Septic arthritis (peds)

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

Kocher Criteria

• One point each
  • Non-weight bearing on affected side
  • ESR >40mm/hr
  • Fever
  • WBC >12,000
• Probability by points
  • 1 of 4 - 3%
  • 2 of 4 - 40%
  • 3 of 4 - 93%
  • 4 of 4 - 99%

Work-Up

• Labs
  • CBC, Blood cx, ESR, CRP, Throat cx
• Arthrocentesis
  • Cell count, GS, glucose, cx

DDx

1. Trauma
2. Septic arthritis
3. Acute Rheumatic Fever
4. Reactive Arthritis (Poststreptococcal)
5. Gonococcal arthritis
6. Lyme disease
7. Sickle cell crisis
8. Henoch-Schonlein Purpura (HSP)
9. Legg Calve Perthes Disease
10. Slipped Capital Femoral Epiphysis (SCFE)
11. Osteomyelitis
12. Juvenile Idiopathic Arthritis
13. Transient (Toxic) Synovitis (Hip)
14. Hemophilia
15. Osgood Schlatter Disease

Treatment

1. Joint drainage
2. 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

See Also

Septic Arthritis (General)

Arthrocentesis

Source

Tintinalli