UMEM Educational Pearls

Title: Septic / Pyogenic Arthritis

Posted: 2/19/2009 by Rose Chasm, MD (Updated: 12/26/2024)
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An acute bacterial infection of a joint.
Peak incidence in children is younger than 2 years of age.
Risk factors:
- history of trauma
- preceding URI
- immunodeficiency
- hemoglobinopathy
- Diabetes.
Age is the most important determinant of cause.
- In all age groups, S aureus is the primary organism accounting for more than 50% of cases.
- Among neonates, enteric gram-negative organisms and group B Streptococcus are the most frequent causes.
- Group A Streptococcus, S pneumoniae, and K kingae are common causes in children younger than 5 years old.
Blood culture, joint fluid aspiration and analysis, gram stain, and culture of fluid is recommended.
In pyogenic arthritis, the joint fluid is usually cloudy and has a leukocyte count of at least 50 x 10000/mcL, with a predominance of polymorphonuclear cells, low glucose concentrations, and high protein values.
Treatment involves a combination of parenteral antibiotics, surgical drainage, and decompression of the affected joint.
All children who have pyogenic arthritis of the hip or shoulder require prompt open surgical drainage and irrigation to prevent permanent joint damage as the increased intra-articular pressure can compromise blood flow resulting in avascular necrosis of the femoral or humeral head and predisposing the patient to dislocations.
Open surgical drainage of other joints usually is not required.

References

Krogstad P. Osteomyelitis and septic arthritis. In: Feigin RD, Cherry JD, Demmler GJ, Kaplan SL, eds. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders Co; 2004713-736.

Tan TQ. Osteomyelitis and septic arthritis. In: Perkin RM, Swift JD, Newton DA, eds. Pediatric Hospital Medicine: Textbook of Inpatient Management. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:497-500.

Yagupsky P, Bar-Ziv Y, Howard CB, Dagan R. Epidemiology, etiology, and clinical features of septic arthritis in children younger than 24 months. Arch Pediatr Adolesc Med. 1995; 149:537-540.