Deep Venous Thrombosis Associated with Osteomyelitis in Children

Hollmig, S. Tyler; Copley, Lawson A.; Browne, Richard; Grande, Linda M.; Wilson, Philip L.

doi:10.2106/jbjs.f.01102

Cited by 50 publications

(63 citation statements)

References 4 publications

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“…With the emergence of CA-MRSA, deep venous thrombosis (DVT) adjacent to the site of OM has been described by several groups (506)(507)(508)(509)(510). DVT with acute OM has been associated with MRSA (506, 508), PVL-positive strains of S. aureus (510), and USA300 in particular (507).…”

Section: Osteoarticular Infections In Childrenmentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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SUMMARY Staphylococcus aureus is a major human pathogen that causes a wide range of clinical infections. It is a leading cause of bacteremia and infective endocarditis as well as osteoarticular, skin and soft tissue, pleuropulmonary, and device-related infections. This review comprehensively covers the epidemiology, pathophysiology, clinical manifestations, and management of each of these clinical entities. The past 2 decades have witnessed two clear shifts in the epidemiology of S. aureus infections: first, a growing number of health care-associated infections, particularly seen in infective endocarditis and prosthetic device infections, and second, an epidemic of community-associated skin and soft tissue infections driven by strains with certain virulence factors and resistance to β-lactam antibiotics. In reviewing the literature to support management strategies for these clinical manifestations, we also highlight the paucity of high-quality evidence for many key clinical questions.

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Section: Osteoarticular Infections In Childrenmentioning

confidence: 99%

Staphylococcus aureus Infections: Epidemiology, Pathophysiology, Clinical Manifestations, and Management

et al. 2015

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“…In a recent series, subperiosteal abscesses only occurred in children with a CRP greater than 3.6 mg/dL. Children with MRSA infection and a CRP greater than 6 mg/dL have a 40% chance of having deep venous thrombosis [11,12].…”

Section: Clinical Considerationsmentioning

confidence: 97%

Infection: musculoskeletal

Jaramillo

2011

Pediatr Radiol

102

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The imaging approach to osteomyelitis has evolved in the past two decades. Advances in MRI allow for whole body imaging, decreasing the need for scintigraphy when symptoms are not localized or the disease may be multifocal. There is an increasing clinical need for depiction of abscesses in the soft tissues and subperiosteal space, particularly because methicillin-resistant Staphylococcus aureus infections constitute more than one-third of all the infections. The increasing emphasis on radiation dose reduction has also led away from scintigraphy and computed tomography. MR imaging has become the advanced imaging modality of choice in osteomyelitis. There is an increasing understanding of the appropriate role for gadolinium enhancement, which is not indicated when the pre-gadolinium images are normal. Other related infections, including pyomyositis, are best imaged with MRI.Keywords Infection . Musculoskeletal . Children . MRI EpidemiologyAcute hematogenous osteomyelitis is the most common form of musculoskeletal infection [1]. Its incidence is difficult to determine, but it has been reported to be 1 per 5,000 [2]. There is conflicting data regarding the change of the disease over time. A study in 1998 found that the incidence in Norway ranged between 70 and 160 per million and that the incidence had remained stable between 1965 and 1994 [3]. An American study, however, found that in the last 20 years the incidence of osteomyelitis had increased 2.8-fold, whereas that of septic arthritis was stable. Methicillin-resistant Staphylococcus aureus (MRSA) was the causative organism in 30% of the children [4]. More than half of the cases occur before 5 years of age, and it appears to be more frequent in boys. Approximately 70% of infections involve the lower extremities and onethird affect the knee [2]. PathophysiologyHematogenous osteomyelitis results from the seeding of bacteria, usually Staphylococcus aureus (S. aureus) in the metaphysis of a long bone (Fig. 1) or in the metaphyseal equivalents of the axial skeleton (Fig. 2). S. aureus bacteria, which are present in the skin or mucosal membranes, enter the bloodstream and lodge in the bone, usually at sites where blood flow is abundant and slow. The metaphyses are richly vascularized and the valveless sinusoidal loops of the metaphyseal venules have sluggish flow and discontinuous endothelium which facilitates bacterial invasion. During childhood, the metaphyses that grow the fastest, such as those around the knee, are the most richly vascularized in order to produce new bone at a rapid rate. These rapidly growing metaphyses also tend to be affected more frequently by infection. S. aureus has the capacity to attach to the bony matrix and produce proteolytic enzymes that destroy the surrounding tissues, allowing the spread of the infection. From the bone, the infection extends through the porous metaphyseal cortex into the subperiosteal space. The periosteum in children is loosely attached to the bone and separates easily from it, creating a space that allows ...

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“…Surgery is likewise more likely to be required for abscess drainage in these patients (Hollmig et al, 2007, Bouchoucha et al, 2010). …”

Section: Venous Thromboembolismmentioning

confidence: 99%

“…Isolated case reports of using other antibiotics such as daptomycin effectively have also been published (Erturan et al, 2012). duration of follow up after discharge from hospital is not established, however, one study reported that thrombus resolved after a mean of 11 weeks (Hollmig et al, 2007). From the authors' previous experience with this condition, serial MRI scans were invaluable in assessing disease progression and identifying late complications e.g.…”

Section: Managementmentioning

confidence: 99%