Paediatric bone and joint infection

Abstract

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.

Acute Hematogenous Osteomyelitis in Children

“…Acute hematogenous osteomyelitis (AHO) is particularly common in children <5 years of age and typically affects the metaphysis because of the rich but slow blood flow of the growing bone. 4 The microorganisms enter the bone via the nutrient artery and are lodged in the metaphyseal capillary loops where they begin to proliferate, resulting in the spread of inflammation. In neonates and children aged <18 months, the metaphyseal vessel loop and epiphyseal vessel are connected via transphyseal vessels traversing across the growth plate.…”

“…5 Early diagnosis and appropriate treatment of osteomyelitis are imperative to avoid serious morbidity and permanent disability. 4…”

“…6 AHO caused by community-associated methicillinresistant S aureus (CA-MRSA) has become common in many countries. [4][5][6][9][10][11] The prevalence of MRSA varies significantly with geography. In one US study, MRSA was implicated in 30%-40% of pediatric osteoarticular infections.…”

Targeting intracellularStaphylococcus aureusto lower recurrence of orthopaedic infection

“…Staphylococcus aureus is a gram‐positive facultatively anaerobic bacterium and important pathogen in bone disease. It is responsible for about 70% of cases of osteomyelitis and 80% of joint infections in patients with rheumatoid arthritis and several other bone diseases . S. aureus infection of bone is associated with rapid, localized destruction of the tissue.…”

“…It is responsible for about 70% of cases of osteomyelitis and 80% of joint infections in patients with rheumatoid arthritis and several other bone diseases. [1][2][3][4] S. aureus infection of bone is associated with rapid, localized destruction of the tissue. Studies have reported the internalization of S. aureus by both epithelial and endothelial cells.…”