MICROBIOLOGICAL SPECTRUM AND CLINICAL CHARACTERISTICS OF SEPTIC ARTHRITIS IN CHILDREN AGED 0–12 YEARS IN EASTERN INDIA: A MULTI-CENTER RETROSPECTIVE STUDY OF 300 CASES 2017–2023

Abstract

Background: Septic arthritis is a serious and potentially debilitating condition in children, particularly in resource-limited settings where delays in diagnosis and treatment can lead to irreversible joint damage. The study aimed to evaluate the clinical presentation, microbiological spectrum, treatment outcomes, and relapse patterns associated with pediatric septic arthritis in this region.

Methods: This retrospective multi-center study analyzed 300 pediatric cases of acute septic arthritis in children aged zero to twelve years, treated at five tertiary care hospitals in Kolkata, Eastern India, between 2017 and 2023.

Results: The hip joint was the most frequently affected site, involved in 213 cases, followed by the knee in 71 cases. Less commonly affected joints included the ankle, elbow, shoulder, and wrist. Clinical features were consistent across the cohort, with joint pain, swelling, fever, and restricted movement being the most prominent symptoms. Microbiological cultures were positive in 82 percent of cases. Staphylococcus aureus was the predominant pathogen, isolated in 59.3 percent of cases, followed by Streptococcus species, Haemophilus influenzae, Acinetobacter, atypical organisms, and Candida species. Disseminated sepsis was present in 87 children, and 59 had multiple joint involvement, indicating a substantial disease burden. All patients were treated with a standardized six-week course of antibiotics, primarily vancomycin and cefuroxime, in combination with surgical drainage procedures such as arthrocentesis or synovectomy. Clinical resolution was achieved in 295 cases, representing a success rate of 98.3 percent. Relapse occurred in five cases, most commonly associated with delayed presentation, fungal infections, or immunocompromised status.

Conclusion: This study highlights the importance of early diagnosis, region-specific microbial surveillance, and combined surgical and medical management in improving outcomes for pediatric septic arthritis. The findings underscore the need for heightened clinical awareness of atypical and resistant pathogens and support the continued use of standardized treatment protocols to reduce morbidity and prevent long-term complications in affected children.