Presentación clínica y tratamiento de las artritis sépticas en niños / Clinical presentation and treatment of septic arthritis in children

Introducción. El objetivo de este estudio es determinar las características epidemiológicas, la presentación clínica y el tratamiento de los niños con artritis séptica en nuestro medio. Material y método. Se revisaron retrospectivamente 141 niños con una artritis séptica tratados en el Hospital Universitario La Paz (Madrid) entre los años 2000 y 2013. Se recogieron datos relativos al paciente, la articulación afectada, la presentación clínica, los valores analíticos, el aspecto, la tinción Gram y el cultivo del líquido articular, las pruebas de imagen y el tratamiento. Resultados. El 94% de los pacientes eran menores de 2 años de edad. La localización más frecuente fue la rodilla (52%), seguida de la cadera (21%). La artritis séptica se confirmó en el 53% de los pacientes. El 49% de ellos no presentaron fiebre ni febrícula inicialmente y el 18% tenían una VSG (mm/h) o PCR (mg/l) menor de 30 en la analítica inicial. El líquido articular fue purulento en el 45% de los casos y turbio en el 12%. La tinción Gram mostró bacterias en el 4%. El cultivo del líquido fue positivo en el 17%. Staphylococcus aureus fue el patógeno más frecuente, seguido de Streptococcus agalactiae, Streptococcus pneumoniae y Kingella kingae. La antibioterapia se administró por vía intravenosa 7 días, seguido de vía oral 21 días. Se realizó una cirugía en el 18% de los pacientes. Conclusiones. La confirmación diagnóstica solo se obtuvo en el 53% de los pacientes. Algunas artritis sépticas confirmadas no presentaron el cuadro clínico/analítico clásico, por lo que es necesario un alto índice de sospecha inicial de la enfermedad por parte del traumatólogo o del pediatra (AU)

Introduction. The aim of this study is to determine the epidemiological features, clinical presentation, and treatment of children with septic arthritis. Material and method. A retrospective review was conducted on a total of 141 children with septic arthritis treated in Hospital Universitario La Paz (Madrid) between the years 2000 to 2013. The patient data collected included, the joint affected, the clinical presentation, the laboratory results, the appearance, Gram stain result, and the joint fluid culture, as well as the imaging tests and the treatment. Results. Most (94%) of the patients were less than 2 years-old. The most common location was the knee (52%), followed by the hip (21%). The septic arthritis was confirmed in 53%. No type of fever was initially observed in 49% of them, and 18% had an ESR (mm/h) or CRP (mg/l) less than 30 in the initial laboratory analysis. The joint fluid was purulent in 45% and turbid in 12%. The Gram stain showed bacteria in 4%. The fluid culture was positive in 17%. Staphylococcus aureus was the most common pathogen found, followed by Streptococcus agalactiae, Streptococcus pneumoniae, and Kingella kingae. Antibiotic treatment was intravenous administration for 7 days, followed by 21 days orally. Surgery was performed in 18% of cases. Conclusions. The diagnosis was only confirmed in 53% of the patients. Some of the confirmed septic arthritis did not present with the classical clinical/analytical signs, demonstrating that the traumatologist or paediatrician requires a high initial level of clinical suspicion of the disease (AU)

Clinical presentation and treatment of septic arthritis in children. / Presentación clínica y tratamiento de las artritis sépticas en niños.

INTRODUCTION: The aim of this study is to determine the epidemiological features, clinical presentation, and treatment of children with septic arthritis. MATERIAL AND METHOD: A retrospective review was conducted on a total of 141 children with septic arthritis treated in Hospital Universitario La Paz (Madrid) between the years 2000 to 2013. The patient data collected included, the joint affected, the clinical presentation, the laboratory results, the appearance, Gram stain result, and the joint fluid culture, as well as the imaging tests and the treatment. RESULTS: Most (94%) of the patients were less than 2 years-old. The most common location was the knee (52%), followed by the hip (21%). The septic arthritis was confirmed in 53%. No type of fever was initially observed in 49% of them, and 18% had an ESR (mm/h) or CRP (mg/l) less than 30 in the initial laboratory analysis. The joint fluid was purulent in 45% and turbid in 12%. The Gram stain showed bacteria in 4%. The fluid culture was positive in 17%. Staphylococcus aureus was the most common pathogen found, followed by Streptococcus agalactiae, Streptococcus pneumoniae, and Kingella kingae. Antibiotic treatment was intravenous administration for 7 days, followed by 21 days orally. Surgery was performed in 18% of cases. CONCLUSIONS: The diagnosis was only confirmed in 53% of the patients. Some of the confirmed septic arthritis did not present with the classical clinical/analytical signs, demonstrating that the traumatologist or paediatrician requires a high initial level of clinical suspicion of the disease.