Ten-year retrospective review of paediatric septic arthritis in a New Zealand centre

Abstract

Background

Paediatric septic arthritis, although a rare diagnosis in the developed world, remains a significant challenge in the New Zealand population. In recent years, there has been effort to characterize the nature of paediatric bone and joint infection for New Zealand due to rising incidence of osteomyelitis and staphylococcal sepsis [1, 2]. We have sought to identify trends in presentation, diagnosis and management of paediatric septic arthritis, with added focus on ethnicity and access to healthcare.

Methods

A ten year retrospective review of all cases < 16 years with presumed septic arthritis presenting to a tertiary referral centre between 2008 and 2018 was performed.

Results

A total of 103 cases met inclusion criteria. Mean age was 5.9 years (SD +/− 4.17) with a male predominance (64%). Traditional laboratory culture method isolated an organism in 66% of cases: Staphylococcus aureus was the most common pathogen identified (61%). Incidence varied greatly by ethnicity 1:16,000 for NZ European children; 1:8760 for Pacifica and 1:4300 for Māori. Mean distance travelled by patients to reach the nearest emergency department was 38.3 km, ranging from 2 to 188 km. Assessment using NZ deprivation scores showed the Māori paediatric population were likely to reside in areas of worse socioeconomic deprivation (p = 0.0005). The majority (66%) of cases were treated surgically with a low recurrence rate (2.9%). Delayed presentation was associated with worse outcomes and more likely in patients residing > 20 km away from the nearest emergency department.

Conclusion

The incidence of paediatric septic arthritis in New Zealand is concerningly high within Māori and Pacific populations. Future health interventions should consider environmental, socioeconomic, and microbiological trends in the burden of disease.