Septic arthritis and acute hematogenous osteomyelitis in childhood at a tertiary hospital in Japan.

BACKGROUND: The aim of the present study was to describe the clinical features of septic arthritis (SA) and acute hematogenous osteomyelitis (AHO) in children and to assess the impact of health-care-associated infections and antimicrobial resistance.

METHODS: A retrospective review of medical records of children presenting to Osaka City General Hospital with SA and AHO was undertaken during an 85 month period. The following data were assessed: location at onset, age and gender, risk factors, involved joints and/or bones, symptoms and time of presentation, causative agents and sensitivity to antibiotics, treatments and late complications.

RESULTS: There were four health-care-associated (HCAI) and 20 community-acquired infections (CAI). The latency period from initial presentation to diagnosis was relatively longer in HCAI than CAI. The most common pathogen was methicillin-resistant Staphylococcus aureus (MRSA). Twenty percent of CAI patients and half of the HCAI patients were treated empirically for MRSA. All patients with complications had MRSA infection.

CONCLUSION: Many pediatric patients with SA were not treated initially with optimal antibiotics. Although surgical intervention was almost inevitably required, selection and administration of effective antibiotics was necessary not only to cure the current infection but also to prevent metastatic infection. In Japan, empiric treatment of SA and AHO should include first-line antibiotics against MRSA.