Pediatric osteoarticular infection: trend in surgically treated patients and association of methicillin-resistant Staphylococcus aureus with requirement of secondary procedures

Jain, Mohit; Bradko, Viachaslau; Zhu, Huirong; Inneh, Ifeoma A.; Shinava, Vinitha R.

doi:10.1097/bpb.0000000000000819

Cited by 6 publications

(14 citation statements)

References 31 publications

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“…They required more than 3 surgical interventions, coinciding with Arnold et al, and others, who stated that patients with MRSA needed surgical procedures more frequently (91%) than cases with MSSA (62%; P < 0.001). 16,[34][35][36] In contrast to the findings of this study, reports from Finland and France, where MSSA predominates, describe less need for surgical procedures. 37,38 Kaplan reported differences in the United States (minor surgeries, shorter duration of antibiotics) possibly due to the predominance of MSSA and the lower frequency of virulence factors, particularly the presence of Panton-Valentine leucocidin.…”

Section: Discussioncontrasting

confidence: 99%

Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics

Camacho-Cruz

Gutiérrez

Brand-López

et al. 2021

Pediatric Infectious Disease Journal

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Background: The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) has changed in recent years. The present article is intended to establish differences between clinical, laboratory and imaging findings and outcomes of MSSA and MRSA infections, as well as among subgroups of infection such as skin and soft tissue infection, osteoarticular, bacteremia or pneumonia in a pediatric population from Bogota, Colombia. Methods: Retrospective cohort study using clinical records of patients under 18 years of age treated at the participating centers in Bogota, Colombia, between 2014 and 2018. The first positive S. aureus culture was studied. MSSA and MRSA were compared. The χ 2 test, Fisher exact test, and Kruskal-Wallis test were calculated, and the statistical significance was presented using the difference and its 95% CI. Results: Five hundred fifty-one patients were included; 211 (38%) corresponded to MRSA and 340 (62%) to MSSA for a total of 703 cultures. A significantly higher probability of having an MSSA infection than MRSA was found in patients with previous heart disease (3.3% vs. 0.5%), neurologic disease (5.9% vs. 2.5%), recent major surgeries (11% vs. 5%) or who has an implanted device (11% vs. 4%). In contrast, in severe MRSA infections (bacteremia, osteoarticular infections and pneumonia), a higher rate of complications was seen (admission to the pediatric intensive care unit, mechanical ventilation and vasoactive support), and in osteoarticular MRSA, more than 1 surgery per case was seen (89% vs. 61%). Laboratory results and mortality were similar. Conclusions: MRSA was associated with a more severe course in bacteremia, osteoarticular infections and pneumonia. Some classical risk factors associated with MRSA infections were found to be related to MSSA. In general, with the exception of skin and soft tissue infection, there was an increased risk of pediatric intensive care unit admission and mechanical and inotropic support with MRSA in a pediatric population.

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Section: Discussioncontrasting

confidence: 99%

Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics

Camacho-Cruz

Gutiérrez

Brand-López

et al. 2021

Pediatric Infectious Disease Journal

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“…However, more level 1 virulence germs are found in the repeated drainage group. In the literature, MRSA [10,13,14,17] and PVL [12,18] are also responsible for a higher risk of repeated drainage varying from 1.2 to 16.4 [13]. Furthermore, Jain et al [13].…”

Section: Discussionmentioning

confidence: 99%

Risk of repeated drainage in pediatric septic arthritis: patient or method?

Royer,

Castel,

Lefevre

et al. 2023

Journal of Pediatric Orthopaedics B

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How drainage of septic arthritis should be performed remains controversial. The aim of the present study was to compare arthrocentesis (Ac) using double intra-articular needle lavage to arthrotomy (At) as first-line drainage treatment for pediatric hip and knee septic arthritis. The secondary objective was to identify risk factors of second articular drainage. A retrospective review of medical records of children with knee and hip septic arthritis was conducted. Inclusion criteria were: children treated for septic arthritis between 2014 and 2020 with a positive culture of joint fluid. Clinical, biological, radiographical and ultrasound data were recorded at presentation and during follow-up. Patients were divided into 2 groups according to the type of drainage performed: Ac or At. 25 hips and 44 knees were included, 42 treated by Ac (15 hips, 27 knees) and 27 by At (10 hips, 17 knees). There is no significant difference between Ac and At regarding the need for repeated drainage and Ac nor At was reported as risk factor for repeated drainage. The presence of associated musculoskeletal infection (MSI) was a significant risk factor of repeated drainage [odds ratio = 11.8; 95% confidence interval = 1.2–114.2; P < 0.001]. Significantly more associated MSI (P < 0.001), level I virulence germs (P < 0.001) and positive blood culture (<0.001) were found in patients who underwent repeated drainage. There was no significant difference between Ac and At regarding rate of repeated drainage. The risk factors for repeated drainage were: associated with MSI, virulent germs and positive blood culture.

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“…The A-SCORE (acute) has been validated as a predictor of a complex course and the C-SCORE (chronic) has been validated as a predictor of chronic morbidity for acute or chronic osteomyelitis 67 . Osteoarticular infections with methicillin-resistant Staphylococcus aureus were found to increase the odds of needing multiple operative debridements by 4.6-fold 68 .…”

Section: Infectionmentioning

confidence: 99%

What’s New in Pediatric Orthopaedics

Andras

Sanders²,

Goldstein

et al. 2022

Journal of Bone and Joint Surgery

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This pediatric orthopaedic update represents a review of articles predominantly from October 2021 to October 2022. Spine Adolescent Idiopathic ScoliosisAs we strive toward optimal adolescent idiopathic scoliosis treatment that will serve patients well into adulthood, longterm follow-up studies are of particular importance. Lander et al. reported on a series of 134 patients treated with Harrington instrumentation with a minimum 40-year follow-up. Patients with a lowest instrumented vertebra (LIV) at L3 or proximal had a lower likelihood of undergoing additional surgical procedures at 13% compared with patients with an LIV at L4 or distal at 36%, but, aside from this, the groups were similar with regard to health-related quality of life and their scores were not different from normal age-based means 11 . Also encouraging was the report on 115 patients with a 25year follow-up that showed that the serum levels of cobalt and chromium ions were similar in the patients treated with Harrington instrumentation compared with a control group of patients treated with bracing 12 . However, questions with regard to the long-term effect of retained implants continue to generate concern as titanium levels were found to be persistently elevated to 5 times the preoperative level at the 2-year follow-up in a series with more contemporary implants 13 . The impact of this remains unknown but warrants continued study.There remains continued interest in leveraging technology to achieve optimal pedicle screw placement safely and consistently. In a systematic review and meta-analysis by Baldwin et al., screws placed with intraoperative computed tomographic (CT) navigation were determined to be one-third Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/H355).

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Pediatric osteoarticular infection: trend in surgically treated patients and association of methicillin-resistant Staphylococcus aureus with requirement of secondary procedures

Cited by 6 publications

References 31 publications

Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics

Differences Between Methicillin-susceptible Versus Methicillin-resistant Staphylococcus aureus Infections in Pediatrics

Risk of repeated drainage in pediatric septic arthritis: patient or method?

What’s New in Pediatric Orthopaedics

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