Septic arthritis in children: evaluation of demographic, clinical, diagnostic, therapeutic characteristics and prognosis

Introduction and Aim: Septic arthritis in children is an orthopedic emergency. Delay in diagnosis and inappropriate treatment may result in destructive joint damage and consequently lifelong disability. In this study, we aimed to evaluate the demographic, clinical, diagnostic, therapeutic features, and prognosis of children hospitalized with the diagnosis of septic arthritis. Materials and Methods: Between 2008 and 2024, patients aged 0–18 years who were diagnosed with septic arthritis and followed up by the Division of Pediatric Infectious Diseases, Çukurova University, were included in the study. Patient files were retrospectively reviewed. The diagnosis of septic arthritis was made by a pediatric infectious diseases specialist based on clinical, laboratory, and radiological findings in patients presenting with complaints compatible with septic arthritis. Results: Sixty-nine pediatric patients were included, with a median age of 96 months (minimum: 1 month – maximum: 241 months); 20 (29%) were female and 49 (71%) male. Involvement of the knee joint was present in 47 (68.1%) patients and the hip joint in 16 (23.6%). Osteomyelitis findings were detected in initial imaging of 30 (44.8%) patients. A pathogen was isolated from blood and synovial fluid cultures in 39 (56.5%) patients, with Staphylococcus aureus (38.4%) being the most frequently identified agent. Surgical debridement was performed in 47 (68.1%) patients. During follow-up, complications developed in 9 (12.9%) patients. In cases of septic arthritis accompanied by osteomyelitis, a history of trauma was present in 63.3%, while in those without osteomyelitis the rate was 30.7%, and this difference was statistically significant (p=0.01). The median duration of symptoms was longer in patients with osteomyelitis [14 days (min: 1–120)] compared to those without osteomyelitis [5 days (min: 1–105)] (p=0.005). Erythrocyte sedimentation rate (ESR) values at admission were higher in patients with concomitant osteomyelitis (42±29/h) than in those without osteomyelitis (30±22/h), and the difference was statistically significant (p=0.04). The rate of osteomyelitis was significantly higher in patients with concomitant soft tissue infection (p=0.001). In our study, a positive and strong correlation was found between C-reactive protein (CRP) levels at admission and the absolute neutrophil count (ANC)/absolute lymphocyte count (ALC) ratio (p<0.001). A positive and moderate correlation was also found between CRP and platelet (PLT)/ALC ratio (p=0.004). Conclusion: The main approach in treatment is early surgical drainage and appropriate intravenous antibiotic therapy. Joint aspiration should not be delayed when there is clinical suspicion, and treatment should be initiated promptly. In our study, longer duration of symptoms before treatment, history of trauma, presence of soft tissue infection, and elevated ESR values at admission were found to be significant for concomitant osteomyelitis, and we suggest that advanced evaluation with magnetic resonance imaging (MRI) is required in patients with these risk factors.