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Acute septic arthritis revisited: a prospective study in 93 patients correlating C-reactive protein levels with duration of intravenous antibiotic therapy, clinical and radiological outcomes

  • Sudeep JainEmail author
  • Praveen Tittal
  • Narender Rohilla
  • Alok Sud
  • C. S. Yadav
  • Rajesh Kumar Kanojia
  • Sudhir K. Kapoor
  • Shishir Rastogi
Original Article

Abstract

Introduction

Septic arthritis is the most dreaded affection of the joints in children. Early diagnosis, urgent arthrotomy and intravenous antibiotic therapy, however, are essential factors in treatment of septic arthritis to prevent devastating complications. However, the optimal duration of intravenous antibiotic therapy for acute septic arthritis after surgical drainage is not well defined.

Materials and methods

We performed a prospective study in 93 patients with age less than 5 years who presented with acute septic arthritis and treated with arthrotomy and sequential antibiotic therapy based on determination of serial quantitative CRP levels correlating radiological and clinical outcome.

Results

Majority of the subjects (84%) had CRP values more than or equal to 96 mg/dl at the time of presentation. More than half of the subjects had CRP values reverted to normal by the seventh day of treatment. By the 21st day of treatment, all the subjects had CRP values at baseline levels. “The clinical and radiological outcome was excellent in 85% of the cases where the CRP normalized by 7 days compared to 25% where the CRP had not normalized by 21 days.” The difference was found to be statistically significant.

Conclusion

We conclude from our study that CRP levels decreases consistently during the antibiotic therapy and patients in whom CRP values return to normal earlier have good clinical and radiological outcomes. We also conclude that intravenous antibiotics should be stopped and switched over to oral therapy once CRP levels return to normal in cases of acute septic arthritis.

Keywords

Septic arthritis C-reactive protein Intravenous antibiotics 

Notes

Conflict of interest statement

No funds were received in support of this study. No benefits in any form have been or will be received from a commercial party related directly or indirectly to subject matter of this manuscript. Analysis and interpretation of data, drafting the article and revising it critically for important intellectual content. I also further affirm that all authors have contributed to, and read the paper and have given permission for their name to be included as a co-author. I also confirm that the manuscript has not been published and will not be submitted simultaneously or published elsewhere. No financial or any otherwise support has been received in any regard from any organization or institution for this study. All authors have made substantial contributions to the conception and design of the study, acquisition of data.

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Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Sudeep Jain
    • 1
    • 2
    Email author
  • Praveen Tittal
    • 3
  • Narender Rohilla
    • 2
  • Alok Sud
    • 4
  • C. S. Yadav
    • 2
  • Rajesh Kumar Kanojia
    • 4
  • Sudhir K. Kapoor
    • 4
  • Shishir Rastogi
    • 2
  1. 1.New DelhiIndia
  2. 2.Department of OrthopaedicsAll India Institute of Medical Sciences (AIIMS)New DelhiIndia
  3. 3.Department of OrthopaedicsMaulana Azad Medical College (MAMC), Lok Nayak Hospital (LNH)New DelhiIndia
  4. 4.Department of OrthopaedicsLady Hardinge Medical College (LHMC) & associated Sucheta Kriplani Hospital, Kalawati Saran Children Hospital & Ram Manohar Lohia HospitalsNew DelhiIndia

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