Related Experiment Videos
Current trends of microorganisms and their sensitivity pattern in paediatric septic arthritis: A prospective study
Girish Motwani1, Rujuta Mehta1, Alaric Aroojis1
1Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India.
Insights
Early septic arthritis treatment is crucial. BACTEC culture improves pathogen detection, revealing resistance to common antibiotics but susceptibility to cephalosporins, recommended for empirical therapy.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Clinical Pharmacology
Background:
- Septic arthritis requires prompt treatment to prevent cartilage damage.
- Empirical antibiotic use is common pending culture results.
- Rising antibiotic resistance necessitates trend analysis.
Purpose of the Study:
- To analyze trends in septic arthritis etiology and antibiotic sensitivity in children.
- To compare conventional and BACTEC culture methods for joint fluid analysis.
- To evaluate empirical antibiotic regimens for pediatric septic arthritis.
Main Methods:
- Retrospective analysis of 60 pediatric septic arthritis cases.
- Joint fluid culture using conventional agar and BACTEC Peds Plus/F methods.
- Antibiotic susceptibility testing via CLSI disc diffusion method.
Main Results:
- The hip was the most common site (56%), particularly in infants under 1 year.
- BACTEC method yielded 71% positive cultures vs. 42% for conventional methods.
- Community-acquired cases often involved methicillin-sensitive Staphylococcus aureus; hospital-acquired cases showed resistant Gram-negative bacilli.
- High resistance to ampicillin-cloxacillin observed; cefazolin showed 82% sensitivity.
Conclusions:
- Staphylococcus aureus remains a common pathogen in pediatric septic arthritis.
- BACTEC system enhances the detection of significant microbial isolates.
- Cephalosporins are recommended as empirical therapy due to observed resistance patterns.
Purpose:
Early treatment of septic arthritis is essential before irreversible damage to the articular cartilage occurs. Clinicians often start empirical antibiotic therapy for symptomatic relief while awaiting a definitive culture report. In present day parlance with variations in different centres in the private and public sector and rampant antibiotic abuse, a lot of resistance is being seen in the flora and their sensitivity patterns. Hence it is imperative to document and analyze these changing trends.
Methods:
The authors conducted a retrospective analysis of prospectively gathered data of 60 patients under 14 years of age. Joint arthrotomy was performed as a standard therapeutic protocol and the drained pus or synovial fluid was sent for gram stain and culture by 2 different methods: conventional agar plate method and BACTEC Peds Plus/F bottle method. Antibiotic susceptibility tests were done by the disc diffusion method of Clinical Laboratory Standards Institute (CLSI).
Results:
The commonest presenting age group was below 1 year (80% patients) including 24 neonates. There were 19 hospital and 41 community acquired cases of septic arthritis. The hip (56%) was the commonest affected joint followed by knee (28%), shoulder joint (11%) and elbow (5%). Microorganism was isolated in 53% isolates of joint fluid only (36 culture positive patients). Conventional agar methods of culture showed positive report in only 42% patients (15/36 patients) while with the BACTEC method the yield was 71%. In the Community acquired septic arthritis, methicillin sensitive Staphylococcus aureus was isolated as commonest microbe while resistant variety of gram negative bacilli including E. coli and Klebsiella were found as predominant organism causing hospital acquired nosocomial infection of joints. The results strikingly differ in terms of response to treatment as most patients (11/19 patients) showed significant resistance to the most commonly practiced empirical antibiotic regimen of ampicillin-cloxacillin group in routine practice. When cefazolin was used as empirical antibiotic, it has shown good response and better sensitivity in 82% patients (27/33 patients).
Conclusion:
S. aureus is still the most common organism in septic arthritis. The BACTEC system was found to improve the yield of clinically significant isolates. Though a significant resistance to common antibiotic regimen is noticed, the strain is susceptible to cephalosporin group of antibiotics. We recommend the use of cephalosporine antibiotics as an empirical therapy till culture and sensitivity report are available.