Concurrent Septic Arthritis and Osteomyelitis in Children

Introduction: Septic arthritis and osteomyelitis can both independently cause substantial morbidity. With concomitant septic arthritis and osteomyelitis, the septic arthritis may be treated without knowledge of the adjacent osteomyelitis resulting in delayed treatment. This study aims to identify factors that may help to diagnosis concurrent infections (CI) earlier. Methods: A retrospective chart review of 200 patients with septic arthritis was performed. Patients with CI were compared with patients with septic arthritis alone using tests determined by the nature of the variable being analyzed (the chi(2) test, the Fisher exact test, the Cochran-Armitage trend test, and the Kruskal-Wallis test.). Results: Two hundred patients were eligible and analyzed, of which 43 (21.5%) had CI. On the basis of age, CI were most common in newborns and adolescents (P < 0.0001). On the basis of location, 72% of shoulder infections (P < 0.0001) were concurrent, whereas < 50% of elbows, hips, knees, and ankle were CI. The most common infective organism was methicillin-sensitive Staphylococcus aureus (P < 0.0001). CI were significantly associated with increased median (6) days of clinical symptoms before presentation (P < 0.0001), increased duration of median (6) days of hospital stay (P < 0.0001), increased number of operative procedures (P = 0.005), and increased need for ICU admission (P = 0.024). Conclusions: Utilizing advanced imaging (CT scan, bone scan, and/or MRI) in patients with septic arthritis who are younger than 4 months of age, between ages 13 and 20 years, with septic arthritis involving the shoulder, and with symptoms for more than 6 days may shorten hospital stays, decrease the number of operative procedures required, and possibly limit infection-related sequelae by identifying CI earlier. Level of Evidence: III.