Improved Diagnosis and Treatment of Bone and Joint Infections Using an Evidence-based Treatment Guideline

Quick, Rachel; Williams, John T; Fernández, Marisol; Gottschalk, Hilton P.; Cosgrove, Peter; Kahlden, Kyle; Merkel, Kathryn; Thoreson, Lynn; Boswell, Patrick; Hauger, Sarmistha B.

doi:10.1097/bpo.0000000000001187

Cited by 24 publications

(38 citation statements)

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“…Bone and joint infections are generally common worldwide and cause considerable patient morbidity (Quick et al, 2018). Despite ongoing medical advances, a high proportion of patients report persistent disability, limited function, and lower quality of life, especially those infected with tubercle bacilli (Wilson and Winn, 2008).…”

Section: Introductionmentioning

confidence: 99%

“…Osteoarticular tuberculosis (TB), which currently accounts for ~15% of extrapulmonary TB cases in developed countries and ~40% in China, usually leads to death or long-term disability ( Pigrau-Serrallach and Rodriguez-Pardo, 2013 ). Patients with comorbidities, especially immunocompromised patients, experience worse outcomes than otherwise healthy patients ( Quick et al, 2018 ). Importantly, surgical interventions are often required for treatment of osteoarticular infections, with medication-based therapies administered prior to surgery to completely eliminate bacteria within lesions.…”

Section: Introductionmentioning

confidence: 99%

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Metagenomic Next-Generation Sequencing Improves Diagnosis of Osteoarticular Infections From Abscess Specimens: A Multicenter Retrospective Study

et al. 2020

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Background: We conducted this retrospective study to reveal the accuracy of metagenomic next-generation sequencing (mNGS) for diagnosing osteoarticular infections from fresh abscess specimens obtained from patients in an HIV-naive population. Methods: We retrospectively analyzed hospital records at three participating TB-specialized hospitals for patients admitted with suggestive diagnoses of osteoarticular tuberculosis between January 2018 and August 2019. Abscess specimens obtained from each patient were tested via pathogen culture, GeneXpert Mycobacterium tuberculosis (MTB)/rifampicin (RIF), and mNGS assay. Results: A total of 82 abscess samples were collected from patients with osteoarticular infections, including 53 cases with (64.6%) bacterial, 21 (25.6%) with mycobacterial, 7 (8.5%) with fungal, and 1 (1.2%) with actinomycetal organisms detected. Analysis of mNGS assay results identified potential pathogens in all cases, with M. tuberculosis complex (MTBC) most frequently isolated, followed by Staphylococcus aureus and Brucella melitensis. Conventional culture testing identified causative pathogens in only 48.4% of samples, a significantly lower rate than the mNGS pathogen identification rate (100%, p < 0.01). Culture-positive group specimens yielded significantly greater numbers of sequence reads than did culture-negative group specimens (p < 0.01). Of patients receiving surgical interventions and mNGS-guided treatment, 76 (92.7%) experienced favorable outcomes by the time of follow-up assessment at 3 months post-treatment. Notably, MTBC detection in two patients experiencing treatment failure suggests that they had mixed infections with MTBC and other pathogens. Conclusion: Results presented here demonstrate that mNGS has a greater pathogen detection rate in osteoarticular infections than conventional culture-based methods.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metagenomic Next-Generation Sequencing Improves Diagnosis of Osteoarticular Infections From Abscess Specimens: A Multicenter Retrospective Study

et al. 2020

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“…Esta falta de consenso se debe principalmente a los diferentes microorganismos resistentes a los antibióticos en las diferentes regiones del mundo. En consecuencia, la elección del antibiótico debe individualizarse para cubrir los perfiles microbianos de las diferentes regiones, así como considerar la edad y el estado clínico del paciente (25). No se profundizara en los protocolos específicos de manejo puesto que no corresponde a los alcances de esta publicación.…”

Section: E554unclassified

Osteomielitis aguda: clasificación, fisiopatología y diagnóstico

Méndez

Solórzano²,

Matamoros³

2020

Rev.méd.sinerg.

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La osteomielitis aguda es un proceso infeccioso e inflamatorio del hueso que puede involucrar desde la medula hasta la corteza. Se caracteriza por un periodo de evolución no mayor a dos semanas desde el inicio de los síntomas hasta el diagnóstico. Se clasifica frecuentemente según su etiología, anatomía y comorbilidades. La osteomielitis aguda se puede originar desde un foco infeccioso adyacente al hueso, por vía hematógena o inoculación directa. Suele ser unifocal, afectando frecuentemente a las metáfisis de huesos largos, especialmente fémur, tibia y húmero .El agente etiológico identificado en la mayoría de los casos independientemente del grupo de edad es el Staphylococcus aureus. La presentación clínica depende del grupo de edad y la etiología. El diagnóstico se basa en la historia clínica, exámenes de laboratorio y técnicas de imagen.

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“…7 Antibiotic coverage should start in suspected cases as soon as blood cultures and synovial fluid samples are collected and the joint has been drained. 4,5…”

Section: Introductionmentioning

confidence: 99%

Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: A systematic review

Donders

Spaans

Bessems

et al. 2021

Journal of Children's Orthopaedics

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Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

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Improved Diagnosis and Treatment of Bone and Joint Infections Using an Evidence-based Treatment Guideline

Abstract: Level III- retrospective comparative study.

Cited by 24 publications

References 25 publications

Metagenomic Next-Generation Sequencing Improves Diagnosis of Osteoarticular Infections From Abscess Specimens: A Multicenter Retrospective Study

Metagenomic Next-Generation Sequencing Improves Diagnosis of Osteoarticular Infections From Abscess Specimens: A Multicenter Retrospective Study

Osteomielitis aguda: clasificación, fisiopatología y diagnóstico

Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: A systematic review

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