[Diagnosis of septic arthritis and initial antibiotic treatment].
OBJECTIVE
This study was designed to determine the similarities and differences in clinical, laboratory and radiographic presentation of septic arthritis in childhood and at adult ages, to find out its etiological profile, and to establish an antibiotic treatment protocol for the initial period and for patients in whom the causative agent could not be identified.


METHODS
Thirty-four patients (age range 15 months to 85 years) who underwent surgery with a diagnosis of septic arthritis were retrospectively studied in two groups, namely, children-adolescents (age = or < 15 years ; 16 patients) and adults (age >15 years; 18 patients). Clinical and laboratory findings of septic arthritis were compared with operation findings. The etiological profile and sensitivity patterns were investigated.


RESULTS
Unflatering features in both groups were clinical findings of decreased range of motion and tenderness, laboratory findings of elevated erythrocyte sedimentation rate and C-reactive protein, and domination of polymorphonuclear leukocytes in the joint fluid. Gram staining of the joint fluid was highly informative in terms of probable bacteria. During the first two years of life, the most common bacteria were H. influenzae and S. pneumoniae, and after two years, staphylococci and streptococci. Ciprofloxacin and sulbactam-ampicillin were found effective against most of the Gram-positive microorganisms isolated in both groups.


CONCLUSIONS
The most useful test for septic arthritis is arthrosynthesis and macroscopic and microscopic analyses of the material. Gram staining is of great help in the planning of initial antibiotic treatment. For patients older than two years of age, treatment with sulbactam-ampicillin is effective against staphylococci and streptococci, and amikacin against Gram-negative bacteria. Detection of Gram-negative bacteria in patients younger than two years should bring H. influenzae in mind, for which ampicillin must be the first choice.
Bombaci
Hasan
H
Department of Orthopedics and Traumatology (Ortopedi ve Travmatoloji Kliniği), Haydarpaşa Numune Training and Research Hospital, Usküdar, Istanbul, Turkey. bombacih@hotmail.com
Canbora
Kerem
K
Onur
Gökhan
G
Görgeç
Mücahit
M
Döşoğlu
Nilgün
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D006801:Humans; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D014421:Turkey / Q000453:epidemiology
D000900:Anti-Bacterial Agents