Article Text

  1. M. Chan,
  2. N. C. Tucker,
  3. T. Darville
  1. Little Rock, AR.


Background The frequency of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is increasing among youth in AR, as evidenced by an increase in the frequency of MRSA among outpatient culture isolates of S. aureus (12% in 2002; 48% in 2004).

Purpose To investigate microbial etiologies, treatment, and outcome of pediatric patients treated for septic arthritis during the recent era of increased CA-MRSA.

Methods Retrospective reviews of medical records identified patients treated for septic arthritis in 2004; demographic and clinical data were gathered and reviewed.

Results 68 patients have been identified; 50 chart reviews have been completed. Microbial cultures were positive in 3 of 15 patients (20%) with synovial fluid cell counts < 75,000/mL vs. 13 of 26 patients (50%) with counts > 75,000/mL. Joint isolates included 7 methicillin-sensitive S. aureus, 5 group A streptococci, 2 K. kingae, 1 Actinomyces, and 1 E. coli. MRSA was isolated from the blood of two patients diagnosed with sacroiliac joint infection by MRI; neither had a joint aspirate performed. All patients had indwelling catheters placed for administration of parenteral antibiotics; 11 of 50 (22%) had catheter-related complications, which included 6 cases of premature line removal, 2 cases of fever and bacteremia, and 1 case of E. coli sepsis. Only 1 of 41 patients (2%) evaluated long-term exhibited residual joint dysfunction.

Conclusion MRSA appears rare as a cause of pediatric septic arthritis of joints outside the pelvis and in the absence of coincident bacteremia. Outcome of pediatric septic arthritis is generally excellent; indwelling catheters impose a rare but real risk of secondary sepsis.

Statistics from

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.