eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Arthritis, Septic: Follow-up

Author: Richard J Scarfone, MD, Associate Professor, Department of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician and Director of Emergency Preparedness, Division of Emergency Medicine, The Children's Hospital of Philadelphia
Contributor Information and Disclosures

Updated: Apr 29, 2009

Follow-up

Further Inpatient Care

  • Hospitalize all children presumed to have septic arthritis (SA) for empiric intravenous antibiotic therapy.

Inpatient & Outpatient Medications

Once an organism is identified, an appropriate antibiotic is selected, and the child is demonstrating a good clinical response, continue outpatient therapy with either high-dose oral antibiotics or parenteral antibiotics. Antibiotics readily enter the joint fluid in high concentrations after oral administration. Frequent revisits to the physician, to ensure compliance and good clinical response, are essential.

  • An S aureus infection usually clears after 3-4 weeks of antibiotic therapy.
  • Antibiotic therapy for 3 weeks for H influenzae type B or S pneumoniae infections is usually sufficient.
  • Gonococcal infections require 7-10 days of antibiotic therapy.

Complications

  • Meningitis (10-30%), osteomyelitis (5-10%), cellulitis (10-30%), and pneumonia (5%) are potential complications in young children with septic arthritis resulting from hematogenous spread of H influenzae type B.
  • Osteonecrosis, growth arrest, and sepsis are potential complications from septic arthritis of any etiology.

Prognosis

  • Time to diagnosis is the most important prognostic factor in septic arthritis. Early institution of therapy helps to prevent degenerative arthritis. Diagnosis may be delayed in young infants, which leads to a poorer outcome.
  • Other poor prognostic factors include infection of the hip joint, which may lead to aseptic necrosis of the femoral head; infection with S aureus; and a prolonged passage of time before the synovial fluid is sterilized.

Patient Education

  • Nontraumatic joint pain with evidence of arthritis, such as swelling, warmth, or redness, requires emergency medical attention.
  • For excellent patient education resources, visit eMedicine's Arthritis Center. Also, see eMedicine's patient education article Knee Pain.

Miscellaneous

Medicolegal Pitfalls

  • Failure to perform an arthrocentesis
  • Delay in diagnosis, leading to a poorer prognosis for joint function
 


More on Arthritis, Septic

Overview: Arthritis, Septic
Differential Diagnoses & Workup: Arthritis, Septic
Treatment & Medication: Arthritis, Septic
Follow-up: Arthritis, Septic
Multimedia: Arthritis, Septic
References
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References

  1. Kocher MS, Zurakowski D, Kasser JR. Differentiating between septic arthritis and transient synovitis of the hip in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am. Dec 1999;81(12):1662-70. [Medline].

  2. Caird MS, Flynn JM, Leung YL, et al. Factors distinguishing septic arthritis from transient synovitis of the hip in children. A prospective study. J Bone Joint Surg Am. Jun 2006;88(6):1251-7. [Medline].

  3. Kaplan SL. 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. 2009;634:111-20. [Medline].

  4. Welkon CJ, Long SS, Fisher MC, Alburger PD. Pyogenic arthritis in infants and children: a review of 95 cases. Pediatr Infect Dis. Nov-Dec 1986;5(6):669-76. [Medline].

  5. Thompson A, Mannix R, Bachur R. Acute pediatric monoarticular arthritis: distinguishing lyme arthritis from other etiologies. Pediatrics. Mar 2009;123(3):959-65. [Medline].

  6. Taekema HC, Landham PR, Maconochie I. Towards evidence based medicine for paediatricians. Distinguishing between transient synovitis and septic arthritis in the limping child: how useful are clinical prediction tools?. Arch Dis Child. Feb 2009;94(2):167-8. [Medline].

  7. Fordham L, Gunderman R, Blatt ER, et al. Limping child--ages 0-5 years. American College of Radiology (ACR). 2007;5.

  8. Dagan R. Management of acute hematogenous osteomyelitis and septic arthritis in the pediatric patient. Pediatr Infect Dis J. Jan 1993;12(1):88-92. [Medline].

  9. Frank G, Mahoney HM, Eppes SC. Musculoskeletal infections in children. Pediatr Clin North Am. Aug 2005;52(4):1083-106, ix. [Medline].

  10. Kratz A, Greenberg D, Barki Y, et al. Pantoea agglomerans as a cause of septic arthritis after palm tree thorn injury; case report and literature review. Arch Dis Child. Jun 2003;88(6):542-4. [Medline].

  11. Shetty AK, Gedalia A. Septic arthritis in children. Rheum Dis Clin North Am. May 1998;24(2):287-304. [Medline].

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Further Reading

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Keywords

septic arthritis, SA, bacterial arthritis, infectious arthritis, pyogenic arthritis, suppurative arthritis, purulent synovitis, pyarthrosis, suppurative synovitis, osteomyelitis, pressure necrosis, avascular necrosis, Haemophilus influenzae type B, community-acquired methicillin-resistant Staphylococcus aureus, MRSA-CA, hemophilia, hemarthrosis, sickle cell anemia, human immunodeficiency virus, HIV, chronic arthritis, joint pain, polyarticular disease, pseudoparalysis, arthralgia, transient synovitus, reactive arthritis, Escherichia coli, varicella-zoster virus, Salmonella, diagnosis, treatment

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Contributor Information and Disclosures

Author

Richard J Scarfone, MD, Associate Professor, Department of Pediatrics, University of Pennsylvania School of Medicine; Attending Physician and Director of Emergency Preparedness, Division of Emergency Medicine, The Children's Hospital of Philadelphia
Richard J Scarfone, MD is a member of the following medical societies: Alpha Omega Alpha and American Academy of Pediatrics
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Joseph Domachowske, MD, Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York-Upstate Medical University
Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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