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Volume 38, Number 3, June 2005

Comparison of the characteristics of culture-negative versus culture-positive septic arthritis in children

Wei-Szu Chang, Nan-Chang Chiu, Hsin Chi, Wen-Chen Li, Fu-Yuan Huang
Department of Pediatrics, Mackay Memorial Hospital, Taipei; and Mackay Medicine, Nursing and Management College, Taipei, Taiwan

Received: June 15, 2004    Revised: October 25, 2004    Accepted: December 2, 2004   


Corresponding author:

Dr. Nan-Chang Chiu, Department of Pediatrics, Mackay Memorial Hospital, 92, Section 2, Chung Shan North Road, Taipei 104, Taiwan. E-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it




Septic arthritis in children can be difficult to diagnose and may be associated with severe morbidity. A majority of apparent septic arthritis cases may have negative culture, thereby creating a dilemma regarding treatment. The medical charts of 209 children with the diagnosis of septic arthritis were retrospectively reviewed to evaluate the differences between culture-negative (n = 64) and culture-positive (n = 145) cases. Demographic data, clinical manifestations, treatment, and outcome were analyzed. Laboratory data recorded included white blood cell count, erythrocyte sedimentation rate, C-reactive protein, imaging studies, and culture results. Patients with culture-negative arthritis had a significantly lower incidence of fever (56.3% vs 70.3%, p=0.047), local pain or tenderness (42.2% vs 69.7%, p=0.0001), changes in the overlying skin (45.3% vs 62.1%, p=0.024), motion limitation (25.0% vs 42.8%, p=0.014), and osteomyelitis (25.0% vs 40.7%, p=0.029). Culture-negative patients had a longer duration of symptoms or signs before diagnosis (10.1 ± 8.9 days vs 6.5 ± 5.7 days, p=0.046) and a shorter antimicrobial course (24.5 ± 5.1 days vs 35.7 ± 8.1 days, p=0.001). Children with culture-negative septic arthritis had a lower prevalence of residual joint dysfunction at 6 months after treatment (3.1% vs 11.7%, p=0.046). In conclusion, children with culture-negative septic arthritis have milder clinical manifestations, earlier response to treatment, and a better outcome than those with culture-positive disease.



Key words:

Bacterial infection, clinical outcome, risk factors, septic arthritis



J Microbiol Immunol Infect 2005;38:189-193.