Current clinical and bacteriological profile of septic arthritis in young infants: a prospective study from a tertiary referral centre

  • Gireesh Sankaran
  • Balaji Zacharia
  • Antony Roy
  • Sulaikha Puthan Purayil
Original Article • PAEDIATRICS - INFECTION

Abstract

Purpose

The study was carried out to evaluate the clinical and bacteriological profile of SA in young infants (age ≤ 3 months) in a tertiary referral centre and to assess the risk factors and to document the changing trends in the epidemiology.

Methods

This was a prospective descriptive study on all young infants with SA. Clinical and perinatal history, examination, radiological and laboratory findings (blood count, ESR, CRP, blood and joint cultures) were studied. Emergency arthrotomy was done and antibiotics were administered in all patients.

Result

Thirty young infants were included with a mean age of 22 ± 13.6 days and with male-to-female ratio 1.5:1. Pseudoparalysis and pain were the most common presenting symptoms. Knee joint was most commonly involved followed by hip. Ultrasound of the joint (86%) and elevated CRP levels (97%) were found to be reliable diagnostic markers. Most common causative organism was methicillin-resistant Staphylococcus aureus (43.3%) followed by Klebsiella pneumonia (23%). Sensitivity to empirical antibiotic regimen was lower (ceftriaxone 53%, amoxicillin 35%) when compared to higher antibiotics (gentamycin 88%, vancomycin 100%). Prematurity (57%), low birthweight (73%), anaemia (80%), previous history of hospitalisation (93%) and invasive procedures (90%) were found to be important risk factors.

Conclusion

The disease has distinct regional variations, and the epidemiological and bacterial profile is constantly changing. There is a shift in causative organisms towards more resistant and gram-negative species. Prematurity, low birthweight and previous hospitalisation are the major predisposing factors. A better understanding of the varied presentations is necessary for an early diagnosis and treatment, which is the most important prognostic factor.

Keywords

Neonate Osteomyelitis Low birthweight Joint Knee MRSA 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institute Ethics Committee, and all procedures followed were in accordance with the ethical standards

Informed consent

Individual written consent was obtained from all the individual participants included in the study.

References

  1. 1.
    Kabak S, Halici M, Akcakus M, Cetin N, Narin N (2002) Septic arthritis in patients followed-up in neonatal intensive care unit. Pediatr Int 44(6):652–657CrossRefPubMedGoogle Scholar
  2. 2.
    Wang CL, Wang SM, Yang YJ, Tsai CH, Liu CC (2003) Septic arthritis in children: relationship of causative pathogens, complications, and outcome. J Microbiol Immunol Infect 36(1):41–46PubMedGoogle Scholar
  3. 3.
    Klinger G, Levy I, Sirota L, Boyko V, Reichman V, Geva LL (2009) Epidemiology and risk factors for early onset sepsis among very-low-birthweight infants. Am J Obstet Gynecol 201(1):38-e1-6CrossRefPubMedGoogle Scholar
  4. 4.
    García-Arias M, Balsa A, Mola EM (2011) Septic arthritis. Best Pract Res Clin Rheumatol 25:407–421CrossRefPubMedGoogle Scholar
  5. 5.
    Narang A, Mukhopadhyay K, Kumar P, Bhakoo ON (1998) Bone and joint infection in neonates. Ind J Pediatr 65(3):461–464CrossRefGoogle Scholar
  6. 6.
    Ho NK, Low YP, See HF (1989) Septic arthritis in the newborn—a 17 years’ clinical experience. Singapore Med J 30:356–358PubMedGoogle Scholar
  7. 7.
    Motwani G, Mehta R, Aroojis A, Vaidya S (2017) Current trends of microorganisms and their sensitivity pattern in paediatric septic arthritis: a prospective study from tertiary care level hospital. J Clin Orthop Trauma. 8(1):89–92CrossRefPubMedGoogle Scholar
  8. 8.
    Castellazzi L, Mantero M, Esposito S (2016) Update on the management of pediatric acute osteomyelitis and septic arthritis. Int J Mol Sci 17:855CrossRefPubMedCentralGoogle Scholar
  9. 9.
    Brischetto A, Leung G, Marshall CS, Bowen AC (2016) A retrospective case-series of children with bone and joint infection from Northern Australia. Medicine 95(8):e2885CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Sreenivas T, Nataraj AR, Kumar A, Menon J (2016) Neonatal septic arthritis in a tertiary care hospital: a descriptive study. Eur J Orthop Surg Traumatol 26(5):477–481CrossRefPubMedGoogle Scholar
  11. 11.
    Morrey BF, Bianco AJ Jr, Rhodes KH (1975) Septic arthritis in children. Orthop Clin N Am 6:923–934Google Scholar
  12. 12.
    Kang SN, Sanghera T, Mangwani J, Paterson JM, Ramachandran M (2009) The management of septic arthritis in children: systematic review of the English language literature. J Bone Joint Surg Br 91:1127–1133CrossRefPubMedGoogle Scholar
  13. 13.
    Vidigal EC, Jacomo AD (1994) Early diagnosis of septic arthritis of the hip in neonates. Int Orthop 18(3):189–192CrossRefPubMedGoogle Scholar
  14. 14.
    Deshpande SS, Taral N, Modi N, Singrakhia M (2004) Changing epidemiology of neonatal septic arthritis. J Orthop Surg (Hong Kong) 12(1):10–13CrossRefGoogle Scholar
  15. 15.
    Li Y, Zhou Q, Liu Y et al (2016) Delayed treatment of septic arthritis in the neonate: a review of 52 cases. Medicine 95(51):e5682CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Bono K, Samora J, Klingele K (2015) Septic arthritis in infants younger than 3 months: a retrospective review. Orthopedics 38:e787–e793CrossRefPubMedGoogle Scholar
  17. 17.
    Lavy CBD, Lavy VR, Anderson I (1996) Salmonella septic arthritis of the shoulder in Zambian children. J R Coll Surg Edinb 41:196–199Google Scholar
  18. 18.
    Shaw BA, Kasser JR (1990) Acute septic arthritis in infancy and childhood. Clin Orthop Relat Res 257:212–225Google Scholar
  19. 19.
    Nunn TR, Cheung WY, Rollinson PD (2007) A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg Br 89(1):100–106CrossRefPubMedGoogle Scholar
  20. 20.
    Peltola H. (2014) Treatment of septic arthritis and acute osteomyelitis. In: Peltola H (ed) 21st european pediatric rheumatology congress, Belgrade, SerbiaGoogle Scholar
  21. 21.
    Kaplan SL (2009) Challenges in the evaluation and management of bone and joint infections and the role of new antibiotics for gram positive infections. Adv Exp Med Biol 634:111–120CrossRefPubMedGoogle Scholar
  22. 22.
    Sanjay Y, Mandeep SD, Sameer A, Sujit KT (2013) Microorganisms and their sensitivity pattern in septic arthritis of North Indian children: a prospective study from tertiary care level hospital. ISRN Orthop.  https://doi.org/10.1155/2013/583013 Google Scholar
  23. 23.
    Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117(3):423–428CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Griselda B, Veronica F, Adriana S et al (2010) Osteoarthritis in the neonate: risk factors and outcome. Braz J Infect Dis 14:4Google Scholar
  25. 25.
    Kliegman RM, Stanton BF, St Geme JW, Schor NF, Behrman RE (2013) Nelson textbook of pediatrics, vol 1, 19th edn. Elsevier Saunders, Philadelphia, pp 629–648Google Scholar
  26. 26.
    Buxton RA, Morran M (2003) Septic arthritis of the hip in infant and young child. Curr Orthop 17:458–464CrossRefGoogle Scholar
  27. 27.
    Caksen H, Oztürk MK, Uzüm K et al (2000) Septic arthritis in childhood. Pediatr Int 42(5):534–540CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of OrthopedicsGovernment Medical CollegeKozhikkodeIndia
  2. 2.Department of PediatricsGovernment Medical CollegeKozhikkodeIndia

Personalised recommendations