{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T01:03:47Z","timestamp":1793149427668,"version":"4.5.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2018,4,30]],"date-time":"2018-04-30T00:00:00Z","timestamp":1525046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Septic arthritis is a serious infection, but the results of blood and joint fluid cultures are often negative in children. We describe here the clinical features and management of culture-negative septic arthritis in children at our hospital and their outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective review of a cohort of children with septic arthritis who were hospitalized at Children\u2019s Hospital of Philadelphia between January 2002 and December 2014. Culture-negative septic arthritis was defined as a joint white blood cell count of &gt;50000\/\u03bcL with associated symptoms, a clinical diagnosis of septic arthritis, and a negative culture result. Children with pretreatment, an intensive case unit admission, Lyme arthritis, immunodeficiency, or surgical hardware were excluded. Treatment failure included a change in antibiotics, surgery, and\/or reevaluation because of a lack of improvement\/worsening.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>We identified 157 children with septic arthritis. The patients with concurrent osteomyelitis (n = 28) had higher inflammatory marker levels at presentation, had a longer duration of symptoms (median, 4.5 vs 3 days, respectively; P &lt; .001), and more often had bacteremia (46.4% vs 6.2%, respectively; P &lt; .001). Among children with septic arthritis without associated osteomyelitis, 69% (89 of 129) had negative culture results. These children had lower C-reactive protein levels (median, 4.0 vs 7.3 mg\/dL, respectively; P = .001) and erythrocyte sedimentation rates (median, 39 vs 51 mm\/hour, respectively; P = .01) at admission and less often had foot\/ankle involvement (P = .02). Among the children with culture-negative septic arthritis, the inpatient treatment failure rate was 9.1%, and treatment failure was more common in boys than in girls (17.1% vs 3.8%, respectively; P = .03). We found no association between treatment failure and empiric antibiotics or patient age. No outpatient treatment failures occurred during the 6-month follow-up period, although 17% of the children discharged with a peripherally inserted central catheter line experienced complications, including 3 with bacteremia.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The majority of septic arthritis infections at our institution were culture negative. Among patients with culture-negative infection, empiric antibiotics failed for 9% and necessitated a change in therapy. More sensitive diagnostic testing should be implemented to elucidate the causes of culture-negative septic arthritis in children.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jpids\/piy034","type":"journal-article","created":{"date-parts":[[2018,3,17]],"date-time":"2018-03-17T16:08:21Z","timestamp":1521302901000},"page":"228-234","source":"Crossref","is-referenced-by-count":45,"title":["Clinical Features and Outcomes of Children with Culture-Negative Septic Arthritis"],"prefix":"10.1093","volume":"8","author":[{"given":"Evangelos","family":"Spyridakis","sequence":"first","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey S","family":"Gerber","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Pennsylvania"},{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Pennsylvania"},{"name":"Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Schriver","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W","family":"Grundmeier","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Pennsylvania"},{"name":"Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric A","family":"Porsch","sequence":"additional","affiliation":[{"name":"Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"III","given":"Joseph W","family":"St. Geme","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Pennsylvania"},{"name":"Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5015-8146","authenticated-orcid":false,"given":"Kevin J","family":"Downes","sequence":"additional","affiliation":[{"name":"Center for Pediatric Clinical Effectiveness, Children\u2019s Hospital of Philadelphia, Pennsylvania"},{"name":"Division of Infectious Diseases, Children\u2019s Hospital of Philadelphia, Pennsylvania"},{"name":"Department of Biomedical and Health Informatics, Children\u2019s Hospital of Philadelphia, 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