC, Blood cx, ESR, CRP, Throat cx
- Arthrocentesis
- Cell count, GS, glucose, cx
DDx
- Trauma
- Septic arthritis
- Acute Rheumatic Fever
- Reactive Arthritis (Poststreptococcal)
- Gonococcal arthritis
- Lyme disease
- Sickle cell crisis
- Henoch-Schonlein Purpura (HSP)
- Legg Calve Perthes Disease
- Slipped Capital Femoral Epiphysis (SCFE)
- Osteomyelitis
- Juvenile Idiopathic Arthritis
- Transient (Toxic) Synovitis (Hip)
- Hemophilia
- Osgood Schlatter Disease
Treatment
- Joint drainage
- IV Abx
| Age | Suspected Organism | Antibiotics |
|---|---|---|
| Newborn (0–2 mo) | Staphylococcus aureus | Vancomycin, 10 milligrams/kg every 6–8 h |
| or | ||
| Clindamycin, 10 milligrams/kg every 6–8 h | ||
| Group B Streptococcus | Ampicillin, 50–100 milligrams/kg every 6 h | |
| and | ||
| Cefotaxime, 50 milligrams/kg every 6–8 h | ||
| or | ||
| Ceftriaxone, 50 milligrams/kg every 12 h | ||
| Gram-negative bacilli | Cefotaxime, 50 milligrams/kg every 8 h | |
| Neisseria gonorrhoeae | Cefotaxime, 50 milligrams/kg every 8 h | |
| Unknown | Vancomycin or clindamycin and cefotaxime or ceftriaxone (dosing as above) | |
| Infant (2–36 mo) | S. aureus | Vancomycin or clindamycin (dosing as above) |
| Streptococcus species | Clindamycin/cefotaxime/ceftriaxone (dosing as above) | |
| Gram-negative bacilli | Cefotaxime or ceftriaxone (dosing as above) | |
| Haemophilus influenzae | Cefotaxime or ceftriaxone (dosing as above) | |
| Unknown | Vancomycin or clindamycin and cefotaxime or ceftriaxone | |
| Child (>36 mo) | S. aureus | Vancomycin or clindamycin |
| Streptococcus species | Clindamycin/cefotaxime/ceftriaxone | |
| Gram-negative bacilli | Cefotaxime or ceftriaxone | |
| N. gonorrhoeae | Cefotaxime or ceftriaxone | |
| Unknown | Vancomycin or clindamycin and cefotaxime or ceftriaxone |
Disposition
Admit
Source
Tintinalli