Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Castellazzi, Luca; Mantero, Marco; Esposito, Susanna

doi:10.3390/ijms17060855

Cited by 131 publications

(119 citation statements)

References 66 publications

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“…[3,4] Surgery makes it possible to get biological samples and then guide the selection of antibiotics according to the causative organisms. It also reduces the intraarticular pressure of the joint, subsequently decreases the risk of complications such as AVN of the bone and permanent cartilage damage.…”

Section: Discussionmentioning

confidence: 99%

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Delayed treatment of septic arthritis in the neonate

Zhou

Liu

et al. 2016

Medicine

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There is still controversy on the management of septic arthritis in neonates. This study aims to investigate the treatment of septic arthritis in neonates.We reviewed 52 neonates (37 males and 15 females) with septic arthritis in our hospital during 2004 to 2015. The mean age at onset of infection was 17.5 ± 7.6 days, mean age at admission was 32.6 ± 10.7 days. A total of 56 joints were involved (22 knees, 18 shoulders, 13 hips, and 3 other joints). Thiryt-six patients underwent surgical drainage, 14 patients were treated nonoperatively, 2 families refused treatment. Forty-four patients (48 joints) were followed for 4.5 ± 1.2 years. Based on treatment, these 48 joints were divided into an operative group and a nonoperative group. Clinical presentations, imaging examination results, treatments, and outcomes were analyzed.Among the patients who were followed-up, the time from onset to treatment in the operatively managed group (12.7 ± 8.1 days) was significantly shorter than that in the conservatively managed group (20.0 ± 8.2 days). There were no significant differences between both groups on the age at onset, age at admission, imaging score, length of hospital stay, WBC counts, and intravenous medication time. Thirty-five sites (72.9%) recovered completely. There was no significant difference on recovery rate between operative and nonoperative group. Only 33.3% of the hips recovered, this was significantly lower than that of knee/ankle (85.0%) and shoulder/elbow (78.9%). Sequels were found in 13 joints. Logistic regression indicated that sex, imaging score, and hip joint involvement were predictors of sequel. One point of imaging score increased the risk of sequels by a factor of 2.960, and hip joint involvement increased the risk of sequels by a factor of 12.712. Females were more likely to have sequels than males.Surgical drainage is recommended for early diagnosed neonatal septic arthritis and hip infections. A conservative approach may be more efficient for patients whose diagnosis and treatment had been delayed for more than 2 weeks. Antibiotics should be administered intravenously for 2 weeks and then orally for another 2 weeks. First-generation cephalosporin and clindamycin are recommended empirical antibiotics before causative agent and its resistance pattern are known.

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Section: Discussionmentioning

confidence: 99%

“…At present, surgery and antibiotics are the main options in the management of septic arthritis in children. [3,4] …”

Section: Introductionmentioning

confidence: 99%

Delayed treatment of septic arthritis in the neonate

Zhou

Liu

et al. 2016

Medicine

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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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“…However, this point could not be confirmed due to the absence of a K. kingae ICD‐10 code . In contrast, Staphylococci and Streptococci were associated with longer stays, more severe sepsis and a possible increase of methicillin‐resistant S. aureus . Although they were poorly coded in the national hospital discharge database, microbiology and resistance coding increased between 2008 and 2013 due to incentive valorisation policies and enhanced diagnostic techniques.…”

Section: Discussionmentioning

confidence: 99%