Septic arthritis (peds): Difference between revisions
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*Patients with sickle cell disease, rheumatoid arthritis, and inflammatory bowel disease are at increased risk | *Patients with sickle cell disease, rheumatoid arthritis, and inflammatory bowel disease are at increased risk | ||
== | ==Clinical Features== | ||
*Neonates | *Neonates | ||
**Do not appear ill | **Do not appear ill | ||
| Line 14: | Line 14: | ||
**CRP >20 | **CRP >20 | ||
**WBC >12K | **WBC >12K | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Trauma | *[[Trauma]] | ||
*[[Septic arthritis]] | *[[Septic arthritis]] | ||
*[[Acute Rheumatic Fever]] | *[[Acute Rheumatic Fever]] | ||
| Line 50: | Line 31: | ||
*[[Hemophilia]] | *[[Hemophilia]] | ||
*[[Osgood Schlatter Disease]] | *[[Osgood Schlatter Disease]] | ||
==Evaluation== | |||
===Work-Up=== | |||
*Labs | |||
**CBC, ESR, CRP, , blood/throat cultures | |||
*[[Arthrocentesis]] | |||
**Cell count, gram stain, glucose, cultures | |||
===Kocher Criteria=== | |||
*One point each | |||
**Non-weight bearing on affected side | |||
**ESR >40mm/hr | |||
**Fever | |||
**WBC >12,000 | |||
*Probability by points<ref> 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.</ref> | |||
**1 of 4 - 3% | |||
**2 of 4 - 40% | |||
**3 of 4 - 93% | |||
**4 of 4 - 99% | |||
==Management== | ==Management== | ||
#Joint drainage/wash out | #Joint drainage/wash out | ||
#IV antibiotics | #IV [[antibiotics]] | ||
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==Disposition== | ==Disposition== | ||
Admit | *Admit | ||
==See Also== | ==See Also== | ||
*[[Septic Arthritis (General)]] | *[[Septic Arthritis (General)]] | ||
*[[Arthrocentesis]] | *[[Arthrocentesis]] | ||
*[[Septic arthritis of the hip (peds)]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pediatrics]] | [[Category:Pediatrics]] | ||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:ID]] | [[Category:ID]] | ||
Latest revision as of 19:29, 22 October 2020
This page is for pediatric patients; for adult patients see septic arthritis.
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
Clinical Features
- Neonates
- Do not appear ill
- Only 50% have fever
- Older infants, toddlers, children
- Fever (>101.3), localizing signs
- Labs
- CRP >20
- WBC >12K
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
Evaluation
Work-Up
- Labs
- CBC, ESR, CRP, , blood/throat cultures
- Arthrocentesis
- Cell count, gram stain, glucose, cultures
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%
Management
- 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.