Managing musculoskeletal infections in children in the era of increasing bacterial resistance

Godley, David R.

doi:10.1097/01.jaa.0000462053.55506.2c

Cited by 17 publications

(12 citation statements)

References 17 publications

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“…Once considered mainly nosocomial, the prevalence of particularly virulent strains of community-acquired S. aureus (CA-SA) is increasing, causing severe forms of BJI. Approximately 70–90% of confirmed cases caused by CA-SA involve methicillin-sensitive strains (MSSA), but there has been an increase in cases of BJI from community-acquired methicillin-resistant S. aureus (CA-MRSA) [ 27 , 28 ]. Studying the regional prevalence of CA-MRSA is mandatory because, according to the recent guidelines published by the European Society for Paediatric Infectious Diseases (ESPID), a local prevalence over 10% should induce clinicians to choose a different empiric treatment from conventional first-line drugs.…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

2020

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Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

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Section: Aetiology and Pathogenesismentioning

confidence: 99%

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

2020

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“…Staphylococcus aureus is definitely the most frequent pathogen responsible for osteomyelitis and septic arthritis in any age group, mainly methicillin-sensitive strains (MSSA), and it is responsible for up to 70%–90% of confirmed cases [ 11 ]. As noted in the adult population, there has also been an increase in cases of osteoarticular infection due to methicillin-resistant strains of S. aureus (MRSA) in pediatric patients that should consequently be considered when choosing an empirical antimicrobial treatment [ 7 , 12 ].…”

Section: Controversies In Managementmentioning

confidence: 99%

“…Acute osteomyelitis and septic arthritis, although not so frequent, should not be underestimated because they could be associated with sepsis and with sequelae such as joint destruction, growth failure, and death of the patient if they are not correctly treated [ 7 , 8 ]. Therefore, early diagnosis and initiation of proper treatment are essential to obtain a better outcome and avoid sequelae.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, early diagnosis and initiation of proper treatment are essential to obtain a better outcome and avoid sequelae. Furthermore, the emergence of bacterial strains particularly virulent and resistant to antibiotics has made the treatment of these conditions more difficult than in the past and has led to the need to have new antibiotic molecules available to deal with these emergencies [ 7 , 9 ]. However, there is no consensus in the literature regarding the best antibiotic therapy to be administered, the mode of administration, and the duration of therapy.…”

Section: Introductionmentioning

confidence: 99%

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Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Castellazzi

Mantero

Esposito

2016

IJMS

140

119

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Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

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“…MRI exploration helps localize the aff ection of the bone and provide an objective view of the lesion extent (10,14). However, x-rays may underestimate bone destruction and remain normal until the irreversible progression of the infection occurs (15,16).…”

Section: Discussionmentioning

confidence: 99%