Frequency of Microorganisms in Septic Arthritis in Children Under the Age of 10 Years

Orthopedics Case reports

Austin J Clin Case Rep. 2023; 10(4): 1287.

Frequency of Microorganisms in Septic Arthritis in Children Under the Age of 10 Years

Muhammad Inam; Ziyad Ahmad; Ronaq Zaman; Imran Khan*; Mian Amjad Ali; Muhammad Shabir

Department of Orthopedic and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar, Pakistan.

*Corresponding author: Imran Khan Department of Orthopedic and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar, Pakistan. Email: drminamkhan71@gamil.com

Received: May 03, 2023 Accepted: June 01, 2023 Published: June 08, 2023

Abstract

Background: Septic arthritis is an infrequent disease although very important due to the possibility of disastrous outcomes if treatment is not adequately established. Adequate information concerning the epidemiology of septic arthritis is still lacking.

Objective: To find determine the frequency of various microorganisms in septic arthritis in children under age of 10 year.

Materials and Methods: This Cross-Sectional Study was conducted in the Department of Orthopedics and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar Pakistan on from September 2022 to March 2023 on 171 consecutive patients. Non Probability Consecutive Sampling Technique was used in the study. Sample size was calculated using WHO sample size formula, using the proportion, anticipated frequency of E. coli, p=8%3, Margin of error=7.5%, Confidence Level=95%. Patient age 1 month to 10 years of both genders presenting with septic arthritis as per operational definition were included in the study while Patients with congenital joint deformity, Immunocompromised patients, Patients with rheumatologic joint disease and Patients with traumatic joint injury were excluded from the study. Septic arthritis was confirmed with clinical fever, pain and tenderness in the joint and ultrasound showing collection and debris in the joint cavity. Synovial fluid was aspirated for C/S. Pattern of microorganisms in the growth in the culture was noted.

Results: Mean age of the patients was 6.68±1.239 years. Out of 177 patients, 96 (%) were male. Large joint arthritis was more common (63.8%). Staph aureus was the most common microorganism isolated in 79 patients (44.6%) while E coli was least commonly isolated (28 patients, 15.8%).

Conclusion: S. aureus is still the most common pathogen in acute joint infections in our environment in children under the age of 10 years.

Key words: Children; Infection; Microorganisms; Septic arthritis

Introduction

Septic arthritis is inflammation of the joints secondary to an infectious etiology such as bacterial, fungal, mycobacterial, viral, or other pathogens. It is usually monoarticular, however, polyarticular septic arthritis involving many or smaller joints may also occur [1]. Incidence varies from 2-10 per 100,000 patient years in the USA and Western Europe [2].

The clinical features of septic arthritis include fever, joint swelling redness, and tenderness with decreased range of both active and passive movement [3]. Septic arthritis is a true orthopedic emergency. Delay in its diagnosis and treatment can lead to disastrous complications like destruction of articular cartilage, physical damage, and dislocation of joints. Despite significant improvement in medicine with availability of better antibiotics, septic arthritis is still a major cause of morbidity [4,5]. The cause is multifactorial as there is a shift in the microbiological spectra and epidemiology with emerging antibiotic resistance. This also has a distinct geographical variation [6].

Septic arthritis most commonly occurs in the hip and knee joints. Other joints commonly infected include the shoulder and ankle but it can occur in any synovial joint in the body. Staphylococcus aureus is the most common pathogen [7,8]. Other causative organisms include group A Streptococcus and Enterobacter species. Hemophilus influenza may also cause septic arthritis in children who have not been vaccinated. The incidence of Kingella kingae septic arthritis is almost certainly significant but underreported due to its fastidious nature in culture [4].

In a study by Moro-Lago and colleagues, in children with age less than 10 years presenting with septic arthritis, Staphylococcus aureus was most commonly isolated pathogen in 23% patients, followed by Streptococcus pneumoniae in 15%, Streptococcus pyogenes in 13% and E. coli in 8% patients [3].

Rationale: Septic arthritis is a debilitating orthopedic disorder that carries several immediate and long-term complications especially if treatment is delayed. There is still scarcity of knowledge regarding the spectrum of various pathogens isolated from the infected joint in our local population. The results of international studies cannot be generalized as there is considerable geographical variation in the pattern of pathogens. Therefore, we planned to determine the frequency of various microorganism in patients with septic arthritis. Results of this study will help in identification of burden of various microorganisms isolated from septic joints in our local population. It will also help researchers on this topic in future.

Materials and Methods

This Cross-Sectional Study was conducted in the Department of Orthopedics and Trauma, Medical Teaching Institute Lady Reading Hospital Peshawar Pakistan on from September 2022 to March 2023 on 171 consecutive patients. Non Probability Consecutive Sampling Technique was used in the study. Sample size was calculated using WHO sample size formula, using the proportion, anticipated frequency of E. coli, p=8%3, Margin of error=7.5%, Confidence Level=95%. Patient age 1 month to 10 years of both genders presenting with septic arthritis as per operational definition were included in the study while Patients with congenital joint deformity, Immunocompromised patients, Patients with rheumatologic joint disease and Patients with traumatic joint injury were excluded from the study.

After approval from hospital ethical board, patients fulfilling the inclusion criteria were enrolled from the indoor department of Orthopedic of the hospital a written informed consent was taken from all study participants after explaining the purpose of study. Demographic data including age (years), gender, duration of illness (days) and type of joint (large/small) and number of joint involved was noted.

Complete history was taken and physical examination was done including careful and gentle examination of the affected joint as per protocol. The involved joint was aspirated under sterile precautions in a separate procedure room under ultrasound guidance. Turbidity in the fluid was noted. 02cc aspirate was sent for gram stain and culture to the hospital laboratory within 30 minutes of taking the sample. Robertson Cooked Meat Media was used to transport the aspirated sample for culture.

The aspirate was cultured both in aerobic and anaerobic medium following standard protocols. Mac Conkey agar, blood agar, and chocolate agar was used for inoculation. The microorganisms was incubated for 48 hours. Growth Staph aureus, E.coli, Strep pneumoniae and Strep pyogenes colonies was noted. Frequency of microorganism was noted as per operational definition. Data was recorded by the researcher himself on especially designed proforma. Data was entered and analyzed by using SPSS version 22.0.

Results

In this study, age of the patients ranged from 1 month to 10 years. Mean age was 6.68±1.239 years, mean weight 12.07±6.463 kg, mean height was 67.55±7.883 cm, mean BMI was 20.865±2.6605 kg/m2 as shown in Table 1.