Clinical characteristics of children with septic arthritis caused by different pathogenic bacteria

Abstract

Septic arthritis is a serious infectious disease in children. In this study, we retrospectively analyzed the relationship between demographics, laboratory values at presentation, reported symptoms at presentation, joint involvement, and distribution characteristics of pathogenic bacteria in 171 patients during the period of 2012–2022. The results showed that a total of 77 pathogen-positive patients were detected in the 171 patients (culture-positive rate of 45.0%), 15 categories of pathogenic bacteria, and the highest detection rates were 52 cases of Staphylococcus aureus (67.5%), Streptococcus pyogenes in 7 cases (9.1%), and Streptococcus pneumoniae in 5 cases (6.5%). Comparison of these three pathogens revealed that the age of the Staphylococcus aureus and Streptococcus pyogenes groups was significantly older than that of the Streptococcus pneumoniae group (p < 0.05), and that the white blood cell count (WBC) of the Streptococcus pyogenes group was significantly higher than that of the Staphylococcus aureus group (p < 0.05), and that the Streptococcus pyogenes group had a significantly higher procalcitonin (PCT), which was significantly higher in the Streptococcus pneumoniae group (p < 0.05). The results suggest that the pathogenic bacteria of septic arthritis in children are mainly Staphylococcus aureus, Streptococcus pneumoniae infection occurred more commonly in the infant stage, and Staphylococcus aureus and Streptococcus pyogenes were detected frequently in school-age children. Streptococcus pyogenes was found to be more pathogenic than Staphylococcus aureus and Streptococcus pneumoniae.

Keywords

children / clinical manifestations / pathogenesis / retrospective analysis / septic arthritis

References

[1] Cohen E, Katz T, Rahamim E, et al. Septic arthritis in children: updated epidemiologic, microbiologic, clinical and therapeutic correlations. Pediatr Neonatol. 2020; 61(3): 325-330.

[2] Momodu II, Savaliya V. Septic arthritis. In: StatPearls. StatPearls Publishing; 2023.

[3] Montgomery NI, Epps HR. Pediatric septic arthritis. Orthop Clin N Am. 2017; 48(2): 209-216.

[4] Aitkens L, Winn M, Waller JL, et al. Septic arthritis in the end-stage renal disease population. J Invest Med. 2022; 70(2): 383-390.

[5] Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology. 2001; 40(1): 24-30.

[6] Pääkkönen M. Septic arthritis in children: diagnosis and treatment. Pediatr Health Med Therapeut. 2017; 8: 65-68.

[7] Spyridakis E, Gerber JS, Schriver E, et al. Clinical features and outcomes of children with culture-negative septic arthritis. J Pediatric Infect Dis Soc. 2019; 8(3): 228-234.

[8] Lee SH, Park JH, Lee JH, Jang WY. False-negative joint aspiration of septic arthritis of the hip in neonates. J Pediatr Orthop B. 2021; 30(6): 556-562.

[9] Porsch EA, Starr KF, Yagupsky P, St Geme JW,. The type a and type b polysaccharide capsules predominate in an international collection of invasive Kingella kingae isolates. mSphere. 2017; 2(2):e00060.

[10] Villani MC, Hamilton EC, Klosterman MM, Jo C, Kang LH, Copley LAB. Primary septic arthritis among children 6 to 48 months of age: implications for PCR acquisition and empiric antimicrobial selection. J Pediatr Orthop. 2021; 41(3): 190-196.

[11] Gouveia C, Duarte M, Norte S, et al. Kingella kingae displaced S. aureus as the most common cause of acute septic arthritis in children of all ages. Pediatr Infect Dis J. 2021; 40(7): 623-627.

[12] Higgins E, Suh GA, Tande AJ. Enhancing diagnostics in orthopedic infections. J Clin Microbiol. 2022; 60(6):e0219621.

[13] van den Boom M, Lennon DR, Crawford H, et al. Microbiology of septic arthritis in young Auckland children. J Paediatr Child Health. 2022; 58(2): 326-331.

[14] Carter K, Doern C, Jo CH, Copley LA. The clinical usefulness of polymerase chain reaction as a supplemental diagnostic tool in the evaluation and the treatment of children with septic arthritis. J Pediatr Orthop. 2016; 36(2): 167-172.

[15] Pääkkönen M, Kallio MJ, Kallio PE, Peltola H. Significance of negative cultures in the treatment of acute hematogenous bone and joint infections in children. J Pediatric Infect Dis Soc. 2013; 2(2): 119-125.

[16] Feng W, Yao Z, Liu H, Zhu D, Song B, Wang Q. Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip. J Orthop Sci. 2024; 29(5): 1294-1299.

[17] Arieli MM, Fowler ML, Lieber SB, Shmerling RH, Paz Z. The profile of the causative organisms which lead to septic arthritis of native joints over the last two decades in a single tertiary medical center in the east coast of the United States. Int J Clin Pract. 2021; 75(12):e15003.

[18] He M, Arthur Vithran DT, Pan L, et al. An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review. Front Cell Infect Microbiol. 2023; 13:1193645.

[19] Lade H, Joo HS, Kim JS. Molecular basis of non-β-lactam antibiotics resistance in Staphylococcus aureus. Antibiotics. 2022; 11(10):1378.

[20] Couderc M, Bart G, Coiffier G, et al. 2020 French recommendations on the management of septic arthritis in an adult native joint. Joint Bone Spine. 2020; 87(6): 538-547.

[21] Lin WT, Wu CD, Cheng SC, et al. High prevalence of Methicillin-resistant Staphylococcus aureus among patients with septic arthritis caused by Staphylococcus aureus. PLoS One. 2015; 10(5):e0127150.

[22] Guo Y, Liang Y, Wei Y, Liu W. Bacterial drug resistance analysis of suppurative bone and joint infection in children. Int J Lab Med. 2021; 42(13): 1618-1621.

[23] Trobisch A, Schweintzger NA, Kohlfürst DS, et al. Osteoarticular infections in pediatric hospitals in Europe: a prospective cohort study from the EUCLIDS consortium. Front Pediatr. 2022; 10:744182.

[24] Riise ØR, Lee A, Cvancarova M, et al. Recent-onset childhood arthritis--association with Streptococcus pyogenes in a population-based study. Rheumatology. 2008; 47(7): 1006-1011.

[25] Yu D, Gao W, Guo D, et al. Case Report: septic arthritis in children caused by Streptococcus pyogenes-rational use of antibiotics. Front Cell Infect Microbiol. 2023; 12:1117217.

[26] Paez-Perez Y, McGovern T, Flannery A, Naim F. Sternoclavicular septic arthritis caused by Streptococcus pyogenes in a child. Clin Pract Cases Emerg Med. 2017; 1(4): 312-314.

[27] Ross JJ. Septic arthritis of native joints. Infect Dis Clin. 2017; 31(2): 203-218.

[28] Ispahani P, Weston VC, Turner DP, Donald FE. Septic arthritis due to Streptococcus pneumoniae in Nottingham, United Kingdom, 1985-1998. Clin Infect Dis. 1999; 29(6): 1450-1454.

[29] Sánchez Granados JM, Malalana Martínez A, González Tomé MI, et al. Septic arthritis due to Streptococcus pneumoniae. An Esp Pediatr. 2002; 56(3): 208-211.

[30] Barbeito-Castiñeiras G, Guinda-Giménez M, Cores-Calvo O, Hernández-Blanco M, Pardo-Sánchez F. Pneumococcal arthritis in paediatric population. Rev Española Quimioter. 2017; 30(2): 118-122.

[31] Huang X, Tang J, Bai Y. Pyogenic arthritis caused by Streptococcus pneumoniae: a case report (in Chinese). Int J Lab Med. 2012; 33(21):2687.

[32] Haas T, Gaston MS, Rutz E, Camathias C. Septic arthritis of the elbow with Streptococcus pneumoniae in a 9-month-old girl. BMJ Case Rep. 2014; 2014:bcr2014205204.

[33] Jiang H, Tang G, Chen H, et al. Acute pyogenic osteomyelitis and arthritis in the right proximal humerus caused by Streptococcus pneumoniae serotype 33F: a case report (in Chinese). Lab Med. 2021; 36(6): 682-684.

[34] Donders CM, Spaans AJ, van Wering H, van Bergen CJ. Developments in diagnosis and treatment of paediatric septic arthritis. World J Orthoped. 2022; 13(2): 122-130.

[35] Siemens N, Lütticken R. Streptococcus pyogenes (“group A Streptococcus”), a highly adapted human pathogen-potential implications of its virulence regulation for epidemiology and disease management. Pathogens. 2021; 10(6): 776.

[36] Li Z, Li G, He B, Zhang Q. Distribution and drug resistance of pathogenic bacteria in children with septic arthritis. J Chongqing Med Univ. 2024; 49(3): 290-294.

[37] Slinger R, Moldovan I, Bowes J, Chan F. Polymerase chain reaction detection of Kingella kingae in children with culture-negative septic arthritis in eastern Ontario. Paediatr Child Health. 2016; 21(2): 79-82.

[38] Samara E, Spyropoulou V, Tabard-Fougère A, et al. Kingella kingae and osteoarticular infections. Pediatrics. 2019; 144(6):e20191509.

[39] Ma J, Gao J, Qin P. Clinical value of metagenomic next-generation sequencing in children with osteoarticular infections. Henan J Surg. 2023; 29(4): 28-31.

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2025 The Author(s). Pediatric Discovery published by John Wiley & Sons Australia, Ltd on behalf of Children's Hospital of Chongqing Medical University.