title: Clinical presentation and treatment of septic arthritis in children.
abstract: BACKGROUND
  The aim of this study is to determine the epidemiological features, clinical presentation, and treatment of children with septic arthritis.
  
  
  METHODS
  A retrospective review was conducted on a total of 141 children with septic arthritis treated in Hospital Universitario La Paz (Madrid) between the years 2000 to 2013. The patient data collected included, the joint affected, the clinical presentation, the laboratory results, the appearance, Gram stain result, and the joint fluid culture, as well as the imaging tests and the treatment.
  
  
  RESULTS
  Most (94%) of the patients were less than 2 years-old. The most common location was the knee (52%), followed by the hip (21%). The septic arthritis was confirmed in 53%. No type of fever was initially observed in 49% of them, and 18% had an ESR (mm/h) or CRP (mg/l) less than 30 in the initial laboratory analysis. The joint fluid was purulent in 45% and turbid in 12%. The Gram stain showed bacteria in 4%. The fluid culture was positive in 17%. Staphylococcus aureus was the most common pathogen found, followed by Streptococcus agalactiae, Streptococcus pneumoniae, and Kingella kingae. Antibiotic treatment was intravenous administration for 7 days, followed by 21 days orally. Surgery was performed in 18% of cases.
  
  
  CONCLUSIONS
  The diagnosis was only confirmed in 53% of the patients. Some of the confirmed septic arthritis did not present with the classical clinical/analytical signs, demonstrating that the traumatologist or paediatrician requires a high initial level of clinical suspicion of the disease.
authors.affiliation: Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, España.
authors.forename: I
authors.initials: I
authors.lastname: Moro-Lago
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
authors.forename: G
authors.initials: G
authors.lastname: Talavera
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España. Electronic address: l.moraleda@yahoo.es.
authors.forename: L
authors.initials: L
authors.lastname: Moraleda
authors.affiliation: Servicio de Cirugía Ortopédica y Traumatología, Hospital Universitario La Paz, Madrid, España.
authors.forename: G
authors.initials: G
authors.lastname: González-Morán
mesh_terms: D000293:Adolescent; D000843:Ankle Joint; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016908:Gram-Positive Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006621:Hip Joint; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007719:Knee Joint; D008297:Male; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome
keywords: Arthritis; Artritis; Clinical presentation; Presentación clínica; Septic; Séptica; Tratamiento; Treatment