Osteoarticular Infections in Children

Arnold, John; Bradley, John S.

doi:10.1016/j.idc.2015.05.012

Cited by 137 publications

(143 citation statements)

References 52 publications

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“…Our study confirms epidemiological data previously well described in literature [5]: AHOM is more commonly reported in males and in young children, it more frequently involves the lower limb and long bones, and the patient’s history is commonly positive for a recent trauma or a febrile episode. In our dataset fever at admission was present only in 45% of children.…”

Section: Discussionsupporting

confidence: 91%

“…Early detection of acute hematogenous osteomyelitis (AHOM) is crucial, given that a delay in the diagnosis of only 5 days is a major risk factor for complications [4]. Even if mortality is rare, permanent disabilities can occur, such as growth arrest with limb length discrepancy or deformity [5]. AHOM etiology is changing according to bacterial susceptibility pattern modifications over time, vaccination programs, and implementation of cultural and polymerase chain reaction (PCR) techniques.…”

Section: Introductionmentioning

confidence: 99%

“…Staphylococcus aureus ( S. aureus ) is the most commonly isolated pathogen [6], accounting for 25–60% of cases of AHOM. Other microorganisms include Group-A Streptococcus pyogenes , Streptococcus pneumoniae , and Gram-negative rods [5]. Kingella kingae is an emergent pathogen [4,7].…”

Section: Introductionmentioning

confidence: 99%

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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: 91%

Section: Introductionmentioning

confidence: 99%

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

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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“…There is increasing evidence that, in appropriate cases, shorter courses of antibiotics are equally effective 37,47-50 with early transition to oral administration. 51-53 Response to treatment, such as improvement in clinical symptoms of pain and range of motion, resolution of fever and reduction of inflammatory markers (ESR, CRP, WBC count), can reliably guide clinicians to a safe transition, 54,55 reducing intravenous line-related complications and re-hospitalisation rates.…”

Section: Treatment Of Acute Paediatric Osteoarticular Infectionsmentioning

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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“…Этот метод намного чувствительнее к данным изменениям и дает возможность визуализировать менее выраженные транс-формации, чем те, которые выявляются при обычной рентгено-графии. КТ дает более полную информацию о степени распро-странения патологического процесса, позволяя, при наличии клинической картины, поставить более точный диагноз и лучше определиться с объемом оперативного лечения [8][9][10][11].…”

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Radiological Methods in Diagnostics of Acute Haematogenous Osteomyelitis in Children

Минаев¹,

Filipieva²,

Leskin³

et al. 2018

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Минаев Сергей Викторович -д. м. н., профессор, заведующий кафедрой детской хирургии с курсом дополнительного профессионального образования ФГБОУ ВО СтГМУ Минздрава России. 355017, г. Ставрополь, ул. Мира, д. 310. E-mail: sminaev@yandex.ru Ростова Наталья Павловна -врач-рентгенолог ГБУЗ СК «КДКБ». 335030, г. Ставрополь, ул. Семашко, д. 3. E-mail: nata-filipeva@mail.ru Филипьева Наталья Владимировна -аспирант кафедры детской хирургии с курсом дополнительного профессионального образования ФГБОУ ВО СтГМУ Минздрава России. 355017, г. Ставрополь, ул. Мира, д. 310. E-mail: nata-filipeva@mail Study Objective: To assess the informative value of radiological diagnostics methods -plan radiography and computer tomography (CT) -in children with acute haematogenous osteomyelitis (AHO). Study Design: Open comparative prospective study. Materials and Methods:Observation included 64 children with AHO (47 boys and 17 girls) aged 3 to 17 years old. Group 1 (n = 15) underwent affected bone CT, and group 2 (n = 49) had radiographic imaging of affected limb segment. Examination was performed during hospitalisation and then on days 7-8, day 21 and day 45 post surgery. Diagnostic efficiency parameters were periosteal thickening, endosteum thinning, osteopenia, soft tissue induration. Study Results: Long bone CT allowed diagnosing AHO as early as upon admission to hospital. Starting from day 7 it was possible to forecast process chronization, whereas in case of routine X-ray investigation the same bone changes were visualised on days 21-45.For the model assessing AHO probability using CT the sensitivity made 86.6%, specificity -89.2%; for X-ray investigation it was 64.4% and 67.7%, respectively. Conclusion: High-level significance and high accuracy make CT more preferable vs. plan radiography of a limb for AHO diagnostics and forecasting of complications in children.

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Osteoarticular Infections in Children

Cited by 137 publications

References 52 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

Paediatric bone and joint infection

Radiological Methods in Diagnostics of Acute Haematogenous Osteomyelitis in Children

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