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Septic arthritis (peds)
From WikEM
Contents
Background
- Most often in patients < 3yo
- MSSA and MRSA are most common causes in all age groups
- Patients with sickle cell disease, rheumatoid arthritis, and inflammatory bowel disease are at increased risk
Evaluation
- 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]
- 1 of 4 - 3%
- 2 of 4 - 40%
- 3 of 4 - 93%
- 4 of 4 - 99%
Work-Up
- Labs
- CBC, ESR, CRP, , blood/throat cultures
- Arthrocentesis
- Cell count, gram stain, glucose, cultures
Differential Diagnosis
- 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/wash out
- IV antibiotics
| 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
References
- ↑ Kocher, MS, et al. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. 1999; 81 (12):1662–70.
Authors
Jordan Swartz, Neil Young, Ross Donaldson, Claire, Daniel Ostermayer
