Caksen H, Oztürk M K, Uzüm K, Yüksel S, Ustünbaş H B, Per H
Department of Pediatrics, Yüzüncü Yil University School of Medicine, Kayseri, Turkey.
Pediatr Int. 2000 Oct;42(5):534-40. doi: 10.1046/j.1442-200x.2000.01267.x.
The purpose of the present study was to determine whether there was a difference between septic arthritis (SA) combined with osteomyelitis and SA alone with regard to clinical and laboratory findings, such as symptoms on admission, age, sex, joint involvement and isolated micro-organisms, and a relationship between age and joint involvement in SA. In addition, we also aimed to determine the prognostic factors in SA.
The clinical and laboratory findings of 40 patients who were diagnosed with SA in our hospital were reviewed retrospectively. The diagnosis of SA was made according to the following criteria: immediate joint fluid aspiration (culture and Gram's stain positive, leukocyte count markedly elevated and glucose level low), blood culture positive and positive cultures from other possible sites of infection.
Of the 40 patients, 22 were boys, 18 were girls and the male to female ratio was 1.2/1. Patient ages ranged from 6 months to 14 years (mean (+/- SD) 8.44 +/- 4.18 years). The most observed symptoms were fever (52.5%), arthralgia (50%) and joint swelling (45%). Thirty-four (85%) patients had only one joint and six patients (15%) had more than one joint involved. In total, arthritis was diagnosed in 49 joints. The joints diagnosed as having arthritis were the following: knee (n = 18), hip (n = 12), ankle (n = 12), elbow (n = 3), shoulder (n = 2), wrist (n = 1) and interphalangeal joint (n = 1). Of the 40 patients, 21 (52.5%) had SA alone and 19 (47.5%) had arthritis together with osteomyelitis. While arthritis was diagnosed in 27 joints in the group of patients with SA, it was diagnosed in 22 joints in the group of patients with SA combined with osteomyelitis; in the latter, an increase was not observed in the number of joints involved. Joint fluid culture was positive in 22 (55%) patients; the growth of Staphylococcus aureus was observed in 20 cases and Pseudomonas aeruginosa and Staphylococcus epidermidis were isolated in each patient. In contrast, in one patient, arthritis occured during meningococcal meningitis (in this patient, Gram-negative diplococci was isolated from a cerebrospinal fluid culture). Patients with SA combined with osteomyelitis and those with SA alone were compared for symptoms on admission, the history of trauma and antibiotic use, sex, age, fever, joint involvement, anemia, leukocytosis and micro-organisms isolated from joint fluid and blood; there were no significant differences for these parameters between the two groups (P > 0.05). In addition, we found that there was no relationship between age and joint involvement in SA and there was no effect of micro-organisms on mortality. Three of 40 patients died; the mortality rate was 7.3%. Of the three patients who died, two had SA alone and one had SA combined with osteomyelitis. The primary disease was sepsis in these three patients; S. aureus was cultured from blood in two patients and Gram-positive cocci was observed following examination of the joint fluid in the other patient.
We would like to emphasize that SA is mono-articular, frequently localized in the knee, hip and ankle in 85% of patients, joint fluid culture was positive in 55% of patients, bacteria was isolated from one or more cultures of blood, joint fluid, pus or bone in 70% of patients and the most common isolated micro-organism was S. aureus. In addition, it must be pointed out that children younger than 2 years of age with fever, a positive trauma history and/or abnormal joint findings should be carefully examined for SA because the rate of SA was lower (7.5%) than expected in this age group. We also found that the mortality of SA was not influenced by age, joint involvement and bacterial agents, and there was no significant difference in symptoms on admission, the history of trauma and antibiotic use, sex, age, fever, joint involvement,anemia, leukocytosis and micro-organisms isolated from joint fluid and blood between patients with SA
本研究的目的是确定脓毒性关节炎（SA）合并骨髓炎与单纯SA在临床和实验室检查结果方面是否存在差异，如入院时症状、年龄、性别、关节受累情况及分离出的微生物，以及SA中年龄与关节受累之间的关系。此外，我们还旨在确定SA的预后因素。
回顾性分析我院确诊为SA的40例患者的临床和实验室检查结果。SA的诊断依据以下标准：即刻关节穿刺液（培养及革兰氏染色阳性、白细胞计数显著升高且葡萄糖水平低）、血培养阳性以及其他可能感染部位的培养阳性。
40例患者中，男孩22例，女孩18例，男女比例为1.2/1。患者年龄范围为6个月至14岁（平均（±标准差）8.44±4.18岁）。最常见的症状为发热（52.5%）、关节痛（50%）和关节肿胀（45%）。34例（85%）患者仅累及一个关节，6例（15%）患者累及一个以上关节。总共49个关节被诊断为关节炎。诊断为关节炎的关节如下：膝关节（n = 18）、髋关节（n = 12）、踝关节（n = 12）、肘关节（n = 3）、肩关节（n = 2）、腕关节（n = 1）和指间关节（n = 1）。40例患者中，21例（52.5%）为单纯SA，19例（47.5%）为关节炎合并骨髓炎。单纯SA组患者中有27个关节被诊断为关节炎，SA合并骨髓炎组患者中有22个关节被诊断为关节炎；在后者中，受累关节数量未观察到增加。22例（55%）患者的关节液培养呈阳性；20例观察到金黄色葡萄球菌生长，每例患者分别分离出铜绿假单胞菌和表皮葡萄球菌。相反，1例患者在脑膜炎球菌性脑膜炎期间发生关节炎（该患者脑脊液培养分离出革兰氏阴性双球菌）。比较了SA合并骨髓炎患者和单纯SA患者的入院症状、创伤史和抗生素使用情况、性别、年龄、发热、关节受累情况、贫血、白细胞增多以及从关节液和血液中分离出的微生物；两组之间这些参数无显著差异（P>0.05）。此外，我们发现SA中年龄与关节受累之间无关系，微生物对死亡率无影响。40例患者中有3例死亡；死亡率为7.3%。在死亡的3例患者中，2例为单纯SA，1例为SA合并骨髓炎。这3例患者的原发性疾病为败血症；2例患者血培养出金黄色葡萄球菌，另1例患者关节液检查发现革兰氏阳性球菌。
我们想强调的是，SA多为单关节发病，85%的患者常累及膝关节、髋关节和踝关节，55%的患者关节液培养呈阳性，70%的患者在血液、关节液、脓液或骨的一种或多种培养中分离出细菌，最常见分离出的微生物为金黄色葡萄球菌。此外，必须指出，对于2岁以下发热、有阳性创伤史和/或关节检查异常的儿童，应仔细检查是否患有SA，因为该年龄组SA的发生率低于预期（7.5%）。我们还发现，SA的死亡率不受年龄、关节受累情况和细菌种类的影响，SA患者在入院症状、创伤史和抗生素使用情况、性别、年龄、发热、关节受累情况、贫血、白细胞增多以及从关节液和血液中分离出的微生物方面无显著差异。
