Septic Arthritis in Children. Regional Epidemiologic, Microbiologic, and Clinical Facts that May Help in Decision Making

Background: Septic arthritis( SA) carries significant morbidity and may need emergency surgical treatment. The hypothesis of the study is that it may be a dynamics over time and from region to region in the epidemiology of SA .

The Purpose of the study: was to define the actual spectrum of bacterial pathogens causing SA in pediatric populations in our region and evaluate prognostic factors.

Patients and Methods: Retrospective cohort study. Computerized charts of children aged 0-15 with an ICD discharge code consistent with SA during 2006-2013 were reviewed. The collected data was searched for epidemiologic changes (etiology , incidence ). Clinical outcome (site, hospitalization length, complications, need for surgery ) was documented. Data were analyzed using statistic tools to compare the treatments.

189 children entered the study: 119 Bedouin (63%) and 70 Jewish (37%). The overall incidence of SA in our region was 11.7/100,000. The incidence of SA in children less than 5 years was 25.75/100,000. The incidence of SA in Bedouin children was 15.4/100,000 and in Jewish children 8.3/100,000. The knee was the most involved (39.7%, 75 cases) followed by hip (28%, 53 cases) and ankle (13.8%, 26 cases).77 patients underwent arthrotomy and lavage; in 13 cases there was need for re-intervention.

Conclusions: The incidence of pediatric SA in southern Israel is higher than reported in literature: 11.7 /100,000 compared with 4-10/100,000 in developed countries. Staph. aureus was isolated in higher rates among children >2 years and K. kingae was isolated in higher rates among children Staph. Aureus(MRSA) was a rarity. This means that the present protocol with Cefazoline or Ceftriaxone as first line antibiotherapy does not have to be changed. Operated patients were hospitalized for longer time compared patients that received antibiotics only .It was statistically proven( p<0.0001) Actual epidemiologic and microbiologic trends of pediatric SA in our referral area influence decision making