Etiology of septic arthritis in children: an update for the 1990s

Pediatr Emerg Care. 1999 Feb;15(1):40-2. doi: 10.1097/00006565-199902000-00012.


Objective: To establish the etiology of septic arthritis in children after implementation of HIB immunization guidelines.

Methods: A retrospective review of all charts with a discharge diagnosis of septic arthritis (ICD-9: 711) from January 1991 to December 1996 at St. Louis Children's Hospital was conducted.

Results: Sixty-four patients (male = 58%) were identified, whose median age was 6.0 years. Twenty-one children (33%) were misdiagnosed on initial presentation. An organism was isolated in 38 (59%) of cases. The predominant organisms were Staphylococcus aureus (10 isolates), Group A Streptococcus (4), Enterobacter species (4), Kingella kingae (3), Neisseria meningitides (3), Streptococcus pneumoniae (2), Neisseria gonorrhoeae (2), Candida (2), Staphylococcus epidermidis (2). The only isolate of Haemophilus influenzae type B was in 1992 in an unimmunized 14 month old.

Conclusions: These data confirm Staphylococcus aureus as a frequent pathogen and suggest that H influenzae type B is no longer the predominant isolate in young children with septic arthritis. In addition, early septic arthritis in children is frequently misdiagnosed on initial evaluation.

MeSH terms

  • Adolescent
  • Adult
  • Arthritis, Infectious / diagnosis
  • Arthritis, Infectious / microbiology*
  • Child
  • Child, Preschool
  • Female
  • Haemophilus Infections / prevention & control
  • Haemophilus influenzae type b / isolation & purification
  • Humans
  • Immunization
  • Infant
  • Kingella kingae / isolation & purification
  • Male
  • Missouri
  • Practice Guidelines as Topic
  • Retrospective Studies
  • Staphylococcus aureus / isolation & purification
  • Synovial Fluid / microbiology*