The etiology and clinical features of acute osteoarthritis in children; 2003-2009

Abstract

Purpose: This study was performed for the purpose of finding causative organisms and clinical features of septic arthritis or acute osteomyelitis in children. Methods: The study involved a retrospective review of the medical records of 63 microbiologically confirmed cases of acute pyogenic arthritis and osteomyelitis. All of the cases were brought about by community-associated infections and managed at the Seoul National University Children's Hospital or Seoul National University Bundang Hospital from June 2003 to July 2009. Results: The median age of all cases was 60 months and there were 35 males and 28 females. Major involved joints included the hip joint (15 cases), knee joint (7 cases), shoulder joint (4 cases), and elbow joint (4 cases). Also, major involved bones included the femur (20 cases), tibia (13 cases), humerus (7 cases), and radius (7 cases). Staphylococcus aureus was the most commonly identified causative organism, accounting for 49 cases (77.8%). Of the 49 isolates of S. aureus, methicillin-resistant S. aureus(MRSA) accounted for 8 cases (16.3%). Group B streptococcusspp. (GBS) and Salmonella spp. accounted for 3 cases, respectively. Nafcillin or cefazolin was often prescribed as an initial empirical antibiotic. There were 9 cases that were managed by a regimen that included vancomycin as the first choice. Fifty four cases (85.7%) recovered without any complications. Methicillin-sensitive S. aureus(MSSA), responsible for 41 cases, caused chronic complications in 3 cases. Of 8 cases caused by MRSA, 1 case showed chronic complication. There were no fatal cases. Conclusion: S. aureusremains the most common organism causing acute pyogenic arthritis and osteomyelitis of childhood acquired in the community. The high prevalence of methicillin resistance among S. aureusshould be considered carefully in the selection of initial empirical antibiotics.