Advances in the Diagnosis and Management of Pediatric Osteomyelitis

Thomsen, Isaac; Creech, C. Buddy

doi:10.1007/s11908-011-0202-z

Cited by 41 publications

(32 citation statements)

References 73 publications

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“…Similarly, in other studies, leukocytosis has been reported only in 36% of children, but increased ESR was observed in 91% of children and CRP in 81% of them [27]. As expected, we observed a low sensitivity of X-ray imaging [28] and US [4]. …”

Section: Discussionsupporting

confidence: 89%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.

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Section: Discussionsupporting

confidence: 89%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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“…6 Boys are nearly twice as commonly affected as girls, 7 with 50% of cases occurring in those under 5 years old, 8 peaking in children under 1 year. 7 In most cases the lesion is solitary but can be multifocal (7% of children and 22% of neonates).…”

Section: Who Gets Osteomyelitis and Why Is It Important?mentioning

confidence: 99%

“…Salmonella is an important pathogen in children with sickle cell disease, especially the non-typical serotypes (S typhimurium, S enteriditis, S choleraesius). 6 It has been suggested that tiny infarctions in the gastrointestinal tract lead to salmonella (and other enteric Gram negative) bacteraemia and ultimately to infection. 35 Children with sickle cell disease and suspected osteomyelitis may require a completely different antibiotic regimen, and local microbiological advice should be sought.…”

Section: Which Organisms Cause Acute Osteomyelitis?mentioning

confidence: 99%

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Acute haematogenous osteomyelitis in children

Yeo

Ramachandran

2014

BMJ

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“…11 Boys are more likely to be affected than girls, with 50% of cases occurring in those aged under five years, peaking in children under the age of one year. 14 …”

Section: Epidemiologymentioning

confidence: 99%

Paediatric bone and joint infection

Iliadis

Ramachandran

2017

EFORT Open Reviews

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Despite advances in understanding and management, paediatric osteoarticular infections continue to pose diagnostic difficulties for clinicians. Delays in diagnosis can lead to potentially devastating morbidity.No single investigation, including joint aspiration, is sufficiently reliable to diagnose conclusively paediatric bone and joint infection. Diagnosis should be based on a combination of clinical signs, imaging and laboratory investigations. Algorithms should supplement, and not replace, clinical decision making in all cases.The roles of aspiration, arthrotomy and arthroscopy in the treatment of septic arthritis are not clearly defined. There is a very limited role for surgery in the management of acute haematogenous osteomyelitis.The ideal duration and mode of administration of antibiotic therapy for osteoarticular paediatric infection is not yet fully defined but there is increasing evidence that shorter courses (three weeks) and early conversion (day four) to oral administration is safe and effective in appropriate cases. Clear and concise antibiotic guidelines should be available based on local population characteristics, pathogens and their sensitivities.Kingella kingae is increasingly identified through polymerase chain reaction and is now recognised as the commonest pathogen in children aged under four years. Methicillin-resistant Staphylococcus aureus and Panton-Valentine leukocidin-producing strains of Staph. aureus are being increasingly reported.A multidisciplinary integrated evidence-based approach is required to optimise outcomes.Further large-scale, multicentre studies are needed to delineate the optimal management of paediatric osteoarticular infection. Cite this article: EFORT Open Rev 2017;1:7-12. DOI: 10.1302/2058-5241.2.160027.

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Advances in the Diagnosis and Management of Pediatric Osteomyelitis

Cited by 41 publications

References 73 publications

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Acute haematogenous osteomyelitis in children

Paediatric bone and joint infection

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