Epidemiology and Management of Neonatal Septic Arthritis: Insights from a State Referral Institute (Research Article)

Author(s): Abdul Hadi Shareef, Sriram V and Khudaija Nazhath M R

Abstract: Septic arthritis in neonates, especially of the hip joint, is a severe infection that can lead to destruction of the joint if not promptly treated. This study evaluates the common causative organisms and management strategies for neonatal septic arthritis at a state referral institute. We reviewed 68 cases of neonatal septic arthritis involving 88 joints. The pre-operative evaluation included history, blood tests and radiological assessments. Most neonates underwent surgery the same day as diagnosis. Samples were analyzed using Gram staining and culture sensitivity. Post-operative monitoring included scans and measurements of erythrocyte sedimentation rate and C-reactive protein at the 3rd and 6th weeks. Oral antibiotics were administered for six weeks. The neonates had an average age of 22 days, with most (60 cases) admitted to the NICU. The hip joint was the most commonly affected (65 joints), followed by the knees (14), shoulders (6), elbows (2), and wrists (1). Pathogens included Klebsiella (29 joints), MRSA (10), Candida (9), and E. coli (3). Less common organisms included alpha-haemolytic Streptococcus, Citrobacter, Enterobacter, and Enterococcus. No growth was found in 26 joints. Carbapenems used in 34 joints, Aminoglycosides and Cephalosporins in 18, Glycopeptides in 7, Azoles for fungal infections in 9, Polymyxins in 4, Beta-lactams in 9, and others in 9. The average duration of injectable antibiotics was 9.7 days. Neonatal septic arthritis remains a critical condition requiring immediate surgical intervention and tailored antibiotic therapy. The emergence of uncommon organisms underscores the need for standardized care protocols to improve outcomes and minimize joint damage. Early diagnosis and prompt treatment are essential to prevent long-term morbidity.

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