FOLLOW-UP: THE BACTERIAL ETIOLOGY AND ANTIBIOTIC MANAGEMENT OF SEPTIC ARTHRITIS IN INFANTS AND CHILDREN

Abstract

In 1966 we published our experience with 117 cases of septic arthritis seen on the pediatric services of Parkland Memorial Hospital and Children's Medical Center in Dallas. That review brought to attention the hitherto unrecognized frequency of Hemophilus influenzae in this disease and, by emphasizing the wide variety of bacteria involved, tried to make the point that precise bacteriological diagnosis was essential to optimal therapy. This follow-up report of 221 patients adds the 104 patients treated from 1966 through 1970 to the previous series. The tabular material is arranged in the same manner as in the report covering the years 1955 through 1965 for easy comparison. (Tables I to IV) This analysis excludes patients with joint involvement secondary to osteomyelitis except for the unique situation of septic hip in which it is difficult to determine whether joint infection or bone infection is the primary event. The average number of cases per year has steadily risen but this appears to reflect mainly the even-enlarging medical population served rather than a real increase in frequency of septic arthritis. For example, total pediatric admissions rose by 32% from 1960 to 1970 while septic arthritis cases increased 46%. 1955-59: 6.4 cases per year 1960-65: 14.2 cases per year 1966-70: 20.8 cases per year A bacteriological diagnosis was established in 66.5% of cases overall (Table I) but the figure is higher during the past decade when the quality of diagnostic bacteriology was improved. 1955-59: 34% 1960-65: 71% 1966-77: 73% Part of the improved percentage of bacteriological diagnosis stems from better use of blood cultures.