Acute haematogenous osteomyelitis in children

Yeo, Andrea; Ramachandran, Manoj

doi:10.1136/bmj.g66

Cited by 88 publications

(89 citation statements)

References 42 publications

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“…The most common pathogen responsible for acute infection in adults is Staphylococcus aureus, with Pseudomonas aeruginosa, Serratia marcescens, and Escherichia coli also involved in traumatic infections and chronic presentations. Infection in children occurs less frequently and is predominantly a result of bacteremia with S. aureus and infection in the growth plate (1). Treatment regimens extend for 4 to 6 weeks, with durations as long as 8 weeks recommended for treatment of infection due to methicillin-resistant S. aureus (MRSA) (2).…”

mentioning

confidence: 99%

Extended-Duration Dosing and Distribution of Dalbavancin into Bone and Articular Tissue

Dunne¹,

Puttagunta²,

Sprenger³

et al. 2015

Antimicrob Agents Chemother

172

137

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Dalbavancin is an intravenous lipoglycopeptide with activity against Gram-positive pathogens and an MIC 90 for Staphylococcus aureus of 0.06 g/ml. With a terminal half-life of >14 days, dosing regimens with infrequent parenteral administration become available to treat infectious diseases such as osteomyelitis and endocarditis that otherwise require daily dosing for many weeks. In order to support a rationale for these novel regimens, the pharmacokinetics over an extended dosing interval and the distribution of dalbavancin into bone and articular tissue were studied in two phase I trials and pharmacokinetic modeling was performed. Intravenous administration of 1,000 mg of dalbavancin on day 1 followed by 500 mg weekly for seven additional weeks was well tolerated and did not demonstrate evidence of drug accumulation. In a separate study, dalbavancin concentrations in cortical bone 12 h after infusion of a single 1,000-mg intravenous infusion were 6.3 g/g and 2 weeks later were 4.1 g/g. A twodose, once-weekly regimen that would provide tissue exposure over the dalbavancin MIC for Staphylococcus aureus for 8 weeks, maximizing the initial exposure to treatment while minimizing the frequency of intravenous therapy, is proposed. Osteomyelitis is an infection of the bone associated with either hematogenous dissemination or direct inoculation as a consequence of trauma or infection from contiguous tissues. Its presentation may be either acute or chronic. The most common pathogen responsible for acute infection in adults is Staphylococcus aureus, with Pseudomonas aeruginosa, Serratia marcescens, and Escherichia coli also involved in traumatic infections and chronic presentations. Infection in children occurs less frequently and is predominantly a result of bacteremia with S. aureus and infection in the growth plate (1). Treatment regimens extend for 4 to 6 weeks, with durations as long as 8 weeks recommended for treatment of infection due to methicillin-resistant S. aureus (MRSA) (2). Commonly used therapies include cefazolin, oxacillin, or vancomycin for coverage of Gram-positive pathogens and cephalosporins, carbapenems, and the ␤-lactamase inhibitor agents for treatment of Gram-negative pathogens (2,3). No other therapies in recent times have received FDA approval.Because the incidence of MRSA in the community in the United States is as high as 40% (4), empirical treatment of osteomyelitis now requires consideration of antimicrobial coverage of this organism, typically with vancomycin. Vancomycin has been demonstrated to be active in animal models of osteomyelitis (5). Concentrations in bone from 2.7 to 9.3 g/ml have been documented (6, 7), exceeding the vancomycin MIC 90 for S. aureus of 1 g/ml (8). Because of the wide variety of underlying etiologies and comorbidities associated with osteomyelitis, it is difficult to generalize the rates of clinical success from clinical trials, but one study documented a clinical response in 10/15 patients after continuous intravenous (i.v.) infusion of vancomycin (9). Long-term d...

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mentioning

confidence: 99%

Extended-Duration Dosing and Distribution of Dalbavancin into Bone and Articular Tissue

Dunne¹,

Puttagunta²,

Sprenger³

et al. 2015

Antimicrob Agents Chemother

172

137

View full text Add to dashboard Cite

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“…Broad spectrum coverage was generally utilized in this population as infants may be infected with a wider variety of organisms. [24]…”

Section: Discussionmentioning

confidence: 99%

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Zhang¹,

Li²,

Li³

et al. 2018

J Orthop Surg Res

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BackgroundOsteomyelitis (OM) is an uncommon disease that originates from many different mechanisms in children. Treatment often involves a combination of surgical debridement combined and antibiotic therapy. The purpose of this article is to evaluate the effect of debridement combined with a new resorbable bone graft substitute (RBGS) mixed with antibiotics in the treatment of infants with OM.MethodsTwenty-two patients diagnosed with OM at our institution underwent debridement combined with implantation of RBGS mixed with vancomycin within 48 h after admission. Clinical and epidemiological factors, preoperative and postoperative radiographs, and laboratory parameters, including white blood cell (WBC), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and neutrophil percentage (NEU%), were documented. The function of the involved extremity was evaluated at the final follow-up.ResultsThe mean age was 6.3 ± 4.8 months (range, 0.5 to 12 months). The mean duration of the symptoms was 14.5 ± 8.4 days (range, 2 to 30 days). The average length of hospitalization was 13.7 ± 6.2 days (range, 6 to 28 days). 13.64% (3/22) had positive results of purulent material obtained at the time of open biopsy and 18.18% (4/22) had positive blood cultures. The most common sites were located in the proximal femur (12), the distal femur (3), and the proximal humerus (3). Ten patients presented with concurrent pyogenic arthritis, while another 12 infants suffered from simple isolated hematogenous OM. The mean follow-up time was 3.0 ± 1.6 years (range, 1.0 to 6.0 years). Seven of 22 patients (31.82%) had complications such as limb length deformity (LLD), avascular necrosis (AVN), and pathologic subluxation of the hip. Fifteen out of 22 (68.18%) patients achieved good results. Additionally, patients who had concomitant pyogenic arthritis were more likely to develop complications than those with isolated OM (p = 0.02).ConclusionsEarly debridement combined with implantation of RBGS mixed with vancomycin in the treatment of infants with OM achieved acceptable results in this series. Compared to those with simple isolated OM, patients with secondary pyogenic arthritis had a more virulent course.

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“…Although soft tissue swelling can be identified on radiographs within a few days of onset, bony changes on plain radiographs, such as osteopenia or osteolytic lesions, may not be detected even 5–10 days after the onset of symptoms 3. Appropriate potent antibiotic therapy is required as in the treatment of any form of osteomyelitis.…”

Section: Discussionmentioning

confidence: 99%

“…According to Yeo and Ramachandran3, the incidence of acute primary haematogeneous osteomyelitis in children is estimated between 1 and 13 per 100 000, and the incidence of subacute osteomyelitis is generally lower 4. The formation of a Brodie abscess is rarer still.…”

Section: Discussionmentioning

confidence: 99%

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Brodie abscess of the femoral capital epiphysis in a 2-year-old child caused byKingella kingae

et al. 2017

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Acute haematogenous osteomyelitis in children

Cited by 88 publications

References 42 publications

Extended-Duration Dosing and Distribution of Dalbavancin into Bone and Articular Tissue

Extended-Duration Dosing and Distribution of Dalbavancin into Bone and Articular Tissue

Clinical experience of debridement combined with resorbable bone graft substitute mixed with antibiotic in the treatment for infants with osteomyelitis

Brodie abscess of the femoral capital epiphysis in a 2-year-old child caused byKingella kingae

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