SEIP–SERPE–SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis

Saavedra-Lozano, Jesús; Calvo, Cristina; Carol, R. Huguet; Rodrigo, C.; Núñez, E.; Obando, I.; Rojo, Pablo; Merino, Rosa; Pérez, C.; Downey, F.J.; Colino, Enrique; García, Javier de Santiago; Cilleruelo, María José; Torner, Ferrán; García, L.

doi:10.1016/j.anpede.2014.10.008

Cited by 8 publications

(10 citation statements)

References 38 publications

(50 reference statements)

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“…Several treatment proposals have been described in an attempt to homogenize the therapeutic approach for OAI (9,(20)(21) and in recent years there has been a trend towards a less invasive approach than the traditionally recommended long intravenous therapy (5)(6). In a prospective study, Peltola et al observed that shorter courses of initial intravenous therapy (2-4 days) followed by oral therapy for 2-3 weeks could be a safe option in children with uncomplicated OAI, especially in children under 3 years in which K.kingae is the main germen identi ed (5,22).…”

Section: Discussionmentioning

confidence: 99%

“…(43)(44) Finally, following the trend of the minimally invasive approach, Group 2 patients with septic arthritis were treated with joint aspiration and lavage. Although it is generally assumed that an early joint lavage should be carried out in SA, there are not consensus of which invasive method should be performed (9). Joint aspiration and lavage with normal saline have not been systematically implemented in the treatment for pediatric patients, especially in the shoulder and hip joints, as there is a potential risk of bone necrosis secondary to hyperpressure.…”

Section: Discussionmentioning

confidence: 99%

“…A nationwide multicenter prospective registry was created by the Spanish Network of Osteoarticular Infections in 2015 (RioPed) with the objective of analyzing the approach that pediatricians use when treating children with these infections (8). After assessing the results of the RioPed registry, with an attempt to improve the quality of care children with OAI receive, a "Consensus document on the etiology, diagnosis and treatment of acute uncomplicated osteoarticular infections" was published with the collaboration of the Spanish Society of Pediatric Infectious Diseases (SEIP), the Spanish Society of Pediatric Rheumatology (SERPE) and the Spanish Society of Pediatric Orthopedics (SEOP) (9).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Alcobendas¹,

Núñez²,

Martin³

et al. 2021

Preprint

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Background Osteoarticular infections are typically treated initially with intravenous antibiotics. The objective of this study was to evaluate whether an exclusive oral treatment in selected children may be appropriate. Methods The Spanish Network of Osteoarticular Infections is a nationwide multicenter registry comprising 37 hospitals in Spain. The registry prospectively includes clinical characteristics and outcome of children with OAI. One of the hospitals from RioPed offers oral treatment to children meeting certain criteria. Patients were classified into two groups. Group 1: management with initial intravenous antibiotic therapy. Group 2: patients exclusively treated with oral antibiotics. A comparison between the two groups was performed. Results We compared 893 children who initially received intravenous antibiotics (Group 1) with 64 children who received exclusively oral therapy (Group 2). Patients from Group 2 were younger (33.9 vs 20.3 months; p=0.001), had a lower percentage of Staphylococcus aureus (23.3% vs 3.1%, p <0.001), a higher proportion of Kingella kingae (12.1% vs 28.1%; p = 0.001), higher ESR/CRP ratio (1.4 IQR 0.6-3.6 vs 3.3 IQR 1.7-5.7, p <0.001) and showed lower rate of fever (63% vs 48.8%; p=0.024). Complications were not found in Group 2. Conclusion An exclusively oral administration could be a safe option in selected patients with OAI. Low-risk criteria are proposed: good general condition, no underlying disease, 6 months-3 years of age, appropriate oral tolerance, CRP ≤80 mg/L, ESR/CRP ratio ≥ 0.67, no skin injury, no recent surgery, no cervical spondylodiscitis and no local complications at onset.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Alcobendas¹,

Núñez²,

Martin³

et al. 2021

Preprint

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“…The network was established as a prospective registry for acute OAI cases and was approved by the Ethics Committee of the Severo Ochoa Hospital in Madrid. Its aim is to analyse the trends in the epidemiology and management of OAI infections and to assess and promote compliance with the Spanish Guidelines . The Guidelines define acute infections as those where the symptoms last less than 14 days.…”

Section: Methodsmentioning

confidence: 99%

Outpatients with acute osteoarticular infections had favourable outcomes when they received just oral antibiotics without intravenous antibiotics

et al. 2018

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“…5,6 Even when national consensus guidelines have been formulated, uptake of the guidelines remains inconsistent. 3,24 Using local consensus building, we overcame the standardization challenges associated with the involvement of multiple specialties and the lack of high-quality evidence or national guidelines. This could be an effective alternative approach to national consensus guidelines for conditions for which available scientific evidence is limited, and care is largely based on observational data and expert opinion.…”

Section: Figurementioning

confidence: 99%

Use of a Clinical Care Algorithm to Improve Care for Children With Hematogenous Osteomyelitis

et al. 2019

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Acute hematogenous osteomyelitis (AHO) causes significant morbidity in children 1 -3 and often requires prolonged and costly treatment. 1, 3 -6 A recent large study from Spain revealed that children with osteomyelitis were hospitalized for an average of 13.5 days, that 20% required surgery, and that 2.3% developed longterm sequelae, such as leg-length discrepancy. 3 Early transition to oral therapy has been shown to be an effective and less costly approach compared with prolonged parenteral therapy. 5 -13 Despite efforts at our institution to reduce costs through early transition to oral therapy, 14 our inpatient costs remained high. In preliminary discussions among specialties involved in caring for children with AHO at our institution, substantial variation in practices from 1 patient to another was identified. We hypothesized that standardizing our practice in all areas would lead to an overall cost reduction and improved care. on behalf of the AHO Care Algorithm Team BACKGROUND AND OBJECTIVES: Acute hematogenous osteomyelitis (AHO) causes significant morbidity in children. Quality improvement (QI) methods have been used to successfully improve care and decrease costs through standardization for numerous conditions, including pediatric AHO. We embarked on a QI initiative to standardize our approach to the inpatient management of AHO, with a global aim of reducing inpatient costs. METHODS:We used existing literature and local consensus to develop a care algorithm for the inpatient management of AHO. We used the Model for Improvement as the framework for the project, which included process mapping, failure mode analysis, and key driver identification. We engaged with institutional providers to achieve at least 80% consensus regarding specific key drivers and tested various interventions to support uptake of the care algorithm. RESULTS:Fifty-seven patients were included. There were 31 patients in the preintervention cohort and 26 in the postintervention cohort, of whom 19 were managed per the algorithm. Mean inpatient charges decreased from $45 718 in the preintervention cohort to $32 895 in the postintervention cohort; length of stay did not change. Adherence to recommended empirical antimicrobial agents trended upward. CONCLUSIONS: A simple and low-cost QI project was used to safely decrease the cost of inpatient care for pediatric AHO at a tertiary care children's hospital. A robust local consensus process proved to be a key component in the uptake of standardization. abstract To cite: Robinette ED, Brower L, Schaffzin JK, et al. Use of a Clinical Care Algorithm to Improve Care for Children With Hematogenous Osteomyelitis.

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SEIP–SERPE–SEOP Consensus document on the treatment of uncomplicated acute osteomyelitis and septic arthritis

Cited by 8 publications

References 38 publications

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Oral Versus Intravenous Antibiotics for Pediatric Osteoarticular Infection: When and to Whom?

Outpatients with acute osteoarticular infections had favourable outcomes when they received just oral antibiotics without intravenous antibiotics

Use of a Clinical Care Algorithm to Improve Care for Children With Hematogenous Osteomyelitis

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