Septic arthritis in a tertiary care NICU in eastern India- A case series

Purpose -This is a retrospective descriptive study of septic arthritis in a neonatal intensive care unit.There is no guided protocol of neonatal septic arthritis.The aim of this study is to know the clinicoetiological spectrum of septic arthritis in newborn, its complications and the treatment outcome with the currently practiced management techniques. Methods - 20 newborns were recruited in the study over a three-year period. The risk factors were analysed and joint predilection,its complications were noted. The causative organisms were analysed and treated with appropriate antibiotics.The outcomes after arthrotomy and antibiotic therapy were studied in terms of clinical and laboratory parameters at discharge and after 3 months. Results - Staphylococcus aureus was found to be the predominant organism in this series. Term babies are more commonly affected and they present with restricted mobility,tenderness,swelling with or without fever.The hip joint was predominantly involved . Ultrasound is an effective tool for diagnosing joint effusion but MRI is required in detecting early osteomyelitis. CRP is an effective marker to guide the duration of therapy. Those with mild joint effusion and difficult to access joints,prolonged antibiotic therapy is the only option. In babies with significant joint effusion both open arthrotomy and prolonged antibiotic therapy was given.Even with open arthrotomy and adequate antibiotic therapy,restricted mobility and limb shortening are noted in some of them. Conclusion - Septic arthritis is a deep-seated infection in neonates. Being immunocompromised the newborns are more susceptible to aggressive joint damage and bony deformity, so they need early targeted therapy to prevent future complications. Even with open arthrotomy and prolonged antibiotic therapy,still there are chances of bone and joint deformity.