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Gram stain will reveal gram negative cocci in pairs
4%
145/3596
The organism is best isolated in blood culture.
129/3596
The organism is transmitted by tick bite
0%
13/3596
Gram stain will reveal gram negative rods
1%
24/3596
The organism is catalase and coagulase positive
90%
3252/3596
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The patient is presenting with symptoms and laboratory data consistent with septic arthritis of the hip. When evaluating the criteria established by Kocher et. al, 4 out of a possible 4 are positive, in addition to an elevated CRP. The probability of septic arthritis is more than 99% in the population. Staphylococcus aureus, which is catalase and coagulase positive, is the most common infectious agent in patients over the age of 2. Organisms implicated in pediatric septic arthritis can vary by age and medical comorbidities. Before the advent of vaccination, H. flu was the most common causative organism in patients age 2-5. Neonates are at risk of infection with group B streptococcus and E. coli. More recently, Kingella species, a member of the HACEK group of organisms, has increased in incidence in the United States. In adolescents, the most common organism is N. gonorrhoeae, Treatment of non-gonococcal septic arthritis is surgical drainage followed by intravenous antibiotics. In gonococcal arthritis, high dose penicillin with initial joint aspiration for synovial fluid sample collection at presentation can be the definitive treatment. However, in cases of persistent effusion, the affected joint may require drainage. Young et al. (2011) retrospectively reviewed cases of septic arthritis in a tertiary care center in patients who were under the age of 13. They found that the hip was the most commonly involved joint. The most common pathogen was MSSA (methicillin sensitive Staph aureus), followed closely by community acquired MRSA (methicillin resistant). Two of 13 cases were secondary to streptococcus species. Incorrect Answers: Answer 1: N. gonorrhoeae infection typically appears as gram negative diplococci on gram stain Answer 2: Kingella species are best isolated on blood culture Answer 3: B. burgdorferi, the causative agent of Lyme disease, is usually tick-borne. Lyme arthritis does not require surgical drainage Answer 4: E. coli infection typically appears as gram negative rods on gram stain
3.5
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