Current Concepts in Pediatric Septic Arthritis

Septic arthritis continues to present challenges regarding the clinical diagnosis, workup, and definitive management. Urgent management is essential, so treating surgeons must efficiently work through differential diagnoses, identify concomitant infections, and do a timely irrigation and débridement. The incidence of methicillin-resistant Staphylococcus aureus is increasing, typically resulting in a more rapid progression of symptoms with more severe clinical presentation. The diagnostic utility of MRI has resulted in improved detection of concomitant septic arthritis and osteomyelitis, although MRI must not substantially delay definitive management. Early diagnosis followed by urgent irrigation and débridement and antibiotic therapy are essential for satisfactory long-term outcomes. Antibiotics should not be administered until blood cultures and arthrocentesis fluid are obtained, except in rare cases of a septic or toxic patient. Once cultures are obtained, empiric antibiotic therapy should commence and provide coverage for the most likely pathogens, given the patient's age. Laboratory markers, especially C-reactive protein, should be followed until normalization and correlate with resolution of clinical symptoms. Definitive antibiotic selection should be shared with a pediatric infectious disease specialist, who can help guide the duration of treatment.