Background Septic arthritis is a joint inflammation caused by intra-articular and hematogenous infection, most common of which are bacterial pathogens. It has higher incidence in young children wherein three fourths of all cases occur by 5 year of age.² Although it accounts for only approximately 6.5% of all childhood arthritides,¹ early diagnosis and prompt treatment are important to prevent permanent disability. Timely and appropriate management requires knowledge on the clinical profile of children with septic arthritis and on the current predominant pathogens causing it.

Objectives To evaluate the clinical profile and determine common pathogens of septic arthritis in Filipino children admitted at Philippine General Hospital from January 2011 to December 2013.

Methods Design: Retrospective, descriptive chart review

Setting: PGH, a tertiary care hospital

Inclusion criteria: Children with septic arthritis admitted at PGH from January 2011 – December 2013 who fulfilled the Modified Newman's diagnostic criteria for septic arthritis (Group A - microbial pathogen isolated from synovial fluid or joint tissue; Group B - typical features of septic arthritis with pathogen isolated from the blood).

Exclusion criteria: Other forms of septic arthritis such as tuberculous, fungal, viral and spirochetal septic arthritis.

Main outcome measure(s): Describe the clinical profile, etiology and outcome of septic arthritis in Filipino children.

Results Out of 27 cases admitted at PGH, 17 patients fulfilled the inclusion criteria. Mean age was 6 years (age range 5 months - 11.6 years, SD 5.6 years). Most common reported risk factors include history of trauma (n=11, 64.7%) and infection from other sites such as osteomyelitis, respiratory tract infection and soft tissue abscess (n=9, 52.9%). The most frequent signs were swelling (n=17, 100%), fever (n=14, 82.4%) and limitation of joint movement (n=13, 76.5%).

Staphylococcus aureus was the most common pathogen among 18 culture positive isolates (61.1%, n=11). Culture studies yielded Methicillin Sensitive Staphylococcus aureus (33.3%, n=6) and Methicillin Resistant Staphylococcus aureus (27.8%, n=5) which were sensitive to Oxacillin and Clindamycin respectively.

C-reactive protein and Erythrocyte sedimentation rate were elevated in 80% (n=12/15) and 86.7% (n=13/15) of patients. Leukocytosis was observed in 82.4% of patients (n=14).

Mean length of stay was 31.8days (15.7-47.9days, SD 16.1days). 94.1% (n=16) of patients were discharged while 5.9% (n=1) died of septic shock secondary to nosocomial sepsis.

Conclusions The most common risk factor reported in pediatric septic arthritis were history of trauma (64.7%) and infection from other sites (52.9%). The most common presenting signs and symptoms were swelling (100%), fever (82.4%) and limitation of joint movement (76.5%).

Culture studies yielded MSSA (33.3%) and MRSA (27.8%) which were sensitive to Oxacillin and Clindamycin respectively.

Observed increased number of MRSA septic arthritis warrants alteration of first-line treatment from Oxacillin to Clindamycin.

References

1. Cassidy,J., Ross,P. Lindsley,C., et al. Textbook of Pediatric Rheumatology 6th Edition. 2011. USA

2. Kliegman, R., Stanto,B., St. Geme,J., et al. Nelsons Textbook of Pediatrics, 19th ed. 2011. USA

Acknowledgements Dr. Lorna Abad, technical adviser

Disclosure of Interest None declared