- 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 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 Peltola H, 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 Haemophilus influenzae type-b vaccination. Implications for treatment.
- 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