Osteoarticular infections in paediatric sickle cell disease: in the era of multidrugresistant bacteria

Gouveia, Catarina; Duarte, Mariana; Norte, Susana; Alves, Pedro; Kjöllerström, Paula; Brito, Maria João; Tavares, Delfin

doi:10.1111/bjh.16568

Cited by 6 publications

(6 citation statements)

References 14 publications

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“… 1 – 4 Nevertheless, patients with renal osteodystrophy, haematologic disorders, those receiving regular steroid therapy, acute lymphoblastic leukaemia and juvenile diabetes are considered at high risk for developing AOI. 48 , 49 Therefore, in the event of acute musculoskeletal symptomatology, acute septic arthritis and haematogenous osteomyelitis should top the list of differential diagnosis.…”

Section: Diagnostic Challengesmentioning

confidence: 99%

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

El-Sobky

Mahmoud

2021

EFORT Open Reviews

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Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis. A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management. Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician’s clinical judgment. Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve. The growing body of evidence on ‘high-risk’ children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets. Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis. Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155

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Section: Diagnostic Challengesmentioning

confidence: 99%

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

El-Sobky

Mahmoud

2021

EFORT Open Reviews

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“…OM is an acute or chronic inflammatory process in the bone caused by bacterial infection. The cumulative occurrence of OM in children with SCD has been reported to range broadly from 1.4 to 12% in different series 4‐6 …”

Section: Introductionmentioning

confidence: 99%

“…Staphylococcus aureus is the most common cause of OM in children, while Salmonella species are a unique cause in children with SCD 9‐12 . Less commonly, other enteric pathogens have been described as the cause of osteoarticular infections in children with SCD, including Serratia, Enterobacter cloacae, Enterococcus faecium , and Pseudomonas aeruginosa 5 …”

Section: Introductionmentioning

confidence: 99%

“…The cumulative occurrence of OM in children with SCD has been reported to range broadly from 1.4 to 12% in different series. [4][5][6] Differentiating OM from VOC may pose a diagnostic challenge, as several clinical, radiological, and laboratory features overlap. However, early recognition and treatment of OM is necessary to prevent longterm morbidity such as chronic OM or recurrent relapses.…”

mentioning

confidence: 99%

“…[9][10][11][12] Less commonly, other enteric pathogens have been described as the cause of osteoarticular infections in children with SCD, including Serratia, Enterobacter cloacae, Enterococcus faecium, and Pseudomonas aeruginosa. 5 The epidemiology of invasive bacterial infections and the treatment of OM in general pediatrics have evolved over the past few decades.…”

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confidence: 99%

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Microbiology and radiographic features of osteomyelitis in children and adolescents with sickle cell disease

Kao

Yee

Maillis

et al. 2020

Pediatric Blood & Cancer

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Background Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM, are common in SCD, thus complicating diagnosis. We reviewed presentation, imaging features, and microbiologic etiologies of children with SCD treated for OM. Methods The comprehensive SCD clinical database of children and adolescents with SCD followed at a single, large tertiary pediatric center were searched to identify all diagnostic coding for potential cases of osteomyelitis in children ages 6 months to 21 years from 2010 to 2019. Medical charts were reviewed to determine OM diagnostic probability based on radiographic and microbiologic findings and the duration of prescribed antibiotic treatment for OM. Results Review of 3553 patients (18 039 person‐years) identified 20 episodes of probable OM in 19 children. Magnetic resonance imaging (MRI) findings to support OM were definitive in 4/19 (21%), probable in 10/19 (53%), suspected in 5/19 (26%), based on blinded radiologist review. Blood and/or operative cultures from bone and tissue debridement isolated Salmonella species in seven (35%) cases and methicillin‐susceptible Staphylococcus aureus (MSSA) in two (10%). Six patients received antibiotic treatment prior to obtainment of cultures. Of culture‐positive cases, MRI findings for OM were definitive or probable in six of nine (67%), suspected in three of nine (33%). Conclusions Distinction between OM and sickle‐related bone infarct or vasoocclusion is difficult based on imaging findings alone. Early attainment of blood and operative cultures increases the likelihood of identifying and adequately treating OM.

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Treatment of bone infections in children in low-income countries – A practical guideline based on clinical cases

Loro,

Fulvio,

Alt

2023

Injury

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Osteoarticular infections in paediatric sickle cell disease: in the era of multidrugresistant bacteria

Cited by 6 publications

References 14 publications

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills

Microbiology and radiographic features of osteomyelitis in children and adolescents with sickle cell disease

Treatment of bone infections in children in low-income countries – A practical guideline based on clinical cases

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