title: Current trends of microorganisms and their sensitivity pattern in paediatric septic arthritis: A prospective study from tertiary care level hospital.
abstract: OBJECTIVE
  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 sensitiveStaphylococcus aureuswas isolated as commonest microbe while resistant variety of gram negative bacilli includingE. coliandKlebsiellawere 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).
  
  
  CONCLUSIONS
  S. aureusis 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.
authors.affiliation: Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India.
authors.forename: Girish
authors.initials: G
authors.lastname: Motwani
authors.affiliation: Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India.
authors.forename: Rujuta
authors.initials: R
authors.lastname: Mehta
authors.affiliation: Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India.
authors.forename: Alaric
authors.initials: A
authors.lastname: Aroojis
authors.affiliation: Department of Paediatric Orthopaedics, B.J. Wadia Hospital for Childrens, Mumbai, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vaidya
keywords: Aureus; BACTEC; Cephalosporine; Septic arthritis; Staphylococcus