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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: ncc88@ms2.mmh.org.tw This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Methods:

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.