To compare the incidence, characteristics, treatment course, and clinical o
utcome of children with culture-negative versus culture-positive septic art
hritis, we reviewed all 105 children treated for septic arthritis at our in
stitution from 1990 to 1997. Seventy-six children had a clinical presentati
on consistent with an isolated joint infection. All underwent a joint aspir
ation with fluid analysis including culture. All were followed up until res
olution of their symptoms. Culture of the synovial aspirates identified an
etiologic organism in only 30% of cases. No significant differences existed
between the culture-positive and culture-negative groups in most clinical
and laboratory criteria. No other diagnoses were demonstrated. All patients
underwent joint drainage, received comparable antibiotic therapy, and had
complete resolution of their infections. The current literature reports dec
eptively low rates of 18-48% for culture-negative septic arthritis. Seventy
percent of children with clinical findings of septic arthritis had negativ
e synovial fluid cultures. As the two culture groups were comparable and no
other diagnoses were demonstrated, the culture-negative cases were likely
infections. Thus we recommend the same aggressive treatment in those cases
with and without identification of a causative organism.