- See:
-
Osteomyelitis Child < 3yrs
-
Septic Hip
- Bacteriology:
- between ages six months and two years,
hemophilus influenza type B is the main
pathogen in septic arthritis (30-50 %), followed by Staph aureus and strep;
- in infants and children 1 month to 3 years old, the predominant organism causing hematogenous septic arthritis
was historically was
haemophilus influenzae, followed by
staphylococci and streptococci;
- predominance of H. influenza has significantly declined since a vaccine has been developed;
- in the study by H. Peltola et al. 1998, the incidence of haemophilus influenza septic arhtritis was 0% after
10 years of routine vaccination;
- Reduced incidence of septic arthritis in children by H. influenza type B vaccination.
H. Peltola et al.
JBJS. Vol 80-B. No 3. May 1988. p 471.
- differential dx: (child 3 mo - 6 yrs)
-
S. aureus:
-
H. influ:
-
Streptococci:
-
Enterobacteriaceae
- Lab Studies:
- only the gram stain and culture are diagnostic of infection;
- it is therefore imperative that material from direct aspiration of site of infection be obtained;
- WBC count is unreliable;
-
ESR is useful for diagnosis and for following response to treatment;
- blood cultures are also useful in diagnosis;
- Treatment:
-
septic hip: emergent drainage;
-
cefuroxime (75-100 mg/kg/day) is the current drug of choice since it provides adequate cerebrospinal fluid levels;
- septic arthritis secondary to influenzae usually responds very rapidly to treatment;
- second choice:
-
cefotaxime
-
ceftriaxone
-
timentin
