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Hospach T, Kallinich T, Martin L, V Kalle T, Reichert F, Girschick HJ, Hedrich CM. [Arthritis and osteomyelitis in childhood and adolescence-Bacterial and nonbacterial]. Z Rheumatol 2024:10.1007/s00393-024-01504-z. [PMID: 38653784 DOI: 10.1007/s00393-024-01504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
Bacterial arthritis and osteomyelitis are usually acute diseases, which in this way differ from the often insidious course of nonbacterial osteomyelitis; however, there is often an overlap both in less acute courses of bacterial illnesses and also in nonbacterial osteitis. The overlapping clinical phenomena can be explained by similar pathophysiological processes. In bacteria-related illnesses the identification of the pathogen and empirical or targeted anti-infectious treatment are prioritized, whereas no triggering agent is known for nonbacterial diseases. The diagnostics are based on the exclusion of differential diagnoses, clinical scores and magnetic resonance imaging (MRI). An activity-adapted anti-inflammatory treatment is indicated.
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Affiliation(s)
- T Hospach
- Zentrum für Pädiatrische Rheumatologie, Olgahospital, Klinikum Stuttgart (ZEPRAS), Kriegsbergstr 62, 70176, Stuttgart, Deutschland.
| | - T Kallinich
- Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - L Martin
- Klinik für Pädiatrie m.S. Pneumologie, Immunologie und Intensivmedizin, Charité, Universitätsmedizin Berlin, Berlin, Deutschland
| | - T V Kalle
- Radiologisches Institut, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - F Reichert
- Pädiatrische Infektiologie, Olgahospital, Klinikum Stuttgart, Stuttgart, Deutschland
| | - H J Girschick
- Vivantes Klinikum Friedrichshain, Berlin, Deutschland
| | - C M Hedrich
- Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, Großbritannien
- Department of Rheumatology, Alder Hey Children's NHS Foundation Trust, Liverpool, Großbritannien
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2
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AlSahlawi H, Shamlooh N. A case report: Osteomyelitis of the ischiopubic synchondrosis with abscess formation. Radiol Case Rep 2024; 19:1592-1595. [PMID: 38322233 PMCID: PMC10844883 DOI: 10.1016/j.radcr.2024.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/11/2024] [Accepted: 01/16/2024] [Indexed: 02/08/2024] Open
Abstract
Osteomyelitis of the ischiopubic synchondrosis is an uncommon condition with high morbidity rates that present with nonspecific symptoms in the pediatric population. In this article, we report a case of a 10-year-old female who presented with right hip pain and fever following a trivial trauma. Laboratory tests revealed leukocytosis and elevated inflammatory markers. Despite negative blood culture and deceptively normal plain radiographs, magnetic resonance imaging demonstrated osteomyelitis of the ischiopubic synchondrosis with intra-osseous and intra-muscular abscess which was managed surgically by incision and drainage. We highlight the clinical importance of familiarity with such uncommon condition and the role of early magnetic resonance imaging in establishing the diagnosis to facilitate prompt surgical intervention.
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Affiliation(s)
- Huda AlSahlawi
- Arab Board of Radiology, Diagnostic Radiology Chief, Salmaniya Medical Complex, Road No 2904, Manama, Bahrain
| | - Noor Shamlooh
- Saudi Board of Radiology, Diagnostic Radiology Specialist, Salmaniya Medical Complex, Road No 2904, Manama, Bahrain
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3
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Stephan AM, Platt S, Levine DA, Qiu Y, Buchhalter L, Lyons TW, Gaines N, Cruz AT, Sudanagunta S, Hardee IJ, Eisenberg JR, Tamas V, McAneney C, Chinta SS, Yeung C, Root JM, Fant C, Dunnick J, Pifko E, Campbell C, Bruce M, Srivastava G, Pruitt CM, Hueschen LA, Ugalde IT, Becker C, Granda E, Klein EJ, Kaplan RL. A Novel Risk Score to Guide the Evaluation of Acute Hematogenous Osteomyelitis in Children. Pediatrics 2024; 153:e2023063153. [PMID: 38239108 DOI: 10.1542/peds.2023-063153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 02/02/2024] Open
Abstract
OBJECTIVES To identify independent predictors of and derive a risk score for acute hematogenous osteomyelitis (AHO) in children. METHODS We conducted a retrospective matched case-control study of children >90 days to <18 years of age undergoing evaluation for a suspected musculoskeletal (MSK) infection from 2017 to 2019 at 23 pediatric emergency departments (EDs) affiliated with the Pediatric Emergency Medicine Collaborative Research Committee. Cases were identified by diagnosis codes and confirmed by chart review to meet accepted diagnostic criteria for AHO. Controls included patients who underwent laboratory and imaging tests to evaluate for a suspected MSK infection and received an alternate final diagnosis. RESULTS We identified 1135 cases of AHO matched to 2270 controls. Multivariable logistic regression identified 10 clinical and laboratory factors independently associated with AHO. We derived a 4-point risk score for AHO using (1) duration of illness >3 days, (2) history of fever or highest ED temperature ≥38°C, (3) C-reactive protein >2.0 mg/dL, and (4) erythrocyte sedimentation rate >25 mm per hour (area under the curve: 0.892, 95% confidence interval [CI]: 0.881 to 0.901). Choosing to pursue definitive diagnostics for AHO when 3 or more factors are present maximizes diagnostic accuracy at 84% (95% CI: 82% to 85%), whereas children with 0 factors present are highly unlikely to have AHO (sensitivity: 0.99, 95% CI: 0.98 to 1.00). CONCLUSIONS We identified 10 predictors for AHO in children undergoing evaluation for a suspected MSK infection in the pediatric ED and derived a novel 4-point risk score to guide clinical decision-making.
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Affiliation(s)
| | - Shari Platt
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine
| | - Deborah A Levine
- Division of Pediatric Emergency Medicine, Departments of Emergency Medicine
| | - Yuqing Qiu
- Population Health Sciences, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Lillian Buchhalter
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Nakia Gaines
- Division of Pediatric Emergency Medicine, University of Texas Southwestern, Children's Medical Center Dallas, Dallas, Texas
| | - Andrea T Cruz
- Divisions of Emergency Medicine and Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Sindhu Sudanagunta
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Isabel J Hardee
- Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Jonathan R Eisenberg
- Division of Pediatric Emergency Medicine, Primary Children's Hospital, University of Utah, Salt Lake City, Utah
| | - Vanessa Tamas
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of California San Diego, Rady Children's Hospital San Diego, San Diego, California
| | - Constance McAneney
- Department of Pediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Sri S Chinta
- Department of Pediatrics, Division of Emergency Medicine, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Claudia Yeung
- Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Jeremy M Root
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia
| | - Colleen Fant
- Department of Pediatrics, Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jennifer Dunnick
- Division of Pediatric Emergency Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elysha Pifko
- Division of Emergency Medicine, Nemours Children's Hospital of Delaware, Wilmington, Delaware
| | - Christine Campbell
- Division of Pediatric Emergency Medicine, Children's of Alabama, University of Alabama at Birmingham, Birmingham, Alabama
| | - Madison Bruce
- University of Alabama at Birmingham, Heersink School of Medicine, Birmingham, Alabama
| | | | - Christopher M Pruitt
- Department of Pediatrics, Division of Emergency Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Leslie A Hueschen
- Division of Pediatric Emergency Medicine, Children Mercy Hospital, University of Missouri-Kansas City, Kansas City, Missouri
| | - Irma T Ugalde
- Division of Emergency Medicine, McGovern, Utah Health, Houston, Texas
| | - Callie Becker
- Division of Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Elena Granda
- Department of Pediatrics, Rio Hortega University Hospital, Valladolid, Spain
| | - Eileen J Klein
- Division of Emergency Medicine, University Department of Pediatrics, Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Ron L Kaplan
- Division of Emergency Medicine, University Department of Pediatrics, Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington
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Kraicer-Melamed H, Latchman A, Howson-Jan BA. Asymétrie du mouvement brachial chez un nourrisson de 10 jours. CMAJ 2023; 195:E1736-E1737. [PMID: 38110213 PMCID: PMC10727786 DOI: 10.1503/cmaj.230014-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Affiliation(s)
- Hannah Kraicer-Melamed
- Départment de pédiatrie (Kraicer-Melamed), Faculté de médecine, Université de la Colombie-Britannique, Vancouver, C.-B.; Département de pédiatrie (Latchman, Howson-Jan), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont
| | - Andrew Latchman
- Départment de pédiatrie (Kraicer-Melamed), Faculté de médecine, Université de la Colombie-Britannique, Vancouver, C.-B.; Département de pédiatrie (Latchman, Howson-Jan), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont
| | - Brittany Anne Howson-Jan
- Départment de pédiatrie (Kraicer-Melamed), Faculté de médecine, Université de la Colombie-Britannique, Vancouver, C.-B.; Département de pédiatrie (Latchman, Howson-Jan), Faculté des sciences de la santé, Université McMaster, Hamilton, Ont.
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Loro A, Fulvio F, Alt V. Treatment of bone infections in children in low-income countries - A practical guideline based on clinical cases. Injury 2023; 54:111066. [PMID: 37856924 DOI: 10.1016/j.injury.2023.111066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 09/24/2023] [Indexed: 10/21/2023]
Abstract
In low-income countries (LIC), the management of bone infections is a huge challenge. A high number of patients are in the pediatric age group. Children and adolescents exhibit good bone healing potential offering treatment options that mainly rely on the biological response of the infected bone. The purpose of this article is to highlight treatment options for these patients in LIC, which is based on clinical cases that illustrate the principles of the treatment, focusing on bone reaction and healing potential. First, identification of emergency cases is of importance. Sepsis of the patient due to bone infections is a life-threatening disease that requires immediate surgical attention with abscess incision. It should be tailored to the surgeon's experience and local conditions to avoid unwanted complications, such as excessive bleeding, fracture or bone loss. In non-septic patients, uncomplicated cases should be distinguished from complicated cases as the first might often require only abscess incision, particularly in small children, without any other major surgical intervention. Biomechanical stability and bone formation capacity, soft tissue conditions and joint involvement are decisive factors differentiating uncomplicated from complicated cases. Central treatment column is the immobilization of the infected bone with simple methods, such as plaster of Paris, braces or external fixation. This is intended to provide sufficient stability to allow for new bone formation that subsequently downsizes the infection site and that can bridge previously infected non-union sites or bone defects. In most cases, antibiotic treatment is not performed as antibiotics are not available or affordable. Severe soft tissue defects remain a major challenge as microvascular surgical experience is often required for reliable coverage, for which referral to one of the very few specialized centers is recommended. Major bone defects should also be treated in centers with sufficient expertise for bone reconstruction procedures. Regular follow-ups are important to ensure healing and to avoid aggravation of the disease. Encouraging success rates can be achieved by these treatment principles. However, it should not be forgotten that poverty in these countries, including limited access to health care, remains one of the world's most important problems.
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Affiliation(s)
- Antonio Loro
- Orthopedic Department, CoRSU Rehabilitation Hospital, Kisubi, Uganda
| | | | - Volker Alt
- Department of Trauma Surgery, University Hospital Regensburg, Regensburg, Germany.
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Kraicer-Melamed H, Latchman A, Howson-Jan BA. A 10-day-old infant with asymmetric arm movement. CMAJ 2023; 195:E1444-E1445. [PMID: 37903519 PMCID: PMC10615341 DOI: 10.1503/cmaj.230014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Affiliation(s)
- Hannah Kraicer-Melamed
- Department of Paediatrics (Kraicer-Melamed), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Paediatrics (Latchman, Howson-Jan), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Andrew Latchman
- Department of Paediatrics (Kraicer-Melamed), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Paediatrics (Latchman, Howson-Jan), Faculty of Health Sciences, McMaster University, Hamilton, Ont
| | - Brittany Anne Howson-Jan
- Department of Paediatrics (Kraicer-Melamed), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Paediatrics (Latchman, Howson-Jan), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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7
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Liu D, Rehemutula A, Si Y, Zhou H, Li J, Chen Z, Li L. Clinical study of drug-loaded calcium sulfate in the treatment of hematogenous osteomyelitis in children. BMC Musculoskelet Disord 2023; 24:822. [PMID: 37848868 PMCID: PMC10580590 DOI: 10.1186/s12891-023-06948-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/08/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND At present, good results have been obtained in the treatment of hematogenous osteomyelitis(HO) in children by the use of drug-loaded calcium sulfate, but there are few clinical studies reported. The aim of this study was to investigate the clinical efficacy of radical debridement combined with drug-laden calcium sulphate antibiotics in paediatric haematogenous osteomyelitis. METHODS In this study, we retrospectively analyzed the clinical data of 15 cases of pediatric hematogenous osteomyelitis admitted to our hospital in recent years. A total of 15 pediatric patients with HO treated in our hospital from January 2018 to February 2022 were included for evaluation. RESULTS All 15 patients were treated with drug-laden calcium sulfate, and the antibiotic of choice was vancomycin in 14 cases and vancomycin combined with gentamicin in 1 case. The follow-up period ranged from 12 to 36 months, with a mean follow-up time of 24.73 months, and all children were treated with drug-laden calcium sulfate with satisfactory clinical outcomes. The results of serological examination showed that the preoperative white blood cell count level, C-reactive protein and erythrocyte sedimentation rate were higher than the postoperative ones, and the differences were statistically significant (P < 0.05).After the operation, referring to the treatment standard of McKee's osteomyelitis, 15 cases were cured without recurrence; According to the Lower Extremities Functional Scale, 12 cases were excellent, 2 cases were good and 1 case was moderate, with an excellent rate of 93.33%. Children with lower limb involvement could walk with full weight bearing, and gait was basically normal. CONCLUSION Drug-loaded calcium sulfate is a good therapeutic method for the treatment of hematogenous osteomyelitis in children, with a effect of reducing complications and reducing recurrence.
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Affiliation(s)
- Dun Liu
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Aierken Rehemutula
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yu Si
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Hongyu Zhou
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jingyang Li
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Zihao Chen
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Li Li
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, The Fourth Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China.
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8
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He Y, Liu S, Su Y. Risk factors of deep vein thrombosis in children with osteomyelitis. Ann Med 2023; 55:2249011. [PMID: 37624766 PMCID: PMC10494723 DOI: 10.1080/07853890.2023.2249011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early detection and treatment of DVT. STUDY DESIGN The clinical data of nine children diagnosed with osteomyelitis and DVT between July 2012 and March 2021 were collected at our hospital, including age, sex, clinical manifestations, body temperature, coagulation function and other data, as well as the clinical data of 27 children diagnosed with osteomyelitis without DVT during the same period. Thirty-six children were divided into thrombus and thrombus-free groups. The clinical characteristics and risk factors for DVT in children with osteomyelitis were analysed. RESULTS Among the 36 children in this study, nine cases of thrombus formation mainly occurred in the femoral vein, popliteal vein and iliac vein, all near the infection site. The main clinical manifestations were lower extremity pain, swelling and pulmonary embolism in three cases. Among them, intensive care unit (ICU) admission, sepsis, higher D-dimer, higher body temperature during hospitalization, and pathogen culture showed that methicillin-resistant Staphylococcus aureus (MRSA) was associated with DVT. MRSA was the independent risk factor for DVT. CONCLUSIONS Admission to ICU, sepsis, higher D-dimer, higher body temperature during hospitalization, and MRSA are risk factors for thrombosis. MRSA is the independent risk factor for DVT. For patients with related risk factors, timely ultrasound examination of the infected site should be considered to achieve early detection and treatment.
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Affiliation(s)
- Yunjian He
- Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Shaoshan Liu
- Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxi Su
- Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Chongqing, China
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Jiamton C, Apivatgaroon A, Aunaramwat S, Chawalitrujiwong B, Chuaychoosakoon C, Suwannaphisit S, Jirawison C, Iamsumang C, Kongmalai P, Sukvanich P, Nakorn PN, Ongbumrungphan W, Rattanasumrit P, Tharakulphan S, Thongtanworapat T, Thammarakcharoen F, Srion A, Suwanprateeb J, Chernchujit B. Efficacy and Safety of Antibiotic Impregnated Microporous Nanohydroxyapatite Beads for Chronic Osteomyelitis Treatment: A Multicenter, Open-Label, Prospective Cohort Study. Antibiotics (Basel) 2023; 12:1049. [PMID: 37370370 DOI: 10.3390/antibiotics12061049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Chronic osteomyelitis is still a serious health problem that causes disabling conditions and has an impact on the quality of life. The objective of this study was to determine the clinical efficacy and safety of localized antibiotics delivery via impregnated microporous nanohydroxyapatite (nHA-ATB) beads for chronic osteomyelitis treatment. A total of 62 patients were enrolled in this study. After radical surgical debridement, the bone defect was filled with three types of antibiotics (vancomycin or gentamicin or fosfomycin) impregnated HA beads. The follow-up period was 48 weeks. It was found that the success rate was approximately 98% with a re-infection in only one patient. Quality of life of all patients after treatment improved significantly over time. Systemic exposure to vancomycin and gentamicin after beads implantation was limited and high local antibiotics concentrations were found in wound drainage fluid at 24, 48 and 72 h. Blood biochemistry measurements did not show any nephrotoxic or hepatotoxic effects. 20 adverse events were reported, but 90% of the events were resolved without having to remove the beads and the patients recovered. Satisfactory outcomes were observed in terms of success rate, quality of life and adverse effect. nHA-ATB beads impregnated by vancomycin or gentamicin or fosfomycin could potentially be employed as an alternative product of choice for localized antibiotics delivery in chronic osteomyelitis treatment.
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Affiliation(s)
- Chittawee Jiamton
- Institute of Orthopaedics, Lerdsin Hospital, Silom Road, Bang Rak, Bangkok 10500, Thailand
- Queen Savang Vadhana Memorial Hospital, Jerm Jom Phon Road, Tambon Si Racha, Si Racha, Chonburi 20110, Thailand
| | - Adinun Apivatgaroon
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Paholyothin Road, Klong Nueng, Klong Luang, Pathum Thani 12121, Thailand
| | - Saree Aunaramwat
- Paholpolpayuhasena Hospital, Sangchuto Road, Pak Phraek, Mueang, Kanchanaburi 71000, Thailand
| | - Banchai Chawalitrujiwong
- Suppasitthiprasong Hospital, Sappasit Road, Nai Mueang, Mueang, Ubon Ratchathani 34000, Thailand
| | - Chaiwat Chuaychoosakoon
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Karnjanavanich Road, Kho Hong, Hat Yai, Songkhla 90110, Thailand
| | - Sitthiphong Suwannaphisit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Karnjanavanich Road, Kho Hong, Hat Yai, Songkhla 90110, Thailand
| | - Choen Jirawison
- Bhudasothon Hospital, Marupong Road, Na Mueang, Mueang, Chachoengsao 24000, Thailand
| | | | - Pinkawas Kongmalai
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Rangsit-Nakhon Nayok Road, Baan na, Ongkharak, Nakhon Nayok 26120, Thailand
| | - Pawaris Sukvanich
- Department of Orthopedics, Faculty of Medicine, Srinakharinwirot University, Rangsit-Nakhon Nayok Road, Baan na, Ongkharak, Nakhon Nayok 26120, Thailand
| | - Pongtep Na Nakorn
- Hatyai Hospital, Ratthakan, Tambon Hat Yai, Hat Yai, Songkhla 90110, Thailand
| | | | - Pawin Rattanasumrit
- Bhumibol Adulyadej Hospital, Phahonyothin Road, Sai Mai, Bangkok 10220, Thailand
| | - Suthee Tharakulphan
- Khon Kaen Hospital, Sri Chant Road, Nai Mueang, Mueang, Khon Kaen 40000, Thailand
| | | | - Faungchat Thammarakcharoen
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), 111 Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - Autcharaporn Srion
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), 111 Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
| | - Jintamai Suwanprateeb
- National Metal and Materials Technology Center (MTEC), National Science and Technology Development Agency (NSTDA), 111 Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani 12120, Thailand
- Thammasat University Center of Excellence in Computational Mechanics and Medical Engineering, Thammasat University, Phahonyothin Road, Khlong Nueng, Khlong Luang, Pathum Thani 12121, Thailand
| | - Bancha Chernchujit
- Department of Orthopaedics, Faculty of Medicine, Thammasat University, Paholyothin Road, Klong Nueng, Klong Luang, Pathum Thani 12121, Thailand
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Abstract
PURPOSE OF REVIEW The aim of this article is to review the recent guidelines and literature regarding the diagnosis and the treatment of common pediatric musculoskeletal infections: septic arthritis, osteomyelitis, pyomyositis, and Lyme disease. RECENT FINDINGS In the last decade, a better understanding of the causative organisms of common bacterial infections, including Kingella , leads to prompt targeted antimicrobial coverage in all musculoskeletal infections. Prompt diagnosis and treatment continues to be the mainstay in the treatment of children with osteoarticular infections. Efforts to improve early detection have lead to improving rapid lab diagnostic testing; however, more advanced diagnostics such as arthrocentesis for septic arthritis and MRI for osteomyelitis and pyomyositis, remain the gold standard. Shorter and narrowed antibiotic courses, with appropriate transition to outpatient oral treatment provide effective infection clearance and reduction in complications of disease. SUMMARY Advances in diagnostics, including pathogen identification as well as imaging continues to improve our ability to diagnose and treat these infections, although still lack ability to provide definitive diagnosis without more invasive nor advanced techniques.
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Affiliation(s)
- Megan Hannon
- Division of Emergency Medicine
- Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
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11
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Johnson SR, Benvenuti T, Nian H, Thomson IP, Baldwin K, Obremskey WT, Schoenecker JG, Moore-Lotridge SN. Measures of Admission Immunocoagulopathy as an Indicator for In-Hospital Mortality in Patients with Necrotizing Fasciitis: A Retrospective Study. JB JS Open Access 2023; 8:JBJSOA-D-22-00106. [PMID: 36864907 PMCID: PMC9974085 DOI: 10.2106/jbjs.oa.22.00106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Necrotizing fasciitis is a rapidly progressive infection with a high mortality rate. Pathogens evade the host containment and bactericidal mechanisms by hijacking the coagulation and inflammation signaling pathways, leading to their rapid dissemination, thrombosis, organ dysfunction, and death. This study examines the hypothesis that measures of immunocoagulopathy upon admission could aid in the identification of patients with necrotizing fasciitis at high risk for in-hospital mortality. Methods Demographic data, infection characteristics, and laboratory values from 389 confirmed necrotizing fasciitis cases from a single institution were analyzed. A multivariable logistic regression model was built on admission immunocoagulopathy measures (absolute neutrophil, absolute lymphocyte, and platelet counts) and patient age to predict in-hospital mortality. Results The overall in-hospital mortality rate was 19.8% for the 389 cases and 14.6% for the 261 cases with complete measures of immunocoagulopathy on admission. A multivariable logistic regression model indicated that platelet count was the most important predictor of mortality, followed by age and absolute neutrophil count. Greater age, higher neutrophil count, and lower platelet count led to significantly higher risk of mortality. The model discriminated well between survivors and non-survivors, with an overfitting-corrected C-index of 0.806. Conclusions This study determined that measures of immunocoagulopathy and patient age at admission effectively prognosticated the in-hospital mortality risk of patients with necrotizing fasciitis. Given the accessibility of neutrophil-to-lymphocyte ratio and platelet count measurements determined from a simple complete blood-cell count with differential, future prospective studies examining the utility of these measures are warranted. Level of Evidence Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | - Teresa Benvenuti
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hui Nian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Isaac P. Thomson
- Division of Infectious Disease, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Keith Baldwin
- Department of Orthopaedics, The Children’s Hospital of Pennsylvania, Philadelphia, Pennsylvania
| | - William T. Obremskey
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G. Schoenecker
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee,Department of Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee,Division of Pediatric Orthopaedics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee,Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee,Email for corresponding author:
| | - Stephanie N. Moore-Lotridge
- Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, Tennessee,Division of Pediatric Orthopaedics, Monroe Carell Jr. Children’s Hospital at Vanderbilt, Nashville, Tennessee,Center for Bone Biology, Vanderbilt University Medical Center, Nashville, Tennessee
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12
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Aguilar-Gómez NE, Merida-Vieyra J, Isunza-Alonso OD, Morales-Pirela MG, Colín-Martínez O, Juárez-Benítez EJ, García de la Puente S, Aquino-Andrade A. Surveillance of osteoarticular infections caused by Staphylococcus aureus in a paediatric hospital in Mexico City. Front Cell Infect Microbiol 2022; 12:999268. [PMID: 36569208 PMCID: PMC9774039 DOI: 10.3389/fcimb.2022.999268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/20/2022] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus is the main aetiologic agent of osteoarticular infections (OAIs) in paediatric patients. The aim of this prospective unicenter study was to describe the phenotypic and genotypic characteristics of S. aureus isolates obtained from OAIs in paediatric patients admitted to tertiary care hospital. Through a surveillance program called OsteoCode, a multidisciplinary team was created and we identified 27 patients with OAIs caused by S. aureus from 2019 to 2021. The susceptibility profile, virulence factors, biofilm formation, pulsed-field gel electrophoresis (PFGE), clonal complex (CC) and sequence type (ST) were determined. In addition, the clinical characteristics and evolution of the patients presented six months after the diagnosis of OAIs were described. Ninety-two percent of the isolates were methicillin-sensitive S. aureus (MSSA). In methicillin-resistant S. aureus (MRSA), SCCmec-II and SCCmec-V were detected. The pvl gene was only observed in MSSA (18.5%) and was associated with highest fever (p=0.015), multiple localization (p=0.017), and soft tissue sites of infection beyond the bone (pyomyositis, pulmonary abscess) (p=0.017). Biofilm formation was detected in 55.6% of isolates. The most common CC were CC5 and CC30 which represent the most common linages for bone and joint infections worldwide. The isolates were distributed in different STs, and ST672 was predominant. MRSA were associated with a longer duration of intravenous treatment and a prolonged hospital stay (p=0.023). Recurrent infection occurred in five children and orthopaedic complications in 33.3% of patients. This is the first study that reflects the epidemiology of S. aureus in OAIs in paediatric patients in Mexico; a clear predominance of MSSA distributed in different STs was observed. Our findings highlight that a multidisciplinary team is required for the diagnosis and treatment of OAIs.
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Affiliation(s)
| | - Jocelin Merida-Vieyra
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Oscar Colín-Martínez
- Department of Orthopaedic Surgery, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Alejandra Aquino-Andrade
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico,*Correspondence: Alejandra Aquino-Andrade,
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13
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Jafari K, Woodward GA. Fever and Knee Effusion in the Pediatric Patient. Pediatr Emerg Care 2022; 38:555-561. [PMID: 36173430 DOI: 10.1097/pec.0000000000002839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The pediatric patient with fever and knee effusion is always a cause for clinical concern. A thorough history and physical examination is required to guide appropriate diagnostic evaluation and management. Although pediatric knee effusions are common in the setting of trauma, the presence of fever should prompt consideration of infectious, rheumatologic, vasculitic, and malignant etiologies. This review covers the key components of the history, physical examination, diagnostic strategies, common etiologies, and initial management of the pediatric patient with fever and knee effusion.
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Affiliation(s)
- Kaileen Jafari
- From the Senior Fellow (PEM faculty as of February 2022), Division of Emergency Medicine, University of Washington Department of Pediatrics, Seattle Children's Hospital
| | - George A Woodward
- Chief, Division of Emergency Medicine, Professor, University of Washington Department of Pediatrics, Seattle Children's Hospital, Seattle, WA
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14
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Krzysztofiak A, Roversi M, Musolino A, Cirillo M, Toniolo RM, Mazza O, Gargiullo L, Lancella L, Rossi P, Villani A. Clinical report and predictors of sequelae of 319 cases of pediatric bacterial osteomyelitis. Sci Rep 2022; 12:14846. [PMID: 36050441 PMCID: PMC9437046 DOI: 10.1038/s41598-022-19208-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
Pediatric osteomyelitis is an insidious disease that can lead to permanent sequelae, the management of which still relies on lengthy intravenous antibiotic therapy. The purpose of this study is to report and describe the clinical course and outcome of pediatric bacterial osteomyelitis in our experience. We reported the clinical, diagnostic, and treatment characteristics of all cases of osteomyelitis in children younger than 18 years of age who were hospitalized between January 2010 and December 2021 at the Bambino Gesù Children’s Hospital in Rome, Italy, we compared patients with and without complications at follow-up, to identify any predictive factor for sequelae. The study sample included 319 cases of pediatric bacterial osteomyelitis. The median age was 7.77 years. Males (60.8%) were more affected than females. The most affected bones were the femur, tibia, and spine. Etiology was identified in 40.1% of cases, with S.aureus as the most common causative agent. Sequelae were reported in 43 cases (13.5%). The main predictors of sequelae were sepsis on admission and hypergammaglobulinemia. Our results show that a severe presentation with sepsis and hypergammaglobulinemia on admission may be associated with a higher frequency of late sequelae. Early recognition and aggressive treatment of this subgroup of patients may lead to a reduction in complications.
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Affiliation(s)
- Andrzej Krzysztofiak
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of Rome Tor Vergata, Rome, Italy
| | - Antonio Musolino
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of Rome Tor Vergata, Rome, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Renato Maria Toniolo
- Traumatology Unit, Surgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Osvaldo Mazza
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Livia Gargiullo
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Pediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Rossi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,University of Rome Tor Vergata, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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15
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Xia Y, Deng C, Zhou Y, Wu D, Liu Z, Xie L, E B, Han J, You C. Effects of prophylactic antibiotic administration and antibiotic timing on culture results and clinical outcomes of paediatric musculoskeletal infection: a protocol for a randomised controlled clinical trial. BMJ Open 2022; 12:e053568. [PMID: 35840306 PMCID: PMC9295648 DOI: 10.1136/bmjopen-2021-053568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Musculoskeletal infection (MSI) is a common cause of morbidity among the paediatric population. Some clinicians recommend withholding prophylactic antibiotics until culture collection with an aim to improve the culture sensitivity. However, a recent retrospective study reported that prophylactic antibiotic administration did not affect culture sensitivities in either disseminated or local MSI in paediatric population, which is surprising. The aim of the present study is to investigate the effects of prophylactic antibiotic administration and the timing of antibiotic administration on culture sensitivity and clinical outcomes of paediatric MSI. METHODS AND ANALYSIS A randomised controlled clinical trial will be carried out. Individuals aged 0-18 years with a diagnosis of MSI will be screened and evaluated at the Shenzhen Children's Hospital. The participants will be randomly allocated into four groups, and they will receive the antibiotic treatment at different time points, that is, 1 week, 3 days, 1 day prior to tissue culture collection and 1 day after tissue culture collection, respectively. The primary outcome will be culture sensitivity. In addition, the disease-related markers including white blood cell count, C reactive protein, erythrocyte sedimentation rate, vital signs as well as the length of hospital stay will be measured or recorded accordingly. Using χ2 tests, the rates of positive cultures will be compared between different groups. Statistical comparisons between the different patient groups regarding the confounding and outcome variables will be conducted using independent t-tests, Mann-Whitney U tests, χ2 tests and Fisher's exact tests as appropriate with the significance level set to 5% (p<0.05). ETHICS AND DISSEMINATION This study has received ethical approval. The findings will be disseminated both in scientific conferences and peer-reviewed journal. TRIAL REGISTRATION NUMBER ChiCTR2100041631.
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Affiliation(s)
- Yongjie Xia
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Chao Deng
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Yibiao Zhou
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Dechao Wu
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Zhiyong Liu
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Liangfu Xie
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Bing E
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Jingming Han
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
| | - Chao You
- Department of Orthopedic, Shenzhen Children's Hospital, Shenzhen, China
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16
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Chida R, Iio K, Ishida Y. Erythema on both the dorsal and plantar foot surfaces. Paediatr Child Health 2022; 27:193-194. [DOI: 10.1093/pch/pxac025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 02/10/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rie Chida
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center , Tokyo , Japan
| | - Kazuki Iio
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center , Tokyo , Japan
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children Medical Center , Tokyo , Japan
| | - Yu Ishida
- Department of Pediatrics, Tokyo Medical University Hachioji Medical Center , Tokyo , Japan
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17
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Upasani VV, Burns JD, Bastrom TP, Baldwin KD, Schoenecker JG, Shore BJ. Practice Variation in the Surgical Management of Children With Acute Hematogenous Osteomyelitis. J Pediatr Orthop 2022; 42:e520-e525. [PMID: 35220335 DOI: 10.1097/bpo.0000000000002123] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The surgical indications to manage children with acute hematogenous osteomyelitis (AHO) remain poorly defined. The purpose of this study was to identify if practice pattern variation exists in the surgical management of pediatric AHO among tertiary pediatric medical centers across the United States. A secondary purpose was to evaluate variables that may impact the rate of surgical intervention among these institutions. METHODS Children with AHO were retrospectively analyzed between January 1, 2010, and December 31, 2016, from 18 pediatric medical centers throughout the United States. The rates of surgery were identified. Admission vitals, labs, weight-bearing status, length of stay, and readmission rates were compared between those who did and did not undergo surgery. Multivariate regression and classification and regression tree analyses were performed to identify the variables that were associated with surgical intervention. RESULTS Of the 1003 children identified with AHO in this retrospective, multicenter database, 619/1003 (62%) were treated surgically. Multivariate analysis revealed institution, inability to ambulate, presence of multifocal infection, elevated admission C-reactive protein, increased admission platelet count, and location of the osteomyelitis were significant predictors of surgery (P<0.01). Patients who underwent surgery were more than twice as likely to have a recurrence or readmission and stayed a median of 2 days longer than those who did not have surgery. In the classification and regression tree analysis, 2 distinct patterns of surgical intervention were identified based on institution, with 12 institutions operating in most cases (72%), regardless of clinical factors. A second cohort of 6 institutions operated less routinely, with 47% receiving surgery overall. At these 6 institutions, patients without multifocal infection only received surgery 26% of the time, which increased to 74% with multifocal infection and admission erythrocyte sedimentation rate >37.5 mm/h. CONCLUSIONS This study is the first to objectively identify significant differences in the rates of surgical management of pediatric AHO across the United States. Variation in the surgical management of AHO appears to be driven primarily based on institutional practice. Twelve institutions operated on 72% of patients, regardless of the severity of disease, indicating that the institution custom or dogma may drive the surgical indications. Six institutions relied more on clinical judgment with significant variability in rates of surgical intervention (26% vs. 74%), depending on the severity of the disease. Surgical intervention is associated with increased recurrence, readmission, and hospital length of stay. As a result of these findings, it is essential to prospectively study the appropriate surgical indications and measure the outcomes in children with pediatric AHO. LEVEL OF EVIDENCE Level III.
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18
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Shet NS, Iyer RS, Chan SS, Baldwin K, Chandra T, Chen J, Cooper ML, Creech CB, Gill AE, Levin TL, Moore MM, Nadel HR, Saidinejad M, Schooler GR, Squires JH, Swenson DW, Rigsby CK. ACR Appropriateness Criteria® Osteomyelitis or Septic Arthritis-Child (Excluding Axial Skeleton). J Am Coll Radiol 2022; 19:S121-S136. [PMID: 35550797 DOI: 10.1016/j.jacr.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Imaging plays an integral role in the evaluation of suspected musculoskeletal infections in children, not only in the accurate identification of infection such as osteomyelitis or septic arthritis, but also in guiding management. Various diagnostic modalities serve different purposes in the assessment of suspected pediatric musculoskeletal infections. The purpose of this document is to provide imaging guidance in the most frequently encountered clinical scenarios in which osteomyelitis and/or septic arthritis are suspected, outside of the axial skeleton. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion.
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Affiliation(s)
- Narendra S Shet
- Children's National Hospital, Washington, District of Columbia.
| | - Ramesh S Iyer
- Panel Chair, Seattle Children's Hospital, Seattle, Washington; and Chair, SPCC (CoPLL)
| | - Sherwin S Chan
- Panel Vice-Chair, Vice Chair of Radiology, Children's Mercy Hospital, Kansas City, Missouri
| | - Keith Baldwin
- Associate Professor, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; American Academy of Orthopaedic Surgeons
| | - Tushar Chandra
- Magnetic Resonance Medical Director, Chief of Research, Chief of Medical Education, Co-director of 3D and Advanced Imaging Lab, Nemours Children's Hospital, Orlando, Florida
| | - Jimmy Chen
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida; American Academy of Pediatrics
| | - Matthew L Cooper
- Pediatric Radiology Division Chief, Radiology Medical Director, Riley Hospital for Children, Indianapolis, Indiana
| | - C Buddy Creech
- Vanderbilt University Medical Center, Nashville, Tennessee; Infectious Diseases Society of America; and President, Pediatric Infectious Diseases Society
| | - Anne E Gill
- Children's Healthcare of Atlanta and Emory University, Atlanta, Georgia
| | - Terry L Levin
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York; Chair ACR Pediatric Practice Parameters
| | - Michael M Moore
- Co-director, Division of Radiology Innovation and Value Enhancement (DRIVE), Penn State Health Children's Hospital, Hershey, Pennsylvania
| | - Helen R Nadel
- Lucile Packard Children's Hospital at Stanford, Stanford, California; Member Committee on Practice Parameters-Pediatric ACR; and Alternate to Senate Stanford University School of Medicine
| | - Mohsen Saidinejad
- UCLA Medical Center, Los Angeles, California; American College of Emergency Physicians; and Director, Institute for Health Services and Outcomes Research-The Lundquist Institute for Biomedical Innovation at Harbor UCLA
| | | | - Judy H Squires
- Chief of Ultrasound; Associate Program Director for Diagnostic Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - David W Swenson
- Alpert Medical School of Brown University, Providence, Rhode Island
| | - Cynthia K Rigsby
- Specialty Chair, Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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19
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Balamohan A, Buchmann RF. Osteomyelitis of the Rib in a Child With Indolent Symptoms. Glob Pediatr Health 2022; 9:2333794X221086583. [PMID: 35400018 PMCID: PMC8990543 DOI: 10.1177/2333794x221086583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/18/2022] [Indexed: 11/15/2022] Open
Abstract
We describe a case of osteomyelitis of the rib caused by methicillin-susceptible Staphylococcus aureus. The patient presented with a subtle, indolent course leading to a suspected 2-year delay in diagnosis. This case highlights that the diagnosis of rib osteomyelitis, which can readily mimic other diagnoses, such as costochondritis, intraabdominal infections, pneumonia, or malignancies warrants a high index of suspicion. Albeit rare, pediatricians should be aware of the possibility of rib osteomyelitis in healthy children to help ensure a prompt diagnosis and appropriate, timely management.
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Affiliation(s)
- Archana Balamohan
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
| | - Robert F Buchmann
- University of Arkansas for Medical Sciences, Little Rock, AR, USA.,Arkansas Children's Hospital, Little Rock, AR, USA
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20
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Global epidemiology of childhood bone and joint infection: a systematic review. Infection 2022; 50:329-341. [DOI: 10.1007/s15010-021-01741-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
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21
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De Marco G, Vazquez O, Gavira N, Ramadani A, Steiger C, Dayer R, Ceroni D. Surgery's role in contemporary osteoarticular infection management. Front Pediatr 2022; 10:1043251. [PMID: 36601031 PMCID: PMC9806351 DOI: 10.3389/fped.2022.1043251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
The treatment paradigm for osteoarticular infections (OAIs) has changed drastically over the past 80 years, from the advent of penicillin to the use of broad-spectrum antibiotics. Before these drugs, surgery was the only available treatment for OAIs; today, antibiotic therapy is considered the primary response to them. As a result, surgical treatment of OAIs is thus far more rarely indicated, sometimes even considered outdated and obsolete. However, long experience has taught us that many OAI contexts can still benefit from surgical management, constituting an essential complement to medical treatment. The present article seeks to contextualize this discussion by providing a chronological review of the surgical treatments used in cases of OAI and describing the quality of evidence supporting their rehabilitation in well-established situations.
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Affiliation(s)
- Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Nathaly Gavira
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Ardian Ramadani
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
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22
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Foong B, Wong KPL, Jeyanthi CJ, Li J, Lim KBL, Tan NWH. Osteomyelitis in Immunocompromised children and neonates, a case series. BMC Pediatr 2021; 21:568. [PMID: 34895166 PMCID: PMC8665553 DOI: 10.1186/s12887-021-03031-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteomyelitis in immunocompromised children can present differently from immunocompetent children and can cause devastating sequelae if treated inadequately. We aim to review the aetiology, clinical profile, treatment and outcomes of immunocompromised children with osteomyelitis. METHODS Retrospective review of all immunocompromised children aged < 16 years and neonates admitted with osteomyelitis in our hospital between January 2000 and January 2017, and referred to the Paediatric Infectious Disease Service. RESULTS Fourteen patients were identified. There were 10 boys (71%), and the median age at admission was 70.5 months (inter-quartile range: 12.3-135.0 months). Causal organisms included, two were Staphylococcus aureus, two were Mycobacterium bovis (BCG), and one each was Mycobacterium tuberculosis, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Burkholderia pseudomallei and Rhizopus sp. One patient had both Clostridium tertium and Clostridium difficile isolated. Treatment involved appropriate antimicrobials for a duration ranging from 6 weeks to 1 year, and surgery in 11 patients (79%). Wherever possible, the patients received treatment for their underlying immunodeficiency. For outcomes, only three patients (21%) recovered completely. Five patients (36%) had poor bone growth, one patient had recurrent discharge from the bone and one patient had palliative care for underlying osteosarcoma. CONCLUSIONS Although uncommon, osteomyelitis in immunocompromised children and neonates can be caused by unusual pathogens, and can occur with devastating effects. Treatment involves prolonged administration of antibiotics and surgery. Immune recovery also seems to be an important factor in bone healing.
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Affiliation(s)
- Bryan Foong
- Singapore General Hospital, Singapore, Singapore.
| | - Kenneth Pak Leung Wong
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Carolin Joseph Jeyanthi
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Deparment of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jiahui Li
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Kevin Boon Leong Lim
- Department of Orthopedic Surgery, KK Women's and Children's Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
| | - Natalie Woon Hui Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Duke-National University of Singapore Medical School, Singapore, Singapore
- Infectious Disease Service, Department of Pediatrics, KK Women's and Children's Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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23
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Butt FE, Lee EY, Chaturvedi A. Pediatric Musculoskeletal Infections: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:165-177. [PMID: 34836563 DOI: 10.1016/j.rcl.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatric musculoskeletal infections often pose a diagnostic challenge due to their frequently vague and nonspecific clinical presentation. Imaging evaluation is a crucial component to diagnostic workup of these entities. Changed epidemiology of these infections over the past 2 decades has resulted in increases in both disease incidence and severity in the pediatric population. Prompt and accurate diagnosis is essential in order to reduce the risk of morbid sequelae, and to optimize patient management. In this article, the unique pathophysiology of musculoskeletal infections and characteristic imaging findings in children compared with adults are reviewed.
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Affiliation(s)
- Frederick E Butt
- Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Apeksha Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
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The Epidemiology of Osteomyelitis in Children. CHILDREN 2021; 8:children8111000. [PMID: 34828711 PMCID: PMC8621985 DOI: 10.3390/children8111000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Pediatric osteomyelitis remains challenging to treat. Detailed epidemiological data are required to estimate future developments. Therefore, we aimed to analyze how the incidence has changed over the last decade depending on age, gender, osteomyelitis subtype, and anatomical localization. Cases were quantified for patients aged 20 years or younger, using yearly reported ICD-10 diagnosis codes from German medical institutions for the time period 2009 to 2019. Incidence rates of osteomyelitis increased by 11.7% from 8.2 cases per 100,000 children in 2009 to 9.2 cases per 100,000 children in 2019. The age-specific incidence rate revealed the highest occurrence of osteomyelitis in patients aged 10–15 years (15.3/100,000 children), which increased by 23% over the observation period, followed by the age group 5–10 years (9.7/100,000 children). In 2019, out of all diagnoses, 39.2% were classified as acute, 38.4% as chronic, and 22.4% were unspecified, whereby chronic cases increased by 38.7%. The lower extremity was mainly affected, with 58.9% of osteomyelitis diagnoses in 2019. In conclusion, pediatric osteomyelitis is a serious issue, even in a developed and industrialized country such as Germany. Considering the recent incidence increase, the permanent need for appropriate treatment should let pediatricians and orthopedic surgeons deal with diagnosis and treatment protocols.
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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26
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Woods CR, Bradley JS, Chatterjee A, Copley LA, Robinson J, Kronman MP, Arrieta A, Fowler SL, Harrison C, Carrillo-Marquez MA, Arnold SR, Eppes SC, Stadler LP, Allen CH, Mazur LJ, Creech CB, Shah SS, Zaoutis T, Feldman DS, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. J Pediatric Infect Dis Soc 2021; 10:801-844. [PMID: 34350458 DOI: 10.1093/jpids/piab027] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute hematogenous osteomyelitis (AHO) in children was developed by a multidisciplinary panel representing Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with AHO, including specialists in pediatric infectious diseases, orthopedics, emergency care physicians, hospitalists, and any clinicians and healthcare providers caring for these patients. The panel's recommendations for the diagnosis and treatment of AHO are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of AHO in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - John S Bradley
- Division of Infectious Diseases, University of California San Diego School of Medicine, and Rady Children's Hospital, San Diego, California, USA
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew P Kronman
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA
| | - Antonio Arrieta
- University of California Irvine School of Medicine and Children's Hospital of Orange County, Irvine, California, USA
| | - Sandra L Fowler
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stephen C Eppes
- Department of Pediatrics, ChristianaCare, Newark, Delaware, USA
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky, USA
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA
| | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Feldman
- New York University Langone Medical Center, New York, New York, USA
| | - Valéry Lavergne
- Department of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of Montreal Research Center, Montreal, Quebec, Canada
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Qin CH, Tao R, Luo JW, Hong L, Xu L, Fang J, Zhou CH. Culture-negative chronic hematogenous osteomyelitis in a two months old girl: a case report. BMC Musculoskelet Disord 2021; 22:679. [PMID: 34380448 PMCID: PMC8359591 DOI: 10.1186/s12891-021-04547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 07/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background Previous articles have focused on the diagnosis and treatment of acute hematogenous osteomyelitis. Here, we present a case of chronic hematogenous osteomyelitis in a 2-month-old girl. The diagnostic procedure was unusual and difficult due to negative culture results. Case presentation A girl aged 2 months and 23 days had fever and swelling in her right lower leg for 7 days. On the basis of her medical history, physical, and histological examination results; and radiologic and magnetic resonance imaging findings, a diagnosis of chronic osteomyelitis was made. The patient underwent surgical treatment and was discharged successfully. The patient showed good recovery and no sequelae at the 12-month follow-up. Conclusion Hematogenous osteomyelitis in babyhood is different from that at any other age. Hematogenous osteomyelitis-related bone destruction in babyhood is more serious and occurs faster. The transition from acute hematogenous osteomyelitis to chronic hematogenous osteomyelitis takes only 7 days. To the best of our knowledge, this chronic hematogenous osteomyelitis patient is the youngest ever reported.
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Affiliation(s)
- Cheng-He Qin
- Department of Orthopaedics and Traumatology, Southern Medical University Nanfang Hospital, No. 1838, Guangzhou Ave. North, Guangzhou, Guangdong, 510515, People's Republic of China.
| | - Rui Tao
- Department of Orthopaedics, Southern Medical University Zengcheng branch of Nanfang Hospital, No. 28, Chuangxin avenue, Yongning Street, Zengcheng District, Guangzhou, 511340, People's Republic of China
| | - Ji-Wei Luo
- Department of Orthopaedics, Southern Medical University Zengcheng branch of Nanfang Hospital, No. 28, Chuangxin avenue, Yongning Street, Zengcheng District, Guangzhou, 511340, People's Republic of China
| | - Liang Hong
- Department of Orthopaedics, Southern Medical University Zengcheng branch of Nanfang Hospital, No. 28, Chuangxin avenue, Yongning Street, Zengcheng District, Guangzhou, 511340, People's Republic of China
| | - Lei Xu
- Department of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, Guangzhou, 510317, People's Republic of China
| | - Jia Fang
- Department of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, the Second Clinical Medical School of Southern Medical University, Guangzhou, 510317, People's Republic of China
| | - Chun-Hao Zhou
- Department of Orthopaedics and Traumatology, Southern Medical University Nanfang Hospital, No. 1838, Guangzhou Ave. North, Guangzhou, Guangdong, 510515, People's Republic of China
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Radiological changes in the formation of Brodie's abscess by sequential magnetic resonance imaging: a case report. Radiol Case Rep 2021; 16:2993-2997. [PMID: 34401040 PMCID: PMC8353412 DOI: 10.1016/j.radcr.2021.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/30/2021] [Accepted: 07/01/2021] [Indexed: 11/24/2022] Open
Abstract
Brodie's abscess is a relatively rare subacute form of osteomyelitis. Early diagnosis is challenging because of its insidious onset and vague symptoms. Magnetic resonance imaging is helpful in the diagnosis of Brodie's abscess; however, to date, no study has described the imaging findings of this disease in the early stage. Here, we present the case of a 14 year-old boy with Brodie's abscess in the proximal tibia. The lesion initially presented as a bone marrow edema in the proximal metaphysis of the left tibia on MRI and was misinterpreted as a bone bruise. Further radiological examination was performed 1 month later; this revealed the formation of an abscess cavity, which suggested Brodie's abscess. The patient was referred to our hospital and underwent curettage and debridement, which led to the definitive diagnosis of Brodie's abscess on histopathological findings and bacterial culture. On careful retrospective evaluation, the initial radiological findings suggested a microabscess on the metaphyseal side of the growth plate and bone marrow edema spreading from the lesion to the epiphysis. These radiological changes could be reliable evidence proving that the metaphyseal side of the growth plate is the origin of Brodie's abscess. Moreover, bone marrow edema with suspected microabscess in the metaphysis of the long bones can be the initial stage of the formation of Brodie's abscess and should be carefully followed up.
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Kokkonen M, Syvänen J, Raitio A, Ivaska L, Peltola V, Helenius I. Fusobacterial Pelvic Osteomyelitis with Brodie's Abscess in a 10-Year-Old Boy Requiring Surgical Evacuation: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00043. [PMID: 34297705 DOI: 10.2106/jbjs.cc.21.00101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE A 10-year-old boy presented with pain in the lateral hip and buttock area and fever. Magnetic resonance imaging revealed osteomyelitis of the pelvis with extensive Brodie's abscess (2.6 × 4.5 × 10.0 cm) continuing into the pelvic cavity. Surgical evacuation through the ilioinguinal approach was performed. In prolonged culture and in polymerase chain reaction of pus, the Fusobacterium nucleatum was found. CONCLUSION Pelvic osteomyelitis caused by Fusobacterium is very rare. In this case, surgical treatment was required after conservative treatment with antibiotics was ineffective.
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Affiliation(s)
- Miina Kokkonen
- Department of Pediatric Surgery and Orthopaedics, University of Turku and Turku University Hospital, Turku, Finland
| | - Johanna Syvänen
- Department of Pediatric Surgery and Orthopaedics, University of Turku and Turku University Hospital, Turku, Finland
| | - Arimatias Raitio
- Department of Pediatric Surgery and Orthopaedics, University of Turku and Turku University Hospital, Turku, Finland
| | - Lauri Ivaska
- Department of Pediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Ville Peltola
- Department of Pediatrics and Adolescent Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Ilkka Helenius
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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30
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Walter N, Baertl S, Alt V, Rupp M. What is the burden of osteomyelitis in Germany? An analysis of inpatient data from 2008 through 2018. BMC Infect Dis 2021; 21:550. [PMID: 34112102 PMCID: PMC8194128 DOI: 10.1186/s12879-021-06274-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/02/2021] [Indexed: 12/19/2022] Open
Abstract
Background The epidemiology of osteomyelitis in Germany is unknown, which makes it difficult to estimate future demands. Therefore, we aimed to analyse how the numbers of cases have developed over the last decade as a function of osteomyelitis subtype, age group, gender, and anatomical localization. Methods Osteomyelitis rates were quantified based on annual ICD-10 diagnosis codes from German medical institutions between 2008 through 2018, provided by the Federal Statistical Office of Germany (Destatis). Results Overall osteomyelitis prevalence increased by 10.44% from 15.5 to 16.7 cases per 100,000 inhabitants between 2008 through 2018. Out of 11,340 cases in 2018, 47.6% were diagnosed as chronic, 33.2% as acute and 19.2% as unspecified osteomyelitis. Men were often affected than women with 63.4% of all cases compared to 36.6%. The largest proportion of patients comprised the age group 60–69 years (22.1%), followed by 70–79 years (21.7%). A trend towards more osteomyelitis diagnoses in older patients was observed. Lower extremities were most frequently infected with 73.8% of all cases in 2018 (+ 10.8% change). Conclusions Osteomyelitis remains a serious problem for orthopedic and trauma surgery. Prevention methods and interdisciplinary approaches are strongly required.
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Affiliation(s)
- Nike Walter
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.,Department for Psychosomatic Medicine, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany
| | - Susanne Baertl
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Volker Alt
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department for Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
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Contemporary clinical isolates of Staphylococcus aureus from pediatric osteomyelitis patients display unique characteristics in a mouse model of hematogenous osteomyelitis. Infect Immun 2021; 89:e0018021. [PMID: 34097469 DOI: 10.1128/iai.00180-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Osteomyelitis can result from the direct inoculation of pathogens into bone during injury or surgery, or from spread via the bloodstream, a condition called hematogenous osteomyelitis (HOM). HOM disproportionally affects children, and more than half of cases are caused by Staphylococcus (S.) aureus. Laboratory models of osteomyelitis mostly utilize direct injection of bacteria into the bone or the implantation of foreign material, and therefore do not directly interrogate the pathogenesis of pediatric hematogenous osteomyelitis. In this study, we inoculated mice intravenously and characterized resultant musculoskeletal infections using two strains isolated from adults (USA300-LAC and NRS384) and five new methicillin-resistant S. aureus isolates from pediatric osteomyelitis patients. All strains were capable of creating stable infections over five weeks, although the incidence varied. Micro-computed tomography (microCT) analysis demonstrated decreases in trabecular bone volume fraction but little effect on bone cortices. Histologic assessment revealed differences in the precise focus of musculoskeletal infection, with varying mixtures of bone-centered osteomyelitis and joint-centered septic arthritis. Whole genome sequencing of three new isolates demonstrated distinct strains, two within the USA300 lineage and one USA100 isolate. Interestingly, this USA100 isolate showed a distinct predilection for septic arthritis, compared to the other isolates tested, including NRS384 and LAC, which more frequently led to osteomyelitis or mixed bone and joint infections. Collectively, these data outline the feasibility of using pediatric osteomyelitis clinical isolates to study the pathogenesis of HOM in murine models and lay the groundwork for future studies investigating strain-dependent differences in musculoskeletal infection.
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Roversi M, Chiappini E, Toniolo RM, Cirillo M, Natale F, Deriu D, Grandin A, Lancella L, Galli L, Villani A, Krzysztofiak A. Neonatal osteomyelitis: an Italian multicentre report of 22 cases and comparison with the inherent literature. J Perinatol 2021; 41:1293-1303. [PMID: 33686117 DOI: 10.1038/s41372-021-00956-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 11/20/2020] [Accepted: 01/21/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The primary objective of this study is to report and compare our data with the most relevant literature of the past decade about neonatal osteomyelitis. STUDY DESIGN We retrospectively review the data of 22 subjects aged 35 days or less who were admitted to three different sites in Italy with a radiological diagnosis of osteomyelitis. The inherent literature was searched and reviewed: five studies were considered for comparison with our data. RESULTS All the neonates, except three (two pre-term and one post-term), were born at term. The male to female ratio was 1.75 (14 males and 8 females). The mean age at presentation was 19.5 days. The most common presenting signs of the infection were local swelling and reduced mobility of the affected segment. The most common sites of infection were the femur, humerus, and tibia. The mean duration of intravenous antibiotic therapy was 29.5 days. In most neonates the diagnosis was prompt and the antibiotic treatment immediate. A low rate of sequelae was reported. All infants survived through follow up. The data from the inherent literature showed a wide variability, probably owing to the setting and the historical period of the different studies. CONCLUSION Neonatal osteomyelitis is an alarming yet poorly understood disease. Nonetheless, our report suggests that a quick diagnosis and treatment can be easily achieved, with good outcome on the remarkably plastic structure of neonatal bones.
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Affiliation(s)
- Marco Roversi
- University of Rome Tor Vergata, Residency School of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Elena Chiappini
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Renato Maria Toniolo
- Department of Orthopaedics and Traumatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Marco Cirillo
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Fabio Natale
- Department of Maternal and Child Health and Urologic Science, "Sapienza" University of Rome, Policlinico Umberto I Hospital, Rome, Italy
| | - Daniele Deriu
- University of Rome Tor Vergata, Residency School of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Annalisa Grandin
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Luisa Galli
- Paediatric Infectious Disease Unit, Anna Meyer Children's University Hospital, Florence, Italy
| | - Alberto Villani
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Furman MS, Restrepo R, Kritsaneepaiboon S, Laya BF, Plut D, Lee EY. Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians. Semin Musculoskelet Radiol 2021; 25:167-175. [PMID: 34020476 DOI: 10.1055/s-0041-1723004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Infants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.
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Affiliation(s)
- Michael S Furman
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island
| | - Ricardo Restrepo
- Interventional Pediatric Radiology and Body Imaging, Division of Radiology, Department of Radiology, Nicklaus Children's Hospital, Miami, Florida
| | - Supika Kritsaneepaiboon
- Section of Pediatric Imaging, Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Bernard F Laya
- Institute of Radiology, Section of Pediatric Radiology, St. Luke's Medical Center-Quezon City, St. Luke's Medical Center College of Medicine - William H. Quasha Memorial, Quezon City, Philippines
| | - Domen Plut
- Division of Pediatric Radiology, Clinical Radiology Institute, University Medical Centre and Faculty of Medicine Ljubljana, Ljubljana, Slovenia
| | - Edward Y Lee
- Division of Thoracic Imaging, Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
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Pediatric Acetabular Osteomyelitis Treated With Hip Arthroscopy. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:e21.00011. [PMID: 33945515 PMCID: PMC8099414 DOI: 10.5435/jaaosglobal-d-21-00011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/18/2021] [Indexed: 11/18/2022]
Abstract
Osteomyelitis of the acetabulum is a rare condition accounting for only 12% of pelvic osteomyelitis cases. This report describes a previously healthy 10-year-old girl with subacute acetabular osteomyelitis and subsequent development of secondary septic arthritis of the hip. The patient presented with 3 weeks of groin pain, elevated erythrocyte sedimentation rate and C-reactive protein, synovial thickening of the hip on ultrasonography and diffuse signal uptake in the acetabulum on magnetic resonance imaging. Despite antibiotic therapy, her symptoms worsened clinically, and repeat Magnetic resonance imaging images showed worsening of the osteomyelitis with likely extension through the acetabulum and into the joint. A hip aspirate was positive for Fusobacterium, an atypical anaerobe. Hip arthroscopy, with identification of the site of extrusion and then extensive débridement and irrigation, was successful in helping to control and ultimately eradicate the infection. The patient regained normal hip function and returned to full activities. This case demonstrates how hip arthroscopy can serve as an important surgical treatment modality for acetabular osteomyelitis with intraarticular extension in addition to septic arthritis of the hip.
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Cain KS, Shetty AK, Strowd L, Sangueza O, Potisek NM. Unremitting Pain and Fever in a 15-Year-Old Boy With Osteomyelitis. Pediatrics 2021; 147:peds.2020-012260. [PMID: 33563770 DOI: 10.1542/peds.2020-012260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/24/2022] Open
Abstract
A previously healthy 15-year-old boy from a rural county in the southeastern United States was evaluated in the emergency department with fever and worsening toe pain in the absence of trauma. He initially presented to his primary care physician 4 weeks before with upper respiratory symptoms and was treated with corticosteroids for presumed reactive airway disease. His respiratory symptoms resolved. One week after this presentation, he developed fever and right great toe pain and presented to an outside hospital. Inflammatory markers were elevated. MRI confirmed a diagnosis of osteomyelitis with associated periosteal abscess. He was treated with intravenous antibiotics and drainage of the abscess. Ten days after his discharge from the outside hospital, he developed fever and had increasing drainage of the toe and pain refractory to oral pain medications. He presented to our facility for further evaluation. Repeat MRI and inflammatory markers corroborated his worsening disease, and he was admitted to the hospital for intravenous antibiotics and underwent serial surgical debridement. He developed painful subcutaneous nodules on his lower extremities and was found to have lung abnormalities on chest radiograph. A multispecialty team collaborated in the management of this patient and unveiled a surprising diagnosis.
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Affiliation(s)
- Kathryn S Cain
- Departments of Pediatrics.,Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina; and
| | - Avinash K Shetty
- Departments of Pediatrics.,Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina; and
| | | | - Omar Sangueza
- Dermatology, and.,Pathology, School of Medicine, Wake Forest University, Winston-Salem, North Carolina
| | - Nicholas M Potisek
- Departments of Pediatrics, .,Brenner Children's Hospital, Wake Forest Baptist Health, Winston-Salem, North Carolina; and.,Department of Pediatrics, Prisma Health Children's Hospital and School of Medicine, University of South Carolina, Greenville, South Carolina
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36
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Hester GZ, Nickel AJ, Watson D, Swanson G, Laine JC, Bergmann KR. Improving Care and Outcomes for Pediatric Musculoskeletal Infections. Pediatrics 2021; 147:peds.2020-0118. [PMID: 33414235 DOI: 10.1542/peds.2020-0118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Pediatric musculoskeletal infection (MSKI) is a common cause of hospitalization with associated morbidity. To improve the care of pediatric MSKI, our objectives were to achieve 3 specific aims within 24 months of our quality improvement (QI) interventions: (1) 50% reduction in peripherally inserted central catheter (PICC) use, (2) 25% reduction in sedations per patient, and (3) 50% reduction in empirical vancomycin administration. METHODS We implemented 4 prospective QI interventions at our tertiary children's hospital: (1) provider education, (2) centralization of admission location, (3) coordination of radiology-orthopedic communication, and (4) implementation of an MSKI infection algorithm and order set. We included patients 6 months to 18 years of age with acute osteomyelitis, septic arthritis, or pyomyositis and excluded patients with complex chronic conditions or ICU admission. We used statistical process control charts to analyze outcomes over 2 general periods: baseline (January 2015-October 17, 2016) and implementation (October 18, 2016-April 2019). RESULTS In total, 224 patients were included. The mean age was 6.1 years, and there were no substantive demographic or clinical differences between baseline and implementation groups. There was an 81% relative reduction in PICC use (centerline shift 54%-11%; 95% confidence interval 70-92) and 33% relative reduction in sedations per patient (centerline shift 1.8-1.2; 95% confidence interval 21-46). Empirical vancomycin use did not change (centerline 20%). CONCLUSIONS Our multidisciplinary MSKI QI interventions were associated with a significant decrease in the use of PICCs and sedations per patient but not empirical vancomycin administration.
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Affiliation(s)
| | - Amanda J Nickel
- Research Institute, Children's Minnesota, Minneapolis, Minnesota; and
| | - David Watson
- Research Institute, Children's Minnesota, Minneapolis, Minnesota; and
| | | | - Jennifer C Laine
- Orthopedic Surgery, and.,Gillette Children's Specialty Healthcare, St Paul, Minnesota
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Andronikou S, Kraft JK, Offiah AC, Jones J, Douis H, Thyagarajan M, Barrera CA, Zouvani A, Ramanan AV. Whole-body MRI in the diagnosis of paediatric CNO/CRMO. Rheumatology (Oxford) 2021; 59:2671-2680. [PMID: 32648576 DOI: 10.1093/rheumatology/keaa303] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/16/2020] [Accepted: 05/02/2020] [Indexed: 11/13/2022] Open
Abstract
Chronic recurrent multifocal osteomyelitis (CRMO) is an auto-inflammatory disorder affecting the skeleton of children and adolescents. Whole-body MRI (WBMRI) is key in the diagnosis and follow-up of CRMO. Imaging protocols should include sagittal short Tau inversion recovery of the spine, imaging of the hands and feet, and T1 images for distinguishing normal bone marrow. CRMO lesions can be metaphyseal, epiphyseal and physeal-potentially causing growth disturbance and deformity. Spinal lesions are common, important and can cause vertebral collapse. Lesion patterns include multifocal tibial and pauci-focal patterns that follow a predictable presentation and course of disease. Common pitfalls of WBMRI include haematopoietic marrow signal, metaphyseal signal early on in bisphosphonate therapy and normal high T2 signal in the hands and feet. Pictorial reporting assists in recording lesions and follow-up over time. The purpose of this paper is to review the different WBMRI protocols, imaging findings, lesion patterns and common pitfalls in children with CRMO.
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Affiliation(s)
- Savvas Andronikou
- Department of Radiology, The Children's Hospital of Philadelphia.,Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeannette K Kraft
- Clarendon Wing Radiology Department, Leeds Children's Hospital at The Leeds General Infirmary, Leeds
| | - Amaka C Offiah
- Department of Radiology, Academic Unit of Child Health, University of Sheffield, Sheffield Children's NHS Foundation Trust, Sheffield.,Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield
| | - Jeremy Jones
- Department of Radiology, Royal Hospital for Sick Children, Edinburgh
| | - Hassan Douis
- Department of Radiology, University Hospital Birmingham NHS Foundation Trust, Birmingham
| | - Manigandan Thyagarajan
- Department of Radiology, Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham
| | | | - Andrea Zouvani
- School of Clinical Sciences, School of Medicine, University of Glasgow, Glasgow
| | - Athimalaipet V Ramanan
- School of Clinical Sciences, Department of Paediatric Rheumatology, Bristol Royal Hospital for Children, UHB Education Centre, Bristol.,School of Clinical Sciences, University of Bristol, Bristol, UK
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38
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Popescu B, Tevanov I, Carp M, Ulici A. Acute hematogenous osteomyelitis in pediatric patients: epidemiology and risk factors of a poor outcome. J Int Med Res 2021; 48:300060520910889. [PMID: 32249643 PMCID: PMC7136940 DOI: 10.1177/0300060520910889] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective Methods Results Conclusions
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Affiliation(s)
- Bogdan Popescu
- Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Iulia Tevanov
- Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Madalina Carp
- Pediatric Orthopedic Surgeon, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania
| | - Alexandru Ulici
- President of the Romanian Pediatric Orthopedic Society, Chief of Surgery, Department of Pediatric Orthopedic Surgery, Emergency Hospital for Children "Grigore Alexandrescu", Bucharest, Romania, Associate Professor at Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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A Comparison of the Epidemiology, Clinical Features, and Treatment of Acute Osteomyelitis in Hospitalized Children in Latvia and Norway. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010036. [PMID: 33406590 PMCID: PMC7824191 DOI: 10.3390/medicina57010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: Paediatric acute osteomyelitis (AO) may result in major life-threatening and limb-threatening complications if not recognized and treated early. The management of AO may depend on local microbial prevalence and virulence factors. This study compares the approach to paediatric AO in hospitals in two countries—Latvia and Norway. Materials and Methods: The study includes patients with AO hospitalized in the paediatric department in the Norwegian hospital Sørlandet Sykehus Kristiansand (SSK), in the period between the 1st of January 2012 and the 31st of December 2019. The results from SSK are compared to the results of a published study of AO in patients hospitalized at the Children’s Clinical University Hospital (CCUH) in Riga, Latvia. Results: The most isolated pathogen from cultures in both hospitals was S. aureus (methicillin-sensitive). The lower extremity was the most affected body part (75% in CCUH, 95% in SSK), the main clinical symptom was pain (CCUH 92%, SSK 96.6%). Deep culture aspiration was most often taken intraoperatively in CCUH (76.6%) and percutaneously in SSK (44.8%). Oxacillin was the most applied antibiotic in CCUH (89.4%), and Cloxacillin in SSK (84.6%). Combined treatment with anti-Staphylococcal penicillins and Clindamycin was administered in 25.5% and 33.8% of CCUH and SSK patients, respectively. The median duration of the intravenous antibacterial treatment in CCUH and SSK was 15 and 10 days, respectively, and a switch to oral therapy was mainly made at discharge in both hospitals. The median total duration of antibiotic treatment was 25 days in CCUH and 35 days in SSK. 75% of CCUH and 10.3% of SSK patients were treated surgically. Complications were seen in 47% of patients in CCUH and in 38% in SSK. Conclusions: The transition to oral antibacterial treatment in both hospitals was delayed, which suggests a lack of criteria for discontinuation of intravenous therapy and could potentially contribute to longer hospitalization, higher cost of treatment and risk of complications. The use of more invasive techniques for deep culturing and significantly more common surgical interventions could possibly be linked to a higher complication rate in AO patients treated at the Latvian hospital.
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Roversi M, Mirra G, Musolino A, Barbuti D, Lancella L, Deriu D, Iorio C, Villani A, Crostelli M, Mazza O, Krzysztofiak A. Spondylodiscitis in Children: A Retrospective Study and Comparison With Non-vertebral Osteomyelitis. Front Pediatr 2021; 9:727031. [PMID: 34746055 PMCID: PMC8567140 DOI: 10.3389/fped.2021.727031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/24/2021] [Indexed: 02/04/2023] Open
Abstract
Objectives: The aim of this study is to provide new data on pediatrics spondylodiscitis for an optimal clinical management of this site-specific osteomyelitis. Methods: We reported 48 cases of pediatric spondylodiscitis and made three comparisons between: (1) tubercular and non-tubercular cases; (2) patients aged more or less than 5 years; (3) children with spondylodiscitis and 62 controls with non-vertebral osteomyelitis. Results: A higher rate of sequelae was reported in patients with tubercular spondylodiscitis, but no significant differences were noted at the cut-off of 5 years of age. Compared to non-vertebral osteomyelitis, pediatric spondylodiscitis affects younger children of both genders, usually presenting with afebrile back pain, and requiring longer time to admission, hospitalization, and antibiotic therapy. Conclusion: Pediatric spondylodiscitis is an insidious disease with a non-specific presentation in childhood and peculiarities of its own. However, when clinical remission is obtained by an early start of broad-spectrum antibiotics, prolonging the therapy does not improve, nor worsens, the outcome. Surgical management is mandatory in case of vertebral instability and neurological signs but can be avoided when the infection is promptly treated with antibiotic therapy.
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Affiliation(s)
- Marco Roversi
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Gianluca Mirra
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Antonio Musolino
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Domenico Barbuti
- Department of Imaging, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Laura Lancella
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Daniele Deriu
- Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Carlo Iorio
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Alberto Villani
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Marco Crostelli
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Osvaldo Mazza
- Spine Surgery Unit, Department of Surgery and Transplantations, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Andrzej Krzysztofiak
- Paediatric and Infectious Disease Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
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McNeil JC. Acute Hematogenous Osteomyelitis in Children: Clinical Presentation and Management. Infect Drug Resist 2020; 13:4459-4473. [PMID: 33364793 PMCID: PMC7751737 DOI: 10.2147/idr.s257517] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022] Open
Abstract
Acute hematogenous osteomyelitis (AHO) is a common invasive infection encountered in the pediatric population. In addition to the acute illness, AHO has the potential to create long-term morbidity and functional limitations. While a number of pathogens may cause AHO, Staphylococcus aureus is the most common organism identified. Despite the frequency of this illness, little high-quality data exist to guide providers in the care of these patients. The literature is reviewed regarding the epidemiology, microbiology and management of AHO in children. A framework for empiric therapy is provided drawing from the available literature and published guidelines.
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Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
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Safdieh G, Silberman J, Nguyen J, Doyle S, Blanco J, Scher D, Green D, Widmann R, Dodwell E. Reply to Letter to the Editor: Pediatric Septic Arthritis and Osteomyelitis in the USA: A National KID Database Analysis. HSS J 2020; 16:500-502. [PMID: 33380987 PMCID: PMC7749880 DOI: 10.1007/s11420-020-09768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 02/07/2023]
Affiliation(s)
| | - Jason Silberman
- grid.62560.370000 0004 0378 8294Brigham and Women’s Hospital and Massachusetts General Hospital, Boston, MA 02114 USA
| | - Joseph Nguyen
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
| | - Shevaun Doyle
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
| | - John Blanco
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
| | - David Scher
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
| | - Daniel Green
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
| | - Roger Widmann
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
| | - Emily Dodwell
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY 10021 USA
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von Heideken J, Bennet R, Eriksson M, Hertting O. A 10-year retrospective survey of acute childhood osteomyelitis in Stockholm, Sweden. J Paediatr Child Health 2020; 56:1912-1917. [PMID: 32779322 DOI: 10.1111/jpc.15077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 06/22/2020] [Accepted: 06/24/2020] [Indexed: 11/30/2022]
Abstract
AIM Children with osteomyelitis present with a range of signs and symptoms and with varying degree of severity. The purpose of this study was to provide data on a population-based 10-year material of children with acute osteomyelitis. METHODS All children, 0-14 years in Stockholm Region with acute osteomyelitis hospitalised in July 2005-June 2015, were retrospectively studied. Time to hospital presentation, disease localization, inflammation markers, imaging procedures, microbiology, severity classified by the presence of complications, surgical procedures, hospital length of stay and seasonal variation were recorded. RESULTS There were 430 children with acute osteomyelitis; 61% were boys. The incidence per 100 000 person-years was 11.6; 9.3 in girls and 13.1 in boys. Median age at admission was 2.9 years with no peak later in childhood. Median time from first symptom to diagnosis was 4 days (range 1-21) and 48% of the cases were localised to femur or tibia. Mean C-reactive protein was 59 mg/L (range 1-376). Blood (n = 82) or tissue cultures (n = 54) were positive in 118 (28%) children. The most common pathogen was Staphylococcus aureus (n = 88) followed by Streptococcus pyogenes (n = 12). Surgery was performed in 71 children (17%). There was no mortality. Severe complications were seen in 14 (3.3%) children, five of whom were admitted to intensive care. Median hospital length of stay was 4 days (range 1-60). CONCLUSIONS Osteomyelitis in children is a diagnostic challenge with a low yield of positive bacterial cultures. Few children with uncomplicated disease need surgery, but the risk of severe complications is not negligible.
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Affiliation(s)
- Johan von Heideken
- Department of Paediatric Orthopaedics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rutger Bennet
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Margareta Eriksson
- Paediatric Infectious Diseases Unit, Department of Paediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.,Paediatric Infectious Diseases Unit, Department of Paediatrics, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
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Michalowitz A, Yang J, Castaneda P, Litrenta J. Existing and emerging methods of diagnosis and monitoring of pediatric musculoskeletal infection. Injury 2020; 51:2110-2117. [PMID: 32732117 DOI: 10.1016/j.injury.2020.06.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 06/03/2020] [Accepted: 06/13/2020] [Indexed: 02/02/2023]
Abstract
Methods of diagnosing and monitoring pediatric musculoskeletal infections are rapidly evolving. Key serologic tests are typically used in screening patients with suspected infections, and remain an integral part of the initial work-up. Synovial studies from arthrocentesis in possible septic arthritis, and source-specific cultures have been the foundation of our treatment algorithm. Given the prevalence of soft tissue abscesses and osteoarticular infections, advanced imaging is an advantageous tool. More affordable use and expanded access to MRI has made it a valuable adjunct to clinical picture and existing tests in order to comprehensively visualize the extent of musculoskeletal infections in children. Ongoing validation for criteria to help determine the patients that stand to benefit the most from MRI, even when surgical intervention may be delayed, remains of significant clinical interest. Given the rates of culture-negative infections, and the need for timely diagnosis, new diagnostic techniques are always being considered. The search for more accurate biomarkers, and technology such as Whole genome sequencing (WGS) and next-generation sequencing (NGS) that can rapidly identify pathogens of all types of phyla based on a small sample of DNA, has promising clinical implications. While once novel and prohibitively expensive, these tests are now being applied in university and tertiary care centers in certain scenarios. Applying these techniques to pediatric musculoskeletal will require a large change in lab workflow and training. However, the benefits of acquiring diagnostic information along with will make them a superior tool in our arsenal of diagnostic tests.
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Affiliation(s)
- Andrew Michalowitz
- NYU Langone Orthopedic Hospital, 301 E. 17th St., New York, NY 10003, United States.
| | - Jenny Yang
- NYU Langone Orthopedic Hospital, 301 E. 17th St., New York, NY 10003, United States.
| | - Pablo Castaneda
- NYU Langone Orthopedic Hospital, 301 E. 17th St., New York, NY 10003, United States.
| | - Jody Litrenta
- NYU Langone Orthopedic Hospital, 301 E. 17th St., New York, NY 10003, United States.
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Cohen LL, Shore BJ, Williams KA, Hedequist DJ, Hresko MT, Emans JB, Karlin LI, Snyder BD, Glotzbecker MP. Diagnosing and treating native spinal and pelvic osteomyelitis in adolescents. Spine Deform 2020; 8:1001-1008. [PMID: 32306283 DOI: 10.1007/s43390-020-00110-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 03/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To describe how pediatric patients with spinal and pelvic osteomyelitis are diagnosed and treated and assess the diagnostic value of magnetic resonance imaging (MRI), needle aspiration biopsy (NAB), and blood cultures in this population. Spinal and pelvic osteomyelitis de novo are uncommon in children and minimal literature exists on the subject. Research has shown that NAB and blood cultures have variable diagnostic yield in adult native osteomyelitis. At our institution, there is no standard protocol for diagnosing and treating pediatric spinal and pelvic osteomyelitis de novo. METHODS All diagnoses of spinal and pelvic osteomyelitis at a pediatric tertiary care center from 2003 to 2017 were reviewed. Patients aged 0-21 at diagnosis were included. Patients with osteomyelitis resulting from prior spinal operations, wounds, or infections and those with chronic recurrent multifocal osteomyelitis were eliminated. All eligible patients' diagnoses were confirmed by MRI. RESULTS 29 patients (18 men, 11 women) met the inclusion criteria. The median age at diagnosis was 11 years old (range 1-18). More than half of all cases (17/29, 59%) affected the lumbar spine. The most common symptoms were back pain (20/29, 69%), fever (18/29, 62%), hip pain (11/29, 38%), and leg pain (8/29, 28%). The majority of NABs and blood cultures performed were negative, but of the positive tests Staphylococcus aureus was the most prevalent bacteria. 86% (25/29) had an MRI before a diagnosis was made and 72% (13/18) had an NAB performed post-diagnosis. CONCLUSIONS MRI is a popular and helpful tool in diagnosing spinal osteomyelitis de novo. NAB cultures are often negative but can be useful in determining antibiotic treatment. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Lara L Cohen
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Benjamin J Shore
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Kathryn A Williams
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Daniel J Hedequist
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - M Timothy Hresko
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Lawrence I Karlin
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Brian D Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael P Glotzbecker
- Department of Orthopedic Surgery, Boston Children's Hospital, Hunnewell 2, 300 Longwood Avenue, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA.
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Filleron A, Laurens ME, Marin G, Marchandin H, Prodhomme O, Alkar F, Godreuil S, Nagot N, Cottalorda J, L'Kaissi M, Rodiere M, Vigue MG, Didelot MN, Michon AL, Delpont M, Louahem D, Jeziorski E. Short-course antibiotic treatment of bone and joint infections in children: a retrospective study at Montpellier University Hospital from 2009 to 2013. J Antimicrob Chemother 2020; 74:3579-3587. [PMID: 31504582 DOI: 10.1093/jac/dkz358] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 07/16/2019] [Accepted: 07/18/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Acute haematogenous bone and joint infections (AHBJI) represent a diagnostic and therapeutic emergency in children, with significant potential sequelae in the case of delayed treatment. Although historically the recommendations for treatment have been based on surgery and prolonged antibiotic therapy, recent studies have demonstrated that short-course antibiotic therapy is also effective. OBJECTIVES We evaluated a short-term antibiotic protocol for both osteomyelitis and septic arthritis in a 6 year retrospective study at the University Hospital of Montpellier. METHODS This protocol was based on an initial intravenous treatment with a re-evaluation after 48 h and an early switch to oral therapy in the case of a favourable clinical course for a minimum total duration of 15 days. Antibiotics were selected based on local microbiological epidemiology and systematically adapted to bacteriological results. RESULTS One hundred and seventy-six cases of AHBJI were included, comprising 56 patients with osteomyelitis, 95 with septic arthritis and 25 who had both of these. The aetiological agent was identified in 42% of the cases, with the main pathogens being Staphylococcus aureus (39%) and Kingella kingae (27%). The mean intravenous treatment duration was 4 days, while the total treatment duration was 15 days. There were no treatment failures, mild sequelae occurred in 1% of the cases and the secondary surgical revision rate was 7%. CONCLUSIONS The results of this study are comparable to those reported for evaluations of prolonged antibiotic therapy protocols, thus indicating that a common short-term antimicrobial therapy for the management of both osteomyelitis and septic arthritis (minimum of 15 days) is a viable option for treating AHBJI in children. Further prospective studies to confirm these findings are hence warranted.
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Affiliation(s)
- A Filleron
- Service de pédiatrie, CHU de Nîmes, Nîmes, France; INSERM U 1183, Université Montpellier-Nîmes, Nîmes, France
| | - M E Laurens
- Département de pédiatrie néonatale et de réanimation, CHU de Montpellier, Montpellier, France
| | - G Marin
- Department d'Information Medicale, CHU Montpellier, Montpellier, France
| | - H Marchandin
- HydroSciences Montpellier, University of Montpellier, CNRS, IRD, Montpellier, France; Laboratoire de microbiologie, CHU Nîmes, Nîmes, France
| | - O Prodhomme
- Département d'imagerie pédiatrique, CHU de Montpellier, Montpellier, France
| | - F Alkar
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - S Godreuil
- Service de bactériologie, CHU Montpellier, Montpellier, France.,Université de Montpellier UMR MIVEGEC, UMR IRD 224-CNRS Inserm, 1058, Montpellier, France
| | - N Nagot
- Department d'Information Medicale, CHU Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - J Cottalorda
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - M L'Kaissi
- Service de chirurgie infantile, CHU de la réunion, Saint-Denis, France
| | - M Rodiere
- Département urgences post-urgences, CHU Montpellier, Montpellier, France
| | - M G Vigue
- Département urgences post-urgences, CHU Montpellier, Montpellier, France
| | - M N Didelot
- Service de bactériologie, CHU Montpellier, Montpellier, France.,Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France
| | - A L Michon
- Service de bactériologie, CHU Montpellier, Montpellier, France
| | - M Delpont
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - D Louahem
- Service de chirurgie orthopédique infantile, CHU Montpellier, Montpellier, France
| | - E Jeziorski
- Pathogenesis and Control of Chronic Infections, INSERM, Université de Montpellier, Montpellier, France.,Département urgences post-urgences, CHU Montpellier, Montpellier, France
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McNeil JC, Vallejo JG, Kok EY, Sommer LM, Hultén KG, Kaplan SL. Clinical and Microbiologic Variables Predictive of Orthopedic Complications Following Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children. Clin Infect Dis 2020; 69:1955-1961. [PMID: 30753346 DOI: 10.1093/cid/ciz109] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/31/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is the most common cause of acute hematogenous osteoarticular infections (AHOAIs) in children. The risk factors for the development of orthopedic complications (OC) after AHOAI are poorly understood. We sought to describe clinical and microbiologic variables present on the index admission that may predict OC in S. aureus AHOAI. METHODS Staphylococcus aureus AHOAI cases were identified from 2011-2017 at Texas Children's Hospital and reviewed for the development of OC. OC included chronic osteomyelitis, growth arrest, avascular necrosis, chronic dislocation, and pathologic fracture. All S. aureus isolates were characterized by pulsed-field gel electrophoresis and agr group. RESULTS A total of 286 cases were examined of which 27 patients (9.4%) developed OC. Patients who developed OC more often had infection with an agr group III organism (P = .04), bacteremia (P = .04), delayed source control (P < .001), ≥2 surgical procedures (P < .001), intensive care unit admission (P = .09), and fever >4 days after admission (P = .008). There was no association with OC and patient age, methicillin resistance, or choice/route of antibiotics. In multivariable analyses of OC, infection with agr group III S. aureus, prolonged fever, and delayed source control remained statistically significant. CONCLUSIONS OC develop following S. aureus AHOAI in 9.4% of cases. Although the development of OC is likely multifactorial, agr group III organisms, prolonged fever, and delayed source control are independently associated with OC. Moreover, early aggressive surgical source control may be beneficial in children with S. aureus AHOAI.
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Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Jesus G Vallejo
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Eric Y Kok
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Lauren M Sommer
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Kristina G Hultén
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Sheldon L Kaplan
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
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Bréhin C, Claudet I, Dubois D, Sales de Gauzy J, Vial J, Chaix Y, Grouteau E. Assessing the management of pediatric bone and joint infections according to French guidelines. Med Mal Infect 2020; 50:515-519. [DOI: 10.1016/j.medmal.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 09/04/2018] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
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Kaziz H, Amine Triki M, Chermiti W, Mouelhi T, Naouar N, Laziz Ben Ayeche M. Acute osteomyelitis of the distal fibula in children: Treatment options and long-term follow-up. Arch Pediatr 2020; 27:342-347. [PMID: 32736914 DOI: 10.1016/j.arcped.2020.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/31/2020] [Accepted: 06/23/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Acute osteomyelitis of the distal fibula is a rare disease in children and is characterized by special features compared with other sites. The objective of this study was to report the functional outcome at long-term follow-up. METHODS We reviewed retrospectively, between January 2000 and December 2010, all cases of acute osteomyelitis of the distal fibula. Epidemiological and bacteriological data as well as therapy and outcome factors were analyzed. At the last follow-up, functional outcome was studied based on ankle motion, growth disturbance, and radiological sequelae. RESULTS Seven cases of acute osteomyelitis of the distal fibula were found. The mean age was patients was 7.71 years and the sex ratio was 2.5. The portal of entry of the pathogen was a skin injury in 57% of cases. Staphylococcusaureus was identified in 71% of cases. The mean duration of antibiotic therapy was 33.2 days. At a mean of 12.85 years of follow-up, no growth disturbance was found. The mean plantar and dorsal flexion was 41° and 27.7°, respectively. The mean postoperative American Orthopedics Foot and Ankle score (AOFAS) was 96.71 points. CONCLUSION Acute osteomyelitis of the distal fibula in children is scarce and rarely reported in the literature. It occurs more often in boys at an average age of 7 years. Local symptoms are usually more obvious than general symptoms. Surgical debridement of the subperiosteal abscess without bone trepanation seems to lead to a satisfactory outcome. LEVEL OF EVIDENCE Level IV - case series. IRB: Sahloul Hospital Human Research Ethics Committee.
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Affiliation(s)
- H Kaziz
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia.
| | - M Amine Triki
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - W Chermiti
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - T Mouelhi
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - N Naouar
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
| | - M Laziz Ben Ayeche
- Orthopaedics department, Hospital Sousse, Sahloul University, city 4000 9, Sousse, Tunisia
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Wang Y, Lin Y, Cheng C, Chen P, Zhang P, Wu H, Li K, Deng Y, Qian J, Zhang X, Yu B. NF-κB/TWIST1 Mediates Migration and Phagocytosis of Macrophages in the Mice Model of Implant-Associated Staphylococcus aureus Osteomyelitis. Front Microbiol 2020; 11:1301. [PMID: 32595631 PMCID: PMC7304240 DOI: 10.3389/fmicb.2020.01301] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 05/22/2020] [Indexed: 12/14/2022] Open
Abstract
Staphylococcus aureus (S. aureus) infection-induced osteomyelitis is a great challenge in clinic treatment. Identification of the essential genes and biological processes that are specifically changed in mononuclear cells at an early stage of S. aureus osteomyelitis is of great clinical significance. Based on transcriptional dataset GSE16129 available publicly, a bioinformatic analysis was performed to identify the differentially expressed genes of osteomyelitis caused by S. aureus infection. ERBB2, TWIST1, and NANOG were screened out as the most valuable osteomyelitis-related genes (OMRGs). A mice model of implant-associated S. aureus osteomyelitis was used to verify the above genes. We found significantly up-regulated expression of TWIST1 in macrophages and accumulation of macrophages around the infected implant. Meanwhile, S. aureus infection increased the expression of TWIST1, MMP9, and MMP13, and stimulated the migration and phagocytosis function of Raw 264.7 cells. Additionally, knock-down of the expression of TWIST1 by siRNA could significantly down-regulate MMP9 and MMP13 and suppress the migration and phagocytosis ability of macrophages in response to S. aureus infection. Furthermore, we found that NF-κB signaling was activated in Raw 264.7 cells by S. aureus and that inhibition of NF-κB signaling by Bay11-7082 blocked the expression of TWIST1, MMP9, and MMP13 as well as cell migration and phagocytosis evoked by S. aureus. Our findings demonstrate that NF-κB/TWIST1 is necessary for migration and phagocytosis of macrophages in response to S. aureus infection. Our study highlights the essential role of NF-κB/TWIST1 in early innate immune response to S. aureus infection in bone.
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Affiliation(s)
- Yutian Wang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yihuang Lin
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Caiyu Cheng
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pengyu Chen
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Zhang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Hangtian Wu
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Kaiqun Li
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ye Deng
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jikun Qian
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianrong Zhang
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Yu
- Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Bone and Cartilage Regenerative Medicine, Nanfang Hospital, Southern Medical University, Guangzhou, China
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