Risk factors associated with complications/sequelae of acute and subacute haematogenous osteomyelitis: an Italian multicenter study

Chiappini, Elena; Krzysztofiak, Andrzej; Bozzola, Elena; Gabiano, Clara; Esposito, Susanna; Vecchio, Andrea Lo; Govoni, Maurizio; Vallongo, Cristina; Dodi, Icilio; Castagnola, Elio; Rossi, Nadia; Valentini, Piero; Cardinale, Fabio; Salvini, Filippo; Bona, Gianni; Bossi, Grazia; Olivieri, Alma Nunzia; Russo, F; Fossali, Emilio F.; Bottone, Gabriella; Dellepiane, Marta; Martino, Maurizio de; Villani, Alberto; Galli, Luisa

doi:10.1080/14787210.2018.1453357

Cited by 17 publications

(19 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In most observational studies and randomised clinical trials, oral therapy consists of high-dose cephalosporin or clindamycin [ 59 , 69 , 70 , 71 ]. Trials conducted by Peltola et al showed a failure rate under 1% at follow-up [ 64 ].…”

Section: Antinfective Treatmentmentioning

confidence: 99%

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

2020

Self Cite

View full text Add to dashboard Cite

Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

show abstract

Section: Antinfective Treatmentmentioning

confidence: 99%

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…Osteomyelitis and septic arthritis can be catastrophic causing various degree of disabilities. [3,4] Prompt diagnosis and appropriate treatment are mandatory to minimize complications including avascular necrosis, growth disturbance, pathologic fractures, deep vein thrombosis, and sepsis. [5,6] In an effort to reduce such complications, advances in imaging techniques including magnetic resonance imaging has enabled early diagnosis of osteomyelitis and septic arthritis.…”

Section: Introductionmentioning

confidence: 99%

Nationwide epidemiologic study for pediatric osteomyelitis and septic arthritis in South Korea

2019

View full text Add to dashboard Cite

Epidemiologic studies of pediatric bone and joint infection have been done mostly by developed Western countries, and such results could be expected to be biased. Therefore, an epidemiologic study to identify the distinct features of an Eastern country would be beneficial to improve their health outcomes and to reduce health care cost. A study was planned to investigate the epidemiology of pediatric osteomyelitis and septic arthritis in South Korea and to find out epidemiologic factors related with the occurrence of surgery.We conducted a cross-sectional study among hospitalized pediatric patients (<18 years old) with osteomyelitis and septic arthritis using nationwide cohort based on the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2016. Percentage of hospitalization was additionally calculated according to several epidemiologic factors including age, month, site of infection, and region of residence. Logistic regression analysis was performed to find out the association between epidemiologic factors and occurrence of surgeryAnnual hospitalization rates (per 100,000) in our country were 7.8 to 9.1 for osteomyelitis, and 11.9 to 20.8 for septic arthritis. Frequent sites of osteomyelitis and septic arthritis were pelvis and lower extremity. The hospitalization rates of osteomyelitis and septic arthritis showed increasing trend with age. After multivariate logistic regression analysis, female gender, children, and adolescents rather than infants, rural area rather than urban area were associated with significantly increased odd ratios for surgery.The hospitalization rate of septic arthritis (11.9 to 20.8 per 100,000) in South Korea was higher than the Western countries (1.1 to 11 per 100,000), and the hospitalization rate of osteomyelitis (peak at 12 years) and septic arthritis (peak at 17 years) showed increasing trend with age, which was different from those of the developed Western countries showing higher incidence in children aged under 5 years. After multivariate logistic regression analysis, our study identified female gender, higher age group including children, and adolescents, and rural residence as epidemiologic risk factors associated with surgery.

show abstract

“…We may speculate that clinicians preferred to prescribe a third-generation cephalosporin in order to reach a larger spectrum. Indeed, a recent multicenter retrospective Italian study showed a high heterogeneity of bacteria isolated in infants and children with AHOM [11]. Moreover, in children ≥3 months of age, the total duration of the treatment was longer in most Italian centers (4–6 weeks) compared to the ESPID recommendation (3–4 weeks).…”

Section: Discussionmentioning

confidence: 99%

Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey

Chiappini

Serrano

Galli

et al. 2019

IJERPH

Self Cite

View full text Add to dashboard Cite

Background: The European Society of Pediatric Infectious Diseases (ESPID) guidelines for acute hematogenous osteomyelitis (AHOM) have been published recently. In uncomplicated cases, an early (2–4 days) switch to oral empirical therapy, preferentially with flucloxacillin, is recommended in low methicillin-resistant Staphylococcus aureus settings. We conducted a survey with the aim of evaluating the behaviors of Italian pediatricians at this regard. Methods: An open-ended questionnaire investigating the empiric therapy adopted in uncomplicated AHOM children according to age was sent by email to 31 Italian pediatric clinics taking care of children with infectious diseases, and results were analyzed. Results: The preferred intravenous (IV) regimen was a penicillin plus an aminoglycoside (n = 10; 32.3%) in children aged <3 months, and a combination of a third-generation cephalosporin plus oxacillin (n = 7; 22.6%), or oxacillin alone (n = 6; 19.4%) in those ≥3 months. In every age class, amoxicillin-clavulanate was the first-choice oral antibiotic. Other antibiotics largely used orally included clindamycin, rifampicin, and trimethoprim/sulfamethoxazole. Flucloxacillin was never prescribed. Only 3 centers switched to oral therapy within 7 days in children ≥3 months of age. The most commonly reported reason influencing the time to switch to oral therapy concerned caregivers’ adherence to oral therapy. Conclusion: Adherence to guidelines was poor, and early transition to oral therapy in the clinical practice was rarely adopted. Given the large use of potentially effective, but poorly studied, oral antibiotics such as amoxicillin/clavulanate, trimethoprim/sulfamethoxazole, and rifampicin, our data may stimulate further studies of this regard.

show abstract

Risk factors associated with complications/sequelae of acute and subacute haematogenous osteomyelitis: an Italian multicenter study

Abstract: AHOM and SAHOM displayed some differences, however occurrence and risk factors for complications and sequelae are similar, and the same empiric treatment might be recommended.

Cited by 17 publications

References 24 publications

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

Nationwide epidemiologic study for pediatric osteomyelitis and septic arthritis in South Korea

Practical Issues in Early Switching from Intravenous to Oral Antibiotic Therapy in Children with Uncomplicated Acute Hematogenous Osteomyelitis: Results from an Italian Survey

Contact Info

Product

Resources

About