Etiology of septic arthritis in children: An update for the 1990s

Objective: To establish the etiology of septic arthritis in children after implementation of HIB immunization guidelines. Methods: A retrospective review of all charts with a discharge diagnosis of septic arthritis (ICD-9: 711) from January 1991 to December 1996 at St. Lo uis Children's Hospital was conducted. Results: Sixty-four patients (male = 58%) were identified, whose median age was 6.0 years. Twenty-one children (33%) were misdiagnosed on initial pres entation, An organism was isolated in 38 (59%) of cases. The predominant or ganisms were Staphylococcus aureus (10 isolates), Group A Streptococcus (4) , Enterobacter species (4), Kingella kingae (3), Neisseria meningitides (3) , Streptococcus pneumoniae (2), Neisseria gonorrhoeae (2), Candida (2), Sta phylococcus epidermidis (2), The only isolate of Haemophilus influenzae typ e B was in 1992 in an unimmunized 14 month old. Conclusions: These data confirm Staphylococcus aureus as a frequent pathoge n and suggest that A influenzae type B is no longer the predominant isolate in young children with septic arthritis. In addition, early septic arthrit is in children is frequently misdiagnosed on initial evaluation.