Osteomyelitis and septic arthritis in children

Dodwell, Emily

doi:10.1097/mop.0b013e32835c2b42

Cited by 211 publications

(183 citation statements)

References 38 publications

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“…MRI is an important early tool to determine location and extent of infection as well as assist with preoperative planning when surgically significant complications of osteomyelitis are identified [1][2][3]. One quandary regarding MRI is whether the presence of joint effusion, in the setting of nearby metaphyseal osteomyelitis, represents an innocuous, non-pyogenic reactive effusion or concurrent septic arthritis.…”

Section: Introductionmentioning

confidence: 98%

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

et al. 2015

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Patients with joint effusions identified by MRI, in the setting of metaphyseal osteomyelitis, should be presumed to have septic arthritis until proven otherwise. Epiphyseal extension of edema, perisynovial edema and epiphyseal non-enhancement in the setting of metaphyseal osteomyelitis are not helpful predictors in differentiating reactive and pyogenic joint effusions. Osteomyelitis at a site with an intra-articular metaphyses, however, is more likely to have concurrent septic arthritis.

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Section: Introductionmentioning

confidence: 98%

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

et al. 2015

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“…[10][11][12] The results showed that a 4-day course of adjuvant dexamethasone shortened the duration of symptoms and hospital stay and reduced residual dysfunction at the end of therapy. The rationale for the dosing schedule was derived from the Haemophilus influenzae B meningitis protocol 13 ; the use of corticosteroids was prompted by findings of a decrease in synovial T-cell and macrophage levels in animals with septic arthritis treated with dexamethasone and antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…12,20 Neonatal age, immunosuppressive diseases, hip joint involvement, delay in antibiotic treatment, and MRSA infection are known predictors of complications. 20 In the current study, no complications of septic arthritis other than osteomyelitis were documented from discharge to the last clinic visit (minimum 6 months) in the patients selected for the study.…”

Section: Discussionmentioning

confidence: 99%

Dexamethasone Therapy for Septic Arthritis in Children

Fogel¹,

Amir²,

Bar‐On³

et al. 2015

PEDIATRICS

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BACKGROUND AND OBJECTIVE: Prospective studies of children with septic arthritis report that adding dexamethasone to antibiotic therapy contributes significantly to clinical and laboratory improvement. This study sought to evaluate the effect of this regimen outside of a randomized controlled trial. METHODS:The sample consisted of children with septic arthritis hospitalized at a tertiary pediatric medical center in 2008 to 2013. Disease course and outcome were compared between children treated with antibiotics alone or with adjuvant dexamethasone, according to the admitting department policy. RESULTS:The cohort included 116 patients, 90 treated with antibiotics alone and 26 treated with antibiotics+dexamethasone. The groups were similar for age, symptom duration before hospitalization, body temperature, acute-phase reactant levels, and rate of positive fluid cultures (21.6% total). Compared with monotherapy, antibiotics+dexamethasone treatment was associated with a shorter duration of fever (mean 2.3 vs 3.9 days, P = .002), more rapid clinical improvement (mean 6.3 vs 10.0 days to no pain/limitation, P , .001), more rapid decrease in C-reactive protein level to ,1 mg/dL (mean 5.3 vs 8.4 days, P = .002), shorter duration of parenteral antibiotic treatment (mean 7.1 vs 11.4 days, P , .001), and shorter hospital stay (mean 8.0 vs 10.7 days, P = .004). Recurrent symptoms of fever and joint pain occurred in 4 patients in the antibiotics+dexamethasone group after completion of the steroid course.CONCLUSIONS: Children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone. WHAT'S KNOWN ON THIS SUBJECT:Two prospective studies of children with septic arthritis have shown that the addition of dexamethasone to antibiotic therapy contributes to clinical and laboratory improvement. Nevertheless, the mainstay of treatment remains antibiotics alone. WHAT THIS STUDY ADDS:This study, which was conducted outside a randomized controlled trial, demonstrates that children with septic arthritis treated early with a short course of adjuvant dexamethasone show earlier improvement in clinical and laboratory parameters than children treated with antibiotics alone.

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“…1,24 Studies conducted in California, 21 Tennessee 22 and Texas 23 have reported S. aureus as the most common pathogen of osteoarticular infection in children, with proportions ranging from 40% to 85%. However, in contrast to those earlier studies, we used a highly sensitive technique to identify K. kingae in the joint aspirate samples.…”

Section: Discussionmentioning

confidence: 99%

Association between oropharyngeal carriage of Kingella kingae and osteoarticular infection in young children: a case–control study

Gravel

Ceroni

Lacroix

et al. 2017

CMAJ

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Osteomyelitis and septic arthritis in children

Abstract: Up to date knowledge of emerging pathogens, utilization of modern diagnostic techniques and implementation of new shorter treatment regimens can optimize the treatment of pediatric septic arthritis and osteomyelitis.

Cited by 211 publications

References 38 publications

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

Metaphyseal osteomyelitis in children: how often does MRI-documented joint effusion or epiphyseal extension of edema indicate coexisting septic arthritis?

Dexamethasone Therapy for Septic Arthritis in Children

Association between oropharyngeal carriage of Kingella kingae and osteoarticular infection in young children: a case–control study

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