title: Pitfalls in diagnosing septic arthritis in Hong Kong children: ten years' experience.
abstract: OBJECTIVE
  To evaluate the initial presentation of septic arthritis in Hong Kong children with respect to clinical and laboratory findings that can aid making a prompt diagnosis.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Five public hospitals in Hong Kong.
  
  
  METHODS
  Data concerning paediatric patients with septic arthritis were collected from January 2001 to December 2010. Patients with postoperative infections and those without enough retrievable information were excluded.
  
  
  RESULTS
  Of 31 patients analysed, on admission only 52% had had a fever of <38.5°C and 71% had raised white blood cell count of <12 x 10(9) /L. In 74% of these patients, Gram stains of blood culture samples yielded no positive findings. The leading causative organism was Staphylococcus aureus (42%), followed by group A Streptococcus (23%). When group A Streptococcus was responsible, five out of seven patients had a complicated clinical course (repeated surgeries, Streptococcus-related organ failure, and chronic joint stiffness). Moreover, in 19% of instances, the empirical antibiotic therapy prescribed on admission did not provide a broad enough spectrum of cover.
  
  
  CONCLUSIONS
  Signs of sepsis such as high fever, raised white blood cell count, and positive Gram smear from blood cultures were only present in around half of these patients with septic arthritis. Furthermore, group A Streptococcus tended to produce many complications. Regrettably, about a quarter of the empirical antibiotic regimens started by frontline staff were deemed not have a broad enough spectrum of cover. Improvement in the initial detection and management of septic arthritis patients is warranted.
authors.affiliation: Division of Paediatric Orthopaedics, Department of Orthopaedics and Traumatology, The Duchess of Kent Children's Hospital, Pokfulam, Hong Kong. eekuong@gmail.com
authors.forename: Evelyn E
authors.initials: EE
authors.lastname: Kuong
authors.forename: Michael
authors.initials: M
authors.lastname: To
authors.forename: M H
authors.initials: MH
authors.lastname: Yuen
authors.forename: Alexander K Y
authors.initials: AK
authors.lastname: Choi
authors.forename: C M
authors.initials: CM
authors.lastname: Fong
authors.forename: W
authors.initials: W
authors.lastname: Chow
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D001170:Arthritis, Infectious / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D006723:Hong Kong; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010818:Practice Patterns, Physicians' / Q000592:standards; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents