Send to

Choose Destination
J Child Orthop. 2017 Oct 1;11(5):387-392. doi: 10.1302/1863-2548.11.170058.

Toxic shock in children with bone and joint infections: a review of seven years of patients admitted to one intensive care unit.

Author information

Dartmouth-Hitchcock Medical Center,, Hanover, New Hampshire, USA.
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Kaiser Permanente Tacoma Medical Center, Tacoma, Washington, USA.
Seattle Children's Hospital, Seattle, Washington, USA.
University of Washington School of Medicine, Seattle, Washington, USA.



The objective of this study was to compare the frequency of severe systemic, multi-organ involvement and toxic shock syndrome (TSS) in patients with Staphylococcus aureus (SA) and Group A β-haemolytic Streptococcus pyogenes (GABS) bone and joint infections.


We retrospectively reviewed patients treated for septic arthritis or osteomyelitis at one children's hospital between 2002 and 2009. The rates of intensive care unit (ICU) admission for methicillin-sensitive SA (MSSA), methicillin-resistant SA (MRSA) and GABS infections were compared, as were the lengths of stay, number of surgeries, operative procedures and cases of TSS.


A total of 16 of 208 patients (7.7%) with culture-positive bone or joint infections were admitted to the ICU for critical illness: more commonly for patients with GABS infection (7/21 or 33%) than those with SA infection (6/132 or 5%) (odds ratio 10.55, 95% confidence interval 3.093 to 35.65, p = 0.0002). Patients with MRSA infections were significantly more likely to need ICU care than those with MSSA infection (p = 0.0009). Six of the ICU patients met the Centers for Disease Control and Prevention criteria for TSS. ICU patients with MRSA and GABS bone and joint infections had similar hospital courses: numerous surgeries (mean three per patient); procedures performed (mean 11 per patient); and prolonged hospital stays.


We found a greater likelihood of patients developing severe, multi-system involvement with bone and joint infections caused by GABS or MRSA when compared with MSSA. Early aggressive treatment of systemic shock and liberal decompressions of infected joints may limit the sequelae of these serious infections.


Group A β-haemolytic Streptococcus; Staphyloccocus aureus; osteomyelitis; septic arthritis; toxic shock syndrome

Supplemental Content

Full text links

Icon for Bone and Joint Publishing Icon for PubMed Central
Loading ...
Support Center