Osteoarticular Infections: Younger Children With Septic Arthritis and Low Inflammatory Patterns Have a Better Prognosis in a European Cohort

Abstract

Background: Osteoarticular infections (OAI) are associated with complications and sequelae in children, whose prediction are of great importance in improving outcomes. We aimed to design risk prediction models to identify early complications and sequelae in children with OAI. Methods: This observational study included children (>3 months–17 years old) with acute OAI admitted to a tertiary-care pediatric hospital between 2008 and 2018. Clinical treatment, complications and sequelae were recorded. We developed a multivariable logistic predictive model for an acute complicated course (ACC) and another for sequelae. Results: A total of 240 children were identified, 17.5% with ACC and 6.0% and 3.6% with sequelae at 6 and 12 months of follow-up, respectively. In the multivariable logistic predictive model for ACC, predictors were fever at admission [adjusted odds ratio (aOR): 2.98; 95% confidence interval (CI): 1.10–8.12], C-reactive protein ≥100 mg/L (aOR: 2.37; 95% CI: 1.05–5.35), osteomyelitis (aOR: 4.39; 95% CI: 2.04–9.46) and Staphylococcus aureus infection (aOR: 3.50; 95% CI: 1.39–8.77), with an area under the ROC curve of 0.831 (95% CI: 0.767–0.895). For sequelae at 6 months, predictors were age ≥4 years (aOR: 4.08; 95% CI: 1.00–16.53), C-reactive protein ≥110 mg/L (aOR: 4.59; 95% CI: 1.25–16.90), disseminated disease (aOR: 9.21; 95% CI: 1.82–46.73) and bone abscess (OR: 5.46; 95% CI: 1.23–24.21), with an area under the ROC curve of 0.887 (95% CI: 0.815–0.959). Conclusions: In our model we could identify patients at low risk for complications and sequelae, probably requiring a less aggressive approach.

Detecting Kingella kingae in Uncomplicated Skeletal System Infections

“…Moreover, with rare exceptions, pediatric K. kingae skeletal system infections usually follow an uncomplicated course, promptly respond to adequate antimicrobial therapy and do not leave long-term functional disabilities. 3,4 These demographic, clinical and biologic features are remarkably similar to those found by Gouveia et al 1 among children in whom the etiology of the infection remained undetermined.…”

“…Using a multivariable logistic predictive model, age older than 4 years, a culture-proven Staphylococcus aureus etiology, fever at admission, C-reactive protein level >100 mg/L and osteomyelitis were associated with increased risk for an acute complicated course. 1 Age ≥4 years, a C-reactive protein level ≥110 mg/L, disseminated disease and formation of bone abscesses predicted long-term disability. 1 The flip side of the study results implies that afebrile patients younger than 4 years of age, without a staphylococcal infection and presenting with low concentrations of acute phase reactants have a better acute and long-term prognosis.…”

“…1 Age ≥4 years, a C-reactive protein level ≥110 mg/L, disseminated disease and formation of bone abscesses predicted long-term disability. 1 The flip side of the study results implies that afebrile patients younger than 4 years of age, without a staphylococcal infection and presenting with low concentrations of acute phase reactants have a better acute and long-term prognosis.…”

“…I read the recent article by Gouveia et al 1 in which the risk factors for acute complications and late orthopedic sequelae were analyzed separately in 240 children with skeletal system infections. Using a multivariable logistic predictive model, age older than 4 years, a culture-proven Staphylococcus aureus etiology, fever at admission, C-reactive protein level >100 mg/L and osteomyelitis were associated with increased risk for an acute complicated course.…”