Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip

IF 1.5 4区 医学 Q3 ORTHOPEDICS Journal of Orthopaedic Science Pub Date : 2024-09-01 DOI:10.1016/j.jos.2023.08.009
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引用次数: 0

Abstract

Background

Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes.

Methods

The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared.

Results

Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L.

Conclusions

Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip.

Level of evidence

Level II, retrospective study.

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细菌培养阴性髋关节化脓性关节炎患儿的临床特征和不良后果的风险因素
背景髋关节化脓性关节炎是儿童的一种严重感染。然而,血液和关节液培养往往呈阴性,这给诊断和治疗带来了挑战。我们分析了细菌培养阴性的髋关节化脓性关节炎患儿的临床特征,并确定了不良预后的风险因素。方法回顾性分析了 2010 年 1 月至 2020 年 12 月期间在我院接受治疗的细菌培养阴性的髋关节化脓性关节炎患儿的临床数据。将细菌培养阴性患儿的临床特征和疗效与同期细菌培养阳性患儿的临床特征和疗效进行比较。培养阴性患者被分为疗效好的一组和疗效差的一组。结果39名髋关节化脓性关节炎细菌培养阴性患儿与37名败血症细菌培养阳性患儿进行了比较。与培养阳性组相比,培养阴性组的平均年龄明显更小,平均血清 C 反应蛋白浓度明显更低。通过对培养阴性患者良好与不良预后的逻辑回归分析发现,不良预后的独立风险因素是血清C反应蛋白浓度升高和从发病到手术时间延长。在培养阴性组中,预测不良预后的临界值是发病到手术时间超过 21 天和 C 反应蛋白浓度超过 23 mg/L。因此,当儿童出现临床症状、炎症标记物浓度和影像学检查结果,临床诊断为髋关节化脓性关节炎时,应积极进行抗感染和髋关节引流治疗。
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来源期刊
Journal of Orthopaedic Science
Journal of Orthopaedic Science 医学-整形外科
CiteScore
3.00
自引率
0.00%
发文量
290
审稿时长
90 days
期刊介绍: The Journal of Orthopaedic Science is the official peer-reviewed journal of the Japanese Orthopaedic Association. The journal publishes the latest researches and topical debates in all fields of clinical and experimental orthopaedics, including musculoskeletal medicine, sports medicine, locomotive syndrome, trauma, paediatrics, oncology and biomaterials, as well as basic researches.
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