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Liu Y, Chen L, Fan M, Zhang T, Chen J, Li X, Lv Y, Zheng P, Chen F, Sun G. Application of AI-assisted MRI for the identification of surgical target areas in pediatric hip and periarticular infections. BMC Musculoskelet Disord 2024; 25:428. [PMID: 38824518 PMCID: PMC11143611 DOI: 10.1186/s12891-024-07548-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/27/2024] [Indexed: 06/03/2024] Open
Abstract
OBJECTIVE To develop an AI-assisted MRI model to identify surgical target areas in pediatric hip and periarticular infections. METHODS A retrospective study was conducted on the pediatric patients with hip and periarticular infections who underwent Magnetic Resonance Imaging(MRI)examinations from January 2010 to January 2023 in three hospitals in China. A total of 7970 axial Short Tau Inversion Recovery (STIR) images were selected, and the corresponding regions of osteomyelitis (label 1) and abscess (label 2) were labeled using the Labelme software. The images were randomly divided into training group, validation group, and test group at a ratio of 7:2:1. A Mask R-CNN model was constructed and optimized, and the performance of identifying label 1 and label 2 was evaluated using receiver operating characteristic (ROC) curves. Calculation of the average time it took for the model and specialists to process an image in the test group. Comparison of the accuracy of the model in the interpretation of MRI images with four orthopaedic surgeons, with statistical significance set at P < 0.05. RESULTS A total of 275 patients were enrolled, comprising 197 males and 78 females, with an average age of 7.10 ± 3.59 years, ranging from 0.00 to 14.00 years. The area under curve (AUC), accuracy, sensitivity, specificity, precision, and F1 score for the model to identify label 1 were 0.810, 0.976, 0.995, 0.969, 0.922, and 0.957, respectively. The AUC, accuracy, sensitivity, specificity, precision, and F1 score for the model to identify label 2 were 0.890, 0.957, 0.969, 0.915, 0.976, and 0.972, respectively. The model demonstrated a significant speed advantage, taking only 0.2 s to process an image compared to average 10 s required by the specialists. The model identified osteomyelitis with an accuracy of 0.976 and abscess with an accuracy of 0.957, both statistically better than the four orthopaedic surgeons, P < 0.05. CONCLUSION The Mask R-CNN model is reliable for identifying surgical target areas in pediatric hip and periarticular infections, offering a more convenient and rapid option. It can assist unexperienced physicians in pre-treatment assessments, reducing the risk of missed and misdiagnosis.
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Affiliation(s)
- Yuwen Liu
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Lingyu Chen
- Department of Computer Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Mingjie Fan
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Tao Zhang
- Department of Orthopaedic Surgery, Qinghai Women's and Children's Hospital, Xining, China
| | - Jie Chen
- Department of Orthopaedic Surgery, Wuxi Children's Hospital, Wuxi, China
| | - Xiaohui Li
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yunhao Lv
- Department of Computer Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China
| | - Pengfei Zheng
- Department of Orthopaedic Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China.
| | - Fang Chen
- Department of Computer Science and Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, China.
| | - Guixin Sun
- Department of Traumatic Surgery, Shanghai East Hospital, Nanjing Medical University, Shanghai, China.
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Zhao C, Guan Z, Jiang Q, Wu W, Wang X. Predictive value of PAR and PNI for the acute complicated course of pediatric acute hematogenous osteomyelitis. J Pediatr (Rio J) 2024:S0021-7557(24)00046-9. [PMID: 38677322 DOI: 10.1016/j.jped.2024.04.002] [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: 12/03/2023] [Revised: 03/25/2024] [Accepted: 04/11/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE Platelet to albumin ratio (PAR) and prognostic nutritional index (PNI) are potential indicators for evaluating nutritional and inflammatory status. This study aimed to examine the relationship between PAR and PNI and the acute complicated course of acute hematogenous osteomyelitis (AHO). METHODS AHO patients were divided into the simple course group and the acute complicated course group. The patient's gender, age, site of infection, body temperature, laboratory results, and pathogen culture results were collected and compared. Multivariate logistic regression analysis was used to determine the independent risk factors of the acute complicated course group. The receiver operating characteristic curve was applied to determine the optimal cut-off value. RESULTS In total, 101 AHO patients with a median age of 7.58 years were included. There were 63 cases (62.4 %) in the simple course group and 38 cases (37.6 %) in the complicated course group. Binary logistic regression analysis revealed that PAR and PNI were independent risk factors for predicting the acute complicated course of AHO (p = 0.004 and p < 0.001, respectively). Receiver operating characteristic curve analysis demonstrated that the combination of PAR and PNI had an area under the curve of 0.777 (95 % CI: 0.680-0.873, p < 0.001) with a cut-off value of 0.51. CONCLUSIONS The incidence of acute complicated courses was significantly higher in patients with high PAR and low PNI. A combined factor greater than 0.51, derived from PAR and PNI measurements within 24 h of admission, may be useful for predicting AHO patients who are likely to develop severe disease.
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Affiliation(s)
- Chaochen Zhao
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Zhiye Guan
- Shanghai Jiao Tong University, School of Medicine, Shanghai Children's Hospital, Department of Orthopaedics, Shanghai, China
| | - Qizhi Jiang
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Wangqiang Wu
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Xiaodong Wang
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China.
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Shihabul Hassan M, Stevenson J, Gandikota G, Veeratterapillay A, Bhamidipaty K, Botchu R. Current updates in MSK infection imaging: A narrative review. J Clin Orthop Trauma 2024; 51:102396. [PMID: 38585385 PMCID: PMC10998214 DOI: 10.1016/j.jcot.2024.102396] [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: 01/23/2024] [Revised: 02/28/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024] Open
Abstract
This article presents a comprehensive overview of the diagnostic utility of existing imaging techniques including radiography, computed tomography, ultrasonography, magnetic resonance imaging (MRI), and radionuclide imaging in the context of the most common orthopaedic or musculoskeletal infections. It also includes illustrative images showcasing significant findings in various musculoskeletal infections including osteomyelitis, cellulitis, septic arthritis, necrotising infections and peri-prosthetic joint infections and their associated complications.
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Affiliation(s)
- M. Shihabul Hassan
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - J. Stevenson
- Department of Orthopedics, Royal Orthopedic Hospital, Birmingham, UK
| | - G. Gandikota
- Department of Radiology, University of North Carolina, USA
| | | | | | - R. Botchu
- Department of Musculoskeletal Radiology, Royal Orthopedic Hospital, Birmingham, UK
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Moore-Lotridge SN, Hou BQ, Hajdu KS, Anand M, Hefley W, Schoenecker JG. Navigating the Enigma of Pediatric Musculoskeletal Infections: A Race Against Time. Orthop Clin North Am 2024; 55:217-232. [PMID: 38403368 DOI: 10.1016/j.ocl.2023.09.004] [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] [Indexed: 02/27/2024]
Abstract
Musculoskeletal infection (MSKI) in children is a critical condition in pediatric orthopedics due to the potential for serious adverse outcomes, including multiorgan dysfunction syndrome, which can lead to death. The diagnosis and treatment of MSKI continue to evolve with advancements in infectious organisms, diagnostic technologies, and pharmacologic treatments. It is imperative for pediatric orthopedic surgeons and medical teams to remain up to date with the latest MSKI practices.
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Affiliation(s)
- Stephanie N Moore-Lotridge
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian Q Hou
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katherine S Hajdu
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Malini Anand
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - William Hefley
- School of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan G Schoenecker
- Department of Orthopedics, Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA.
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Woods CR, Bradley JS, Chatterjee A, Kronman MP, Arnold SR, Robinson J, Copley LA, Arrieta AC, Fowler SL, Harrison C, Eppes SC, Creech CB, Stadler LP, Shah SS, Mazur LJ, Carrillo-Marquez MA, Allen CH, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA): 2023 Guideline on Diagnosis and Management of Acute Bacterial Arthritis in Pediatrics. J Pediatric Infect Dis Soc 2024; 13:1-59. [PMID: 37941444 DOI: 10.1093/jpids/piad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the 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 ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA 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 approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). 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 Health Sciences Center College of Medicine Chattanooga, Chattanooga, Tennessee
| | - John S Bradley
- Division of Infectious Diseases, Department of Pediatrics, University of California San Diego, School of Medicine, and Rady Children's Hospital, San Diego, California
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois
| | - Matthew P Kronman
- Division of Pediatric Infectious Diseases, University of Washington, Seattle Children's Hospital, Seattle, Washington
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas
| | - Antonio C Arrieta
- Division of Infectious Diseases, Children's Hospital of Orange County and University of California, Irvine, California
| | - Sandra L Fowler
- Division of Infectious Diseases, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas
| | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas
| | - 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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Iseri Nepesov M, Kilic O, Sali E, Yesil E, Akar A, Kaman A, Metin Akcan O, Kilic Cil M, Ozlu C, Lacinel Gurlevik S, Ulusoy E, Cetin BS, Akici N, Cakir D, Uslu Aygun FD, Hancerli CO, Tekin Yilmaz A, Alkan G, Uygun H, Bucak IH, Bursal B, Celik T, Sutcu M, Oz FN, Gayretli Aydin ZG, Karbuz A, Akturk H, Kepenekli E, Emiroglu M, Oncel S, Nuhoglu C, Korucu IH, Incesu M, Kaya A, Bombaci H, Dinleyici M, Carman KB, Duman M, Turel O, Yilmaz D, Alabaz D, Belet N, Tanir G, Turgut M, Celebi S, Kuyucu N, Arisoy ES, Durmaz G, Kaya M, Kara A, Dinleyici EC. Pathogens in Pediatric Septic Arthritis: A Multi-Center Study in Turkiye (PEDSART Study). CHILDREN (BASEL, SWITZERLAND) 2024; 11:134. [PMID: 38275444 PMCID: PMC10813905 DOI: 10.3390/children11010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. METHODS In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. RESULTS Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. CONCLUSIONS Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.
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Affiliation(s)
- Merve Iseri Nepesov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye; (M.I.N.); (O.K.)
| | - Omer Kilic
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye; (M.I.N.); (O.K.)
| | - Enes Sali
- Department of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
| | - Edanur Yesil
- Department of Pediatric Infectious Diseases, Mersin City Hospital, Mersin 33240, Türkiye
| | - Asuman Akar
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin 33110, Türkiye
| | - Ayse Kaman
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Ozge Metin Akcan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye
| | - Merve Kilic Cil
- Department of Pediatric Infectious Diseases, Adana City Hospital, Adana 01230, Türkiye
| | - Canan Ozlu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35210, Türkiye
| | - Sibel Lacinel Gurlevik
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye
| | - Emel Ulusoy
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Health Sciences Izmir Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir 35210, Türkiye
| | - Benhur Sirvan Cetin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri 38030, Türkiye
| | - Narin Akici
- Department of Pediatrics, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Deniz Cakir
- Department of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
| | - Fatma Deniz Uslu Aygun
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Cerrahpaşa University, Istanbul 34098, Türkiye
| | - Cafer Ozgur Hancerli
- Department of Orthopedics and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul 34303, Türkiye
| | - Ayse Tekin Yilmaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Gulsum Alkan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya 42130, Türkiye
| | - Hatice Uygun
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Ibrahim Hakan Bucak
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Burcu Bursal
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul 34303, Türkiye
| | - Taylan Celik
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale 17020, Türkiye
| | - Murat Sutcu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Istinye University, Istanbul 34010, Türkiye
| | - Fatma Nur Oz
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Zeynep Gokce Gayretli Aydin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Türkiye
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul 34384, Türkiye
| | - Hacer Akturk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Koc University, Istanbul 34010, Türkiye
| | - Eda Kepenekli
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul 34854, Türkiye
| | - Melike Emiroglu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya 42130, Türkiye
| | - Selim Oncel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Cagatay Nuhoglu
- Department of Pediatrics, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Ismail Hakki Korucu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye
| | - Mustafa Incesu
- Department of Orthopedics and Traumatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Ahmet Kaya
- Department of Orthopedics and Traumatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Hasan Bombaci
- Department of Orthopedics and Traumatology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Meltem Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Kursat Bora Carman
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Murat Duman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35160, Türkiye
| | - Ozden Turel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Medeniyet University, Istanbul 34700, Türkiye
| | - Dilek Yilmaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Derya Alabaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana 01330, Türkiye
| | - Nursen Belet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35210, Türkiye
| | - Gonul Tanir
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Mehmet Turgut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Solmaz Celebi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Uludag University, Bursa 16059, Türkiye
| | - Necdet Kuyucu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin 33110, Türkiye
| | - Emin Sami Arisoy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Gul Durmaz
- Department of Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Mucahit Kaya
- Diagen Biotechnological Systems Healthcare and Automation Company, Ankara 06070, Türkiye
| | - Ates Kara
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
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Ren C, Yuan Q, Yin C, Yao F, Yu W, Zhang F, Wang X. The use of the ratio of C-reactive protein to albumin for the diagnosis of pediatric septic arthritis. Front Pediatr 2024; 11:1308513. [PMID: 38293658 PMCID: PMC10824903 DOI: 10.3389/fped.2023.1308513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/29/2023] [Indexed: 02/01/2024] Open
Abstract
Purpose This study aimed to investigate the relationship between the ratio of c-reactive protein to albumin (CAR) and pediatric septic arthritis (PSA). Methods Clinical and laboratory data were collected. Receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of CAR in identifying PSA. Multivariable logistic regression analyses was performed to calculate adjusted odds ratio (OR) with 95% confidence interval (CI). Results We included 305 patients with PSA (CAR ≤ 0.447, 182 patients; CAR > 0.447, 123 patients) between September 2013 and November 2022. ROC analysis showed that CAR performed best in diagnosing PSA, with an area under curve (AUC) value of 0.828. After adjusted for potential confounders, we found that high CAR was associated with PSA (OR = 6.85, 95% CI: 2.30-20.40, p = 0.001). In sensitivity analyses, subgroups analyses, and propensity score matching, the results remain stable. Conclusions The CAR (>0.447) at admission was an independent risk factor for PSA. It is worthy to further investigate this association.
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Affiliation(s)
- Chong Ren
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Orthopedics, Guiyang Maternal and Child Health-Care Hospital, Guiyang, Guizhou, China
| | - Quanwen Yuan
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Chunhua Yin
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Feng Yao
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wentao Yu
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Fuyong Zhang
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaodong Wang
- Department of Orthopedics, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
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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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Nathani HR, Samal S. Septic Arthritis Associated With Hip Joint Subluxation and Epiphyseal Plate Deformation as a Sequala of Sickle Cell Anemia. Cureus 2023; 15:e48103. [PMID: 38046768 PMCID: PMC10691398 DOI: 10.7759/cureus.48103] [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: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
This case report emphasizes the critical nature of septic arthritis in pediatric patients, particularly its predilection for large joints like the hip. It underscores the importance of rapid diagnosis and early intervention to preserve joint function. The case involves a six-year-old patient with sickle cell anemia who presented with persistent hip pain and hip subluxation and underwent hip joint arthrotomy. Clinical findings revealed limited mobility, weakness, and radiographic abnormalities. Comprehensive rehabilitation resulted in significant improvements in pain, mobility, and function. The key takeaway is the pivotal role of early diagnosis and comprehensive rehabilitation in managing septic arthritis in pediatric patients, especially those with underlying conditions like sickle cell anemia.
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Affiliation(s)
- Harsh R Nathani
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Subrat Samal
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Dimopoulou D, Mantadakis E, Koutserimpas C, Samonis G. A Narrative Review on the Role of Dalbavancin in the Treatment of Bone and Joint Infections. Antibiotics (Basel) 2023; 12:1492. [PMID: 37887193 PMCID: PMC10604335 DOI: 10.3390/antibiotics12101492] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Bone and joint infections (BJI) require prolonged antimicrobial treatment, leading to lengthy hospitalizations, high costs, the risk of nosocomial infections, and the development of antimicrobial resistance. Dalbavancin is a novel semisynthetic lipoglycopeptide approved for the treatment of adults and children with acute bacterial skin and skin structure infections. This narrative review aims to summarize the characteristics of dalbavancin and the current scientific evidence regarding its clinical efficacy and safety in the treatment of BJI. A literature search until June 2023 was performed to identify all published research about the role of dalbavancin in the management of BJI. Due to its unique pharmacokinetics characterized by prolonged half-life, high bactericidal activity against most Gram-positive bacteria, a good safety profile, and high tissue penetration, dalbavancin can be a valuable alternative to the treatment of BJI. Clinical studies have shown its non-inferiority compared to conventional therapies in BJI, offering potent activity against key pathogens and an extended dosing interval that may shorten hospitalization. In conclusion, dalbavancin represents a promising treatment option for BJI with a favorable safety profile, but further research in both adults and particularly children, who are ideal candidates for long-acting antibiotics, is necessary to evaluate the role of dalbavancin in BJI.
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Affiliation(s)
- Dimitra Dimopoulou
- Second Department of Pediatrics, “Aghia Sophia” Children’s Hospital, 115 27 Athens, Greece;
| | - Elpis Mantadakis
- Department of Pediatrics, University General Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece;
| | - Christos Koutserimpas
- Department of Orthopaedics and Traumatology, “251” Hellenic Air Force General Hospital of Athens, 115 25 Athens, Greece;
| | - George Samonis
- Department of Medicine, University of Crete, 715 00 Heraklion, Greece
- First Department of Medical Oncology, “Metropolitan” Hospital, 185 47 Attica, Greece
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11
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Xu Q, Wang Q, Zhu J, Lin J, Lu Z, Wang T, Wang X, Xia Q. Clinical outcomes of proximal femoral reconstruction technique combined with THA in the treatment of high dislocation secondary to septic arthritis: a retrospective single-center study. BMC Musculoskelet Disord 2023; 24:732. [PMID: 37710190 PMCID: PMC10500876 DOI: 10.1186/s12891-023-06818-8] [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: 05/13/2023] [Accepted: 08/22/2023] [Indexed: 09/16/2023] Open
Abstract
PURPOSE The aim of this retrospective study was to examine the clinical outcomes and complications of proximal femur reconstruction (PFR) combined with total hip arthroplasty (THA) in patients with high hip dislocation secondary to septic arthritis (SA). METHODS Between September 2016 to September 2021, we performed a series of 15 consecutive PFR combined with THA on patients with high dislocation of the hip secondary to SA, of these,12 hips were reviewed retrospectively, with a mean follow-up of 2.5 years (range, 1.5-6 years). The mean age of the patients at the time of surgery was 52 years (range, 40-70 years). RESULTS All patients were followed up. At 1-year postoperative follow-up, the median HHS increased from 32.50 preoperatively to 79.50 postoperatively. The median VAS decreased from 7 before surgery to 2 at 1 year after surgery. The median LLD reduced from 45 mm preoperatively to 8 mm at 1 year after surgery. The mean operative time 125 ± 15 min (range 103-195 min). Mean estimated blood loss was500 ± 105ml (range 450-870 ml). Mean hospital days 9.5 days (range 6-15 days). Two patients developed nerve injuries that improved after nutritional nerve treatment. One patient had recurrent postoperative dislocation and underwent reoperation, with no recurrence dislocation during the follow-up. There were no cases of prosthesis loosening during the follow-up period. One patient developed acute postoperative periprosthetic joint infection (PJI) that was treated with Debridement, Antibiotics and Implant Retention (DAIR) plus anti-infective therapy, with no recurrence during 2 years of follow-up. CONCLUSION This study indicates PFR combined with THA shows promise as a technique to manage high hip dislocation secondary to SA, improving early outcomes related to pain, function, and limb length discrepancy.
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Affiliation(s)
- Qingshan Xu
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China
| | - Qijin Wang
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China
| | - Jianfu Zhu
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China
| | - Jianguo Lin
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China
| | - Zhenbao Lu
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China
| | - Tihui Wang
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China
| | - Xu Wang
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China.
| | - Qiujin Xia
- Department of Orthopedics, Affiliated Mindong Hospital of Fujian Medical University, Ningde, 355000, Fujian, China.
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Fukayama H, Myojin S, Funaki T, Fukuda Y, Nakamura T, Ishiguro A, Ogimi C. Septic Arthritis Caused by Haemophilus parainfluenzae : A Pediatric Case Report and Literature Review. Pediatr Infect Dis J 2023; 42:e336-e340. [PMID: 37235760 DOI: 10.1097/inf.0000000000003979] [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: 05/28/2023]
Abstract
We report a healthy 5-year-old boy without apparent risk factors who developed septic arthritis of the hip from Haemohilus parainfluenzae infection. A literature review revealed only 4 pediatric cases of osteoarticular infection caused by this pathogen. To our knowledge, our case may be the first pediatric case of septic arthritis of the hip caused by H. parainfluenzae .
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Affiliation(s)
- Haruka Fukayama
- From the Division of Infectious Diseases, Department of Medical Subspecialties
- Center for Postgraduate Education and Training
| | - Shota Myojin
- From the Division of Infectious Diseases, Department of Medical Subspecialties
| | - Takanori Funaki
- From the Division of Infectious Diseases, Department of Medical Subspecialties
| | | | - Tomoo Nakamura
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Chikara Ogimi
- From the Division of Infectious Diseases, Department of Medical Subspecialties
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13
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Ryan CB, Romere CM, Shah R, Souder CD, Ellington M. Rate of concomitant cellulitis and osteoarticular infections in a pediatric population. J Pediatr Orthop B 2023; 32:476-480. [PMID: 36445357 DOI: 10.1097/bpb.0000000000001037] [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: 11/30/2022]
Abstract
Concern for infection is a common presentation in pediatric emergency departments. Clinical signs of cellulitis in pediatric patients often lead to a workup for osteoarticular infection despite a lack of evidence to suggest that the two entities commonly co-exist. With this in mind, we asked: (1) What is the rate of concomitant cellulitis and osteoarticular infections in the pediatric population? (2) What factors are associated with concomitant cellulitis and osteoarticular infections? This is a retrospective study of 482 pediatric patients who underwent MRI to evaluate for either cellulitis or an osteoarticular infection at a single tertiary care children's hospital. Data were analyzed to assess the prevalence of osteomyelitis concomitant with cellulitis in our sample population. Concomitant cellulitis and osteoarticular infection were present in 11% of all cases (53/482). Of the concomitant infections, 92% percent (49/53) were present in distal locations (Group 1) and 8% (4/53) were present in proximal locations (Group 2). Bivariate analysis showed that concomitant infections on the distal extremities were significantly more common than concomitant infections on the proximal extremities ( P < 0.001). We found that concomitant cellulitis and osteoarticular infection were (1) uncommon and (2) significantly less common when clinical signs of cellulitis were present in the proximal extremities (proximal to ankle or wrist). This suggests that advanced imaging is most appropriate for patients who present with cellulitis on the distal extremities and can be used more judiciously in patients presenting with cellulitis on the proximal extremities. Level of Evidence - Level III.
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Affiliation(s)
- Claire Berdelle Ryan
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Chase Matthew Romere
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Romil Shah
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Christopher D Souder
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
- Department of Orthopedic Surgery, Central Texas Pediatric Orthopedics, Austin, Texas, USA
| | - Matthew Ellington
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
- Department of Orthopedic Surgery, Central Texas Pediatric Orthopedics, Austin, Texas, USA
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Sander E. Septic Arthritis of the Elbow in a Premature Neonate: An Uncommon Disease in an Uncommon Location. Pediatr Ann 2023; 52:e292-e296. [PMID: 37561826 DOI: 10.3928/19382359-20230613-07] [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: 08/12/2023]
Abstract
Septic arthritis (SA) is an infrequent diagnosis in the neonate. This case illustrates the presentation of SA within the elbow, an atypical location for neonatal SA. SA should be considered in any neonate with joint swelling, as symptoms are often subtle. Constitutional symptoms of infection, including fever, may not be present in the neonate. Staphylococcus aureus is the most common etiologic organism, and neonatal SA is often caused by hematogenous spread partially due to unique neonatal intraosseous anatomy. Joint aspiration can provide a definitive diagnosis and aid in targeted antimicrobial therapy. Other laboratory tests, including C-reactive protein and erythrocyte sedimentation rate, can aid in diagnosis. Ultrasound and magnetic resonance imaging can demonstrate joint effusion along with osteomyelitis, which is often seen concurrently with neonatal SA. There are no definitive guidelines for the treatment of neonatal SA. Conservative therapy with antimicrobials along with surgical intervention are the mainstays of treatment. Prompt diagnosis and treatment are crucial to decrease permanent joint damage. [Pediatr Ann. 2023;52(8):e292-e296.].
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15
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Caldaci A, Testa G, Vaccalluzzo MS, Vescio A, Prestianni I, Lucenti L, de Cristo C, Sapienza M, Pavone V. Clinical and Radiographic Outcomes and Treatment Algorithm for Septic Arthritis in Children. J Pers Med 2023; 13:1097. [PMID: 37511710 PMCID: PMC10381621 DOI: 10.3390/jpm13071097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/14/2023] [Accepted: 06/28/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Septic arthritis (SA) in children is an acute inflammatory disease of the joints. If not treated promptly, it could become a surgical emergency. The incidence of the disease in children in Europe is approximately 2-7 per 100,000 children. The aim of this systematic review was to investigate which of these treatments-arthrocentesis, arthrotomy, and arthroscopy-provides better results in children and when to use them. METHODS Three independent authors conducted a systematic review of PubMed, ScienceDirect, and MEDLINE databases to assess studies with any level of evidence that reported the surgical outcome of SA. Two senior investigators evaluated and approved each stage's findings. RESULTS A total of 488 articles were found. After screening, we chose 24 articles that were suitable for full-text reading based on the inclusion and exclusion criteria. The results of our analysis showed that there are no numerically significant differences reported in the literature on clinical and radiographic outcomes by surgical technique. CONCLUSIONS We developed an algorithm that could be used if septic arthritis is suspected. Based on our results, the surgical technique to be used will depend on the operator who will perform it.
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Affiliation(s)
- Alessia Caldaci
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Gianluca Testa
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Simone Vaccalluzzo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Andrea Vescio
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Ignazio Prestianni
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Ludovico Lucenti
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Claudia de Cristo
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Marco Sapienza
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
| | - Vito Pavone
- Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics, A.O.U. Policlinico Rodolico-San Marco, University of Catania, 95123 Catania, Italy
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16
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Nikkhahmanesh N, Vij N, Ranade AS, Belthur M. Primary Fibular Osteomyelitis in Children: A Systematic Review. Cureus 2023; 15:e41345. [PMID: 37546085 PMCID: PMC10398615 DOI: 10.7759/cureus.41345] [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] [Accepted: 07/03/2023] [Indexed: 08/08/2023] Open
Abstract
Osteomyelitis of the fibula is rare and is especially rare in children. The published literature is limited to case series and is thus lacking a comprehensive description of the disease. The purpose of this systematic review is to provide the first comprehensive summary of the demographics, presenting symptoms, laboratory values, microbiology, and treatment results of osteomyelitis of the fibula in children based on the existing literature. This institutional review board (IRB)-exempt systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines. Three search engines were used for a total of 239 studies. Twenty-six studies were screened by full text. Twelve articles underwent a quantitative analysis. Due to limited data and heterogenous reporting, the data were summarized descriptively. The methodologic quality of the studies was evaluated based on the Newcastle-Ottawa scale. The average age was 7.71±3.49 years, and males comprised 57% of the 21 cases. The most common presenting symptoms were fever (86%), antalgic gait (57%), and localized tenderness (81%). The most common site of involvement was the distal third of the fibula (90%). The average C-reactive protein (CRP) was 90.1±38.3 mg/L, and the average erythrocyte sedimentation rate (ESR) was 58.8±21.2 mm/hour. Staphylococcus aureus was the most cultured pathogen reported in 10/21 cases (48%). Open surgery was performed in 17/21 cases (81%), and there were no reported complications. Fever, antalgic gait, and localized tenderness should raise the index of suspicion. Prompt laboratory and radiographic evaluations can help reduce delays in diagnosis and improve outcomes. Blood and tissue cultures are currently performed in about half of the cases. Improvement in our microbiologic diagnosis has the potential to improve antibiotic selection. Local methicillin-resistant Staphylococcus aureus (MRSA) prevalence must be taken into consideration when starting empiric antibiotic treatment. Surgical treatment is often required with a low complication rate. The clinical and laboratory parameters identified in this study have the potential for integration into a composite clinical score.
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Affiliation(s)
- Nia Nikkhahmanesh
- Orthopedics, University of Arizona College of Medicine, Phoenix, USA
| | - Neeraj Vij
- Orthopedics, University of Arizona College of Medicine, Phoenix, USA
| | - Ashish S Ranade
- Orthopedics, Blooming Buds Centre for Pediatric Orthopaedics, Deenanath Mangeshkar Hospital and Research Centre, Pune, IND
| | - Mohan Belthur
- Pediatric Orthopedics, Phoenix Children's Hospital, University of Arizona College of Medicine, Phoenix, USA
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Jaybhaye A, LG S, Dash N, Verghese V, Chacko A, Madhuri V, Palocaren T, Gahukamble A, James D, Prakash J, Rose W. Clinical Spectrum and Microbial Etiology of Bone and Joint Infections in Children: A Retrospective Analysis from South India. Am J Trop Med Hyg 2023; 108:936-941. [PMID: 37037428 PMCID: PMC10160895 DOI: 10.4269/ajtmh.22-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/06/2023] [Indexed: 04/12/2023] Open
Abstract
Acute infections of bone and joints are medical emergencies. Early diagnosis and treatment are essential for limb salvage and prevention of deformities. Data from developing countries are essential to develop region-specific treatment guidelines including choice of empiric antibiotics. We reviewed electronic medical records of children (≤ 12 years old) admitted to the pediatrics or orthopedics department of a tertiary care hospital in South India from 2013 to 2017 with a diagnosis of septic arthritis and/or osteomyelitis. Clinical, microbiological, and follow-up data were collected and analyzed. The median (interquartile range, IQR) age of the children (N = 207) was 48 (7.5-105) months. Acute infections were more common in infants, whereas chronic cases were common in children > 5 years of age. Staphylococcus aureus (71%) was the most common organism identified. Gram-negative organisms were more frequently isolated in infants compared with older children. Blood and/or wound culture positivity was 78% (N = 161) overall and 78% (N = 31) in chronic cases. The median (IQR) duration of antibiotics was 7 (5-8) weeks. Sequelae and readmissions occurred in 47% (N = 81) of the 172 patients followed for a year. Culture positivity rates especially of wound were high even after receiving antibiotics.
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Affiliation(s)
- Amol Jaybhaye
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Shyamsunder LG
- Department of Pediatric Orthopedics, Christian Medical College, Vellore, India
| | - Nabaneeta Dash
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Valsan Verghese
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Anila Chacko
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
| | - Vrisha Madhuri
- Department of Pediatric Orthopedics, Christian Medical College, Vellore, India
| | - Thomas Palocaren
- Department of Pediatric Orthopedics, Christian Medical College, Vellore, India
| | - Abhay Gahukamble
- Department of Pediatric Orthopedics, Christian Medical College, Vellore, India
| | - Deeptiman James
- Department of Pediatric Orthopedics, Christian Medical College, Vellore, India
| | - John Prakash
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
| | - Winsley Rose
- Pediatric Infectious Diseases, Department of Pediatrics, Christian Medical College, Vellore, India
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He M, Arthur Vithran DT, Pan L, Zeng H, Yang G, Lu B, Zhang F. An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review. Front Cell Infect Microbiol 2023; 13:1193645. [PMID: 37249986 PMCID: PMC10214960 DOI: 10.3389/fcimb.2023.1193645] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Acute septic arthritis is on the rise among all patients. Acute septic arthritis must be extensively assessed, identified, and treated to prevent fatal consequences. Antimicrobial therapy administered intravenously has long been considered the gold standard for treating acute osteoarticular infections. According to clinical research, parenteral antibiotics for a few days, followed by oral antibiotics, are safe and effective for treating infections without complications. This article focuses on bringing physicians up-to-date on the most recent findings and discussions about the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis. In recent years, the emergence of antibiotic-resistant, particularly aggressive bacterial species has highlighted the need for more research to enhance treatment approaches and develop innovative diagnosis methods and drugs that might combat better in all patients. This article aims to furnish radiologists, orthopaedic surgeons, and other medical practitioners with contemporary insights on the subject matter and foster collaborative efforts to improve patient outcomes. This review represents the initial comprehensive update encompassing patients across all age groups.
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Affiliation(s)
- Miao He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linyuan Pan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haijin Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guang Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bangbao Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fangjie Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
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19
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Wen Y, Wang C, Jia H, Liu T, Yu J, Zhang M. Comparison of diagnosis and treatment of MSSA and MRSA osteomyelitis in children: a case-control study of 64 patients. J Orthop Surg Res 2023; 18:197. [PMID: 36915118 PMCID: PMC10012508 DOI: 10.1186/s13018-023-03670-3] [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: 08/04/2022] [Accepted: 03/02/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND We aimed to compare the clinical characteristics of acute osteomyelitis caused by methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) in children. METHODS We retrospectively analyzed the data of 64 children treated between September 2017 and June 2021. Based on the bacterial culture results, they were divided into MRSA and MSSA infection groups. Both groups were treated with debridement and vacuum-assisted closure for negative pressure drainage. Parameters including clinical manifestations, number of operations, length of hospital stay, inflammatory indicators, and concurrent arthritis were compared between the two groups. RESULTS In the MRSA infection group, there was one case each of residual joint stiffness and pathological fracture. Conversely, the MSSA group had two cases of residual joint stiffness. The MRSA infection group was more prone to high fever (t = 3.61, P = 0.001), white blood cell count elevation (t = 2.41, P = 0.022), arthritis (X2 = 7.48, P = 0.013), metastatic abscess (X2 = 4.78, P = 0.042), and a shorter length of progression from onset to admission (t = - 2.04, P = 0.046); however, it required more surgeries (t = 2.68, P = 0.009) and longer hospital stay (t = 2.04, P = 0.045). CONCLUSIONS Pediatric acute osteomyelitis caused by MRSA is more prone to cause high fever and markedly elevated of white blood cell count, and is often accompanied with suppurative infection of adjacent joints and metastatic abscesses, thus requiring more surgeries and longer hospital stay.
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Affiliation(s)
- Yuwei Wen
- Department of Orthopaedics, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No. 56, Nalishi Road, Beijing, 100045, China
| | - Chunhua Wang
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China.
| | - Haiting Jia
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China
| | - Tao Liu
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China
| | - Jiazhi Yu
- Department of Orthopaedic Trauma Surgery, Children's Hospital Affiliate to Shandong University, Jinan Children's Hospital, No. 23976 Jingshi Road, Huaiyin District, Jinan, 250022, Shandong, China
| | - Mengyuan Zhang
- Department of Peking Union Medical College, Class of 2025, Beijing, 100730, China
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20
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Cohen E, Klassov Y, Leibovitz R, Mazilis B, Gefler A, Leibovitz E. Surgical treatment of septic arthritis of the hip in children: arthrotomy compared with repeated aspiration-lavage. INTERNATIONAL ORTHOPAEDICS 2023; 47:1609-1618. [PMID: 36899196 DOI: 10.1007/s00264-023-05751-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE To review two cohorts of children treated by two different protocols (repeated needle aspiration-lavage vs. arthrotomy) for surgical treatment of septic arthritis of the hip (SAH). METHODS In order to compare between the two methods, the following parameters were checked: (a) Scar cosmesis was assessed by the Patient and Observer Scar Assessment Scale (POSAS). We considered satisfactory results (no scar discomfort) when POSAS was within 10% of the ideal score; (b) 24-h post-operative pain was evaluated by visual analog scale (VAS); (c) Complication rates of incomplete drainage (re-arthrotomy/therapy modification from aspiration-lavage to arthrotomy). The results were evaluated by the Student t-test or by the chi-square test. RESULTS Seventy-nine children (aged 2-14 years) admitted during 2009-2018 and available for at least two years of follow-up were enrolled. The POSAS score (range 12-120 points) at the latest follow-up was higher in the arthrotomy group compared with the aspiration-lavage group (18.10 ± 6.22 versus 12.27 ± 1.40, p < 0.001); 77.4% of patients treated by arthrotomy had no scar discomfort. The 24-h post-intervention VAS (range 1-10) was 5.06 ± 1.29 after arthrotomy and 4.03 ± 1.13 after aspiration-lavage, p < 0.04. Complications were three times more frequent in the aspiration-lavage group (8.8% in the arthrotomy group and 26.7% in the aspiration-lavage group, p = 0.045). CONCLUSIONS We conclude that the lower complication rate observed in the arthrotomy group outweighs by far scar cosmesis and post-operative pain advantages in the aspiration-lavage group. Arthrotomy as a drainage method is safer than aspiration-lavage.
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Affiliation(s)
- Eugen Cohen
- Department of Orthopaedics, Soroka Medical Center, POB 151, 84101, Beer Sheva, Israel. .,Ben Gurion University, Beer Sheva, Israel.
| | - Yuri Klassov
- Department of Orthopaedics, Soroka Medical Center, POB 151, 84101, Beer Sheva, Israel.,Ben Gurion University, Beer Sheva, Israel
| | - Ron Leibovitz
- Division of Pediatrics, Soroka Medical Center, Beer Sheva, Israel
| | | | - Alexander Gefler
- Department of Orthopaedics, Soroka Medical Center, POB 151, 84101, Beer Sheva, Israel.,Ben Gurion University, Beer Sheva, Israel
| | - Eugene Leibovitz
- Ben Gurion University, Beer Sheva, Israel.,Division of Pediatrics, Soroka Medical Center, Beer Sheva, Israel
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21
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Kamiya Y, Mishima K, Tanaka T, Sawamura K, Matsushita M, Imagama S. Acute osteomyelitis of the patella due to Pseudomonas aeruginosa in an immunocompetent child: A case report. Medicine (Baltimore) 2023; 102:e33012. [PMID: 36800616 PMCID: PMC9936032 DOI: 10.1097/md.0000000000033012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
RATIONALE Plentiful vascularity and lack of the physis are thought to render the patella less vulnerable to osteomyelitis. Pseudomonas aeruginosa (PA) is an opportunistic pathogen predominantly affecting immunocompromised hosts. Despite the ubiquitous nature of PA, osteomyelitis of the patella caused by PA has been rarely reported in children. PATIENT CONCERNS A 5-year-old boy who had presented with a prolonged history of the left anterior knee pain following minor trauma was diagnosed with prepatellar bacterial cellulitis and bursitis. Afterward, a focal osteolytic lesion emerged at the ventral surface of the patella despite oral and intravenous antibiotic therapy lasting for weeks. We described clinical presentation as well as medical and surgical management of pediatric patellar osteomyelitis secondary to prepatellar septic bursitis. DIAGNOSES Pseudomonas aeruginosa-associated osteomyelitis of the patella. Magnetic resonance imaging of the left knee showed a focal destructive change of the ventral half of the cartilaginous patella and a suprapatellar joint effusion. Bacterial culture from the bursa revealed Pseudomonas aeruginosa. INTERVENTIONS Systemic inflammation, patellar osteochondral destruction, and purulent synovial fluid of the knee were prolonged for 6 weeks despite antibiotics use deemed appropriate and reparative surgical debridement, whereas they were eventually resolved with a 6-week course of intravenous ceftazidime and cessation of continuous intracapsular irrigation. OUTCOMES He was clinically asymptomatic at the latest follow-up but exhibited a minor leg length discrepancy <2 cm associated with overgrowth of the affected femur. LESSONS This is a rare case of Pseudomonas osteomyelitis of the patella in a healthy pediatric patient. Uncommon osteochondral sequelae occurred probably because of a protracted arthritis of the affected knee. We would like to emphasize the ineffectiveness of continuous irrigation without antibiotics for Pseudomonas aeruginosa-associated osteomyelitis.
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Affiliation(s)
- Yasunari Kamiya
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kenichi Mishima
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- * Correspondence: Kenichi Mishima, Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan (e-mail: )
| | - Tetsuji Tanaka
- Department of Orthopaedic Surgery, Holy Spirit Hospital, Nagoya, Aichi, Japan
| | - Kenta Sawamura
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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22
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Zhang B, Chen X, Yao X, Li M, Li Z, Liu B, Liu S, Liu Z, Huo J, Han Y. The diagnostic value of blood metagenomic next-generation sequencing in patients with acute hematogenous osteomyelitis. Front Cell Infect Microbiol 2023; 13:1106097. [PMID: 36779189 PMCID: PMC9911542 DOI: 10.3389/fcimb.2023.1106097] [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: 11/23/2022] [Accepted: 01/16/2023] [Indexed: 01/28/2023] Open
Abstract
Aims This study aims to evaluate the diagnostic value of blood metagenomic next-generation sequencing (mNGS) in detecting pathogens from patients clinically diagnosed as acute hematogenous osteomyelitis (AHO). Methods This retrospective study enrolled 66 patients with AHO. The test results of mNGS and bacterial culture on different samples, including blood and puncture fluid samples, from patients with AHO were compared to explore the diagnostic value of blood mNGS. Besides, this study also explored the efficacy of blood mNGS in decision making for antibiotic administration and analyzed the factors associated with the positive result of blood mNGS. Results The most common causative pathogens were Staphylococcus and Streptococcus. The sensitivity of blood mNGS (77.3%) was higher than that of blood culture (42.4%) (P<0.001), while the turnaround time of blood mNGS (2.1 ± 0.4 d) is much less than that of blood culture (6.0 ± 2.1 d) (P<0.001). Besides, the sensitivity of blood mNGS tests (77.3%) was slightly lower than that of puncture fluid mNGS (89.4%). Furthermore, detection comparison at pathogen level unravels that blood mNGS might be suitable for diagnosing AHO caused by common pathogens, while puncture fluid mNGS could be considered as preferred examination in diagnosing AHO caused by uncommon pathogens. Finally, three independent factors associated with the true positive result of blood mNGS in patients with AHO were identified, including Gram-positive pathogens (OR=24.4, 95% CI = 1.4-421.0 for Staphylococcus; OR=14.9, 95%CI= 1.6-136.1 for other Gram-positive bacteria), body temperature at sampling time (OR=8.2, 95% CI = 0.6-107.3 for body temperature of >38.5°C; OR=17.2, 95% CI = 2.0-149.1 for patients who were chilling), and no use of antibiotics before sampling (OR=8.9, 95% CI =1.4-59.0). Conclusion This is the first report on evaluating and emphasizing the importance of blood mNGS in diagnosing AHO. Blood sample might be an alternative sample for puncture fluid for mNGS, and its extensive application in diagnosing AHO could be expected.
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Affiliation(s)
- Bingshi Zhang
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Xiao Chen
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Xiaowei Yao
- Department of Orthopedics, The Chest Hospital of Hebei Province, Shijizhuang, Hebei, China
| | - Mengnan Li
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Zhijie Li
- Orthopedics Department, Affiliated Hospital of Hebei Engineering University, Handan, Hebei, China
| | - Bo Liu
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Sikai Liu
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Zeming Liu
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Jia Huo
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China
| | - Yongtai Han
- Department of Osteonecrosis and Hip Surgery, The Third Hospital of Hebei Medical, Shijiazhuang, Hebei, China,*Correspondence: Yongtai Han,
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23
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Mitsiakos G, Gialamprinou D, Tsakalidis C, Babatseva E, Lithoxopoulou M, Diamanti E. Osteomyelitis and Thrombosis in a Newborn with Group A Streptococcus Infection. Prague Med Rep 2023; 124:293-300. [PMID: 37736952 DOI: 10.14712/23362936.2023.23] [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] [Indexed: 09/23/2023] Open
Abstract
Neonatal osteomyelitis (OM), although exceptionally rare, has been linked to detrimental sequel, as diagnosis in the early stages is challenging and any delay in treatment can lead to disturbance in skeletal growth. In pediatric OM the most commonly grown bacteria is Staphylococcus aureus followed by group A Streptococcus (GAS). Notwithstanding, sepsis-induced coagulopathy is a well-known entity in children and adults, still sepsis-associated thrombosis is sparsely observed. we present a case of a newborn with GAS associated OM and thrombosis. A term neonate on the 11th day of life was referred to our NICU due to right (R) lower limb edema, cyanosis and core temperature up to 39 °C. Late onset sepsis was suspected and started on vancomycin and amikacin. A colour Doppler scan showed thrombosis of the R common femoral vein. The neonate started on iv unfractionated heparin. Ampicillin was added given positive for GAS blood culture. An MRI on the 5th day of admission, showed evidence of thrombosis resolution. On the 14th day of admission, a bone Tc99 scan showed evidence of OM of R femur. Antibiotic treatment switched to amoxicillin per os. The management was restricted to anticoagulant therapy with low molecular weight heparin for 3 months and antibiotic therapy for 6 months without surgery intervention and the patient recovered and discharged at 42 days of age. Early diagnosis and treatment of neonatal osteomyelitis can prevent bone destruction. Sepsis-associated thrombosis is barely observed during osteomyelitis, yet it should be considered as an emerged case requiring prompt treatment.
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Affiliation(s)
- Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Dimitra Gialamprinou
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Tsakalidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Evgenia Babatseva
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Lithoxopoulou
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Diamanti
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
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24
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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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25
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Walinga AB, Struijs PA, de Waard S, Kerkhoffs GM, Kievit AJ. Needle arthroscopy in the treatment of bacterial arthritis of the hip in a neonate and two infants. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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26
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Aparisi Gómez MP, Bazzocchi A, Simoni P, Inarejos Clemente EJ. Postsurgical Evaluation of the Pediatric Foot and Ankle. Semin Musculoskelet Radiol 2022; 26:755-776. [PMID: 36791743 DOI: 10.1055/s-0042-1760244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
This article reviews situations in which surgical treatment is required in the context of different types of pathology in the foot and ankle of children, focusing on the role of imaging in surgical planning and postsurgical assessment. The types of pathology analyzed from this perspective are congenital pathology, neuromuscular disorders, osteochondral lesions, fractures and infection, ligament injuries, and tumors.We address the most common pitfalls of postsurgical imaging of the ankle and foot in children. With some exceptions, postsurgical follow-up focuses on clinical assessment, with imaging follow-up only needed in patients where complications are suspected or symptoms recur. Postoperative assessment of the foot and ankle in children and adolescents requires knowing the indications for surgery and the most common types of interventions, along with their imaging characteristics. The radiologist needs to be aware of the normal sequence of development of structures and how to select adequate imaging techniques to assess anatomy at various stages or in different postsurgical scenarios.
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Affiliation(s)
- Maria Pilar Aparisi Gómez
- Department of Radiology, Auckland City Hospital, Auckland, New Zealand.,Department of Radiology. IMSKE, València, Spain
| | - Alberto Bazzocchi
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Simoni
- Diagnostic Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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27
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Yıldız K, Makav M, Adalı Y, Bulut M. Therapeutic Effects of Boric Acid in a Septic Arthritis Model Induced by Escherichia coli in Rats. Biol Trace Elem Res 2022; 200:4762-4770. [PMID: 35034263 DOI: 10.1007/s12011-021-03065-7] [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: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 01/09/2023]
Abstract
The study aimed to evaluate the therapeutic effect of boric acid (BA) in experimentally induced septic arthritis. A total of 30 rats, 6 rats in each group (5 groups), were used in the study. No treatment was applied to the rats in the control group. Only BA was administered intraperitoneally (IP) to the rats in the bor group. Escherichia coli was administered at a single dose of 25 μL, 1 × 1010 cfu/rat from the right foot pad of the rats, via intra-articular route, to the mice in the arthritis, arthritis-bor, and arthritis-antb groups. Then, BA at a dose of 50 mg/kg and cefazolin at a dose of 25 mg/kg were administered to the rats in the arthritis-bor and arthritis-antb groups, respectively, for 7 days via the IP route. At the end of the study, all animals were euthanized following the ethical rules. Blood and tissue samples were taken from the rats for biochemical and histopathological analyses. The levels of GSH, MDA, Endoglin, Endocan, and TNF-β markers were measured in the blood samples taken. A significant decrease was observed in MDA and Endoglin levels in the boric acid-administered group compared with the arthritis group, while a significant increase was observed at the GSH level. Histopathologically, it was determined that the reactive surrounding tissue response in the bor group was significantly reduced. As a result, a significant decrease in inflammation was found biochemically and histopathologically in the groups treated with BA.
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Affiliation(s)
- Kadri Yıldız
- Orthopeadia and Traumatology Department, Kafkas University Medical School, Ana Kampüs, 36000, Kars, Turkey.
| | - Mustafa Makav
- Physiology Department, Kafkas University Veterinary School, Kars, Turkey
| | - Yasemen Adalı
- Department of Pathology, Faculty of Medicine, Izmir University of Economics, İzmir, Turkey
| | - Menekşe Bulut
- Food Engineering Department, Faculty of Engineering, Igdır University, Igdır, Turkey
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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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29
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Ossurarson F, Thors V, Haraldsson A. Simplified antibiotic treatment for paediatric osteoarticular infections achieved good outcomes. Acta Paediatr 2022; 111:2188-2194. [PMID: 35924594 DOI: 10.1111/apa.16510] [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: 04/06/2022] [Revised: 06/23/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
AIM Early diagnosis of osteoarticular infections (OAI) in children and effective treatment prevents complications. The objective of this study was to evaluate effectiveness and safety of shortened intravenous antibiotic treatment of OAI. Incidence, diagnostics, and pathogens of paediatric OAI were assessed. METHODS This retrospective study included all paediatric OAI admissions to The Children's Hospital Iceland in 2006-2020. The treatment was evaluated by dividing the study cohort into two groups. The simplified treatment group received intravenous antibiotics for less than seven days. The longer intravenous group received intravenous antibiotics for a minimum of seven days. RESULTS In total, 205 cases of OAI were included: 106 osteomyelitis, 83 septic arthritis and 16 with both. Age standardized incidence was 17 per 100,000 children and decreased over the study period (p = 0.004). A pathogen was identified in 37% (75/205) of cases of which 65% (49/75) were Staphylococcus aureus and 12% (9/75) Kingella kingae. Simplified treatment was not associated with increased risk of complications. CONCLUSION This study supports claims that simplified treatment for OAI is safe and effective. Further simplification of treatment might be viable. For uncertain reasons the incidence of OAI was decreasing in Iceland, predominantly in young children.
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Affiliation(s)
| | - Valtyr Thors
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland.,Children´s Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | - Asgeir Haraldsson
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland.,Children´s Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
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30
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Elbow Septic Arthritis caused by Klebsiella pneumoniae in a Newborn - Case Report and Literature Review. REV ROMANA MED LAB 2022. [DOI: 10.2478/rrlm-2022-0029] [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]
Abstract
Abstract
Septic arthritis is a rare condition in children, especially in neonates. Early recognition and proper treatment are required to avoid serious complications. We present the case of a male newborn diagnosed with septic arthritis of the right elbow who was treated with repeated joint aspiration and i.v. antibiotics (Amikacin and Meropenem). Blood culture and joint cultures were positive for Klebsiella pneumoniae. The final outcome was good, with no apparent local or systemic complications. General considerations regarding this rare condition, etiology and treatment options are also included in the paper.
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Meroni G, Tsikopoulos A, Tsikopoulos K, Allemanno F, Martino PA, Soares Filipe JF. A Journey into Animal Models of Human Osteomyelitis: A Review. Microorganisms 2022; 10:microorganisms10061135. [PMID: 35744653 PMCID: PMC9228829 DOI: 10.3390/microorganisms10061135] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 05/28/2022] [Accepted: 05/30/2022] [Indexed: 12/24/2022] Open
Abstract
Osteomyelitis is an infection of the bone characterized by progressive inflammatory destruction and apposition of new bone that can spread via the hematogenous route (hematogenous osteomyelitis (HO)), contiguous spread (contiguous osteomyelitis (CO)), and direct inoculation (osteomyelitis associated with peripheral vascular insufficiency (PVI)). Given the significant financial burden posed by osteomyelitis patient management, the development of new preventive and treatment methods is warranted. To achieve this objective, implementing animal models (AMs) of infection such as rats, mice, rabbits, avians, dogs, sheep, goats, and pigs might be of the essence. This review provides a literature analysis of the AMs developed and used to study osteomyelitis. Historical relevance and clinical applicability were taken into account to choose the best AMs, and some study methods are briefly described. Furthermore, the most significant strengths and limitations of each species as AM are discussed, as no single model incorporates all features of osteomyelitis. HO’s clinical manifestation results in extreme variability between patients due to multiple variables (e.g., age, sex, route of infection, anatomical location, and concomitant diseases) that could alter clinical studies. However, these variables can be controlled and tested through different animal models.
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Affiliation(s)
- Gabriele Meroni
- One Health Unit, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Pascal 36, 20133 Milan, Italy; (F.A.); (P.A.M.)
- Correspondence: ; Tel.: +39-3428-262-125
| | - Alexios Tsikopoulos
- Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | | | - Francesca Allemanno
- One Health Unit, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Pascal 36, 20133 Milan, Italy; (F.A.); (P.A.M.)
| | - Piera Anna Martino
- One Health Unit, Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Via Pascal 36, 20133 Milan, Italy; (F.A.); (P.A.M.)
| | - Joel Fernando Soares Filipe
- Department of Veterinary Medicine and Animal Sciences, University of Milan, Via dell’Università 6, 26900 Lodi, Italy;
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Is Early Surgical Intervention Necessary for Acute Neonatal Humeral Epiphyseal Osteomyelitis: A Retrospective Study of 31 Patients. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040527. [PMID: 35455571 PMCID: PMC9028880 DOI: 10.3390/children9040527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/03/2022] [Accepted: 04/04/2022] [Indexed: 11/16/2022]
Abstract
Objective: To review the treatment experience of neonatal humeral epiphyseal osteomyelitis retrospectively. Study design: Retrospective cohort study of infants with neonatal humeral epiphyseal osteomyelitis. Patients were divided into conservative group and surgical group, and the surgical group was subdivided into early and delayed surgical group. Results: In total, there were 7 patients in the conservative group and 24 in the surgical group. The length of hospital stay and intravenous course of antibiotic therapy were both significantly shorter in the surgical group (p < 0.001). The full recovery rate was also higher in the surgical group (83.3%) than the conservative group (14.3%) (p < 0.001). Early surgery group (n = 14) had an insignificantly higher positive rate of pus/aspirate culture and full recovery rate than delayed surgery group (n = 10). Conclusion: Surgical treatment for neonatal humeral epiphyseal osteomyelitis demonstrated significantly higher rates of positive culture for the pathogen, a shorter course of intravenous oral antibiotics, and lower incidence of growth abnormality than conservative treatment. In our institution, most of culture outcome Gram-positive bacteria, and early surgical treatment was recommended with better outcome than delayed surgical group. Empirical antibiotics should be tailored to the epidemiological characteristics of local virulent bacteria.
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Exposure and Health Effects of Bacteria in Healthcare Units: An Overview. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12041958] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Healthcare units consist of numerous people circulating daily, such as workers, patients, and companions, and these people are vehicles for the transmission of microorganisms, such as bacteria. Bacteria species may have different allergenic, pathogenic, infectious, or toxic properties that can affect humans. Hospital settings foment the proliferation of bacteria due to characteristics present in the indoor hospital environment. This review article aims to identify the potential health effects caused by bacterial contamination in the context of healthcare units, both in patients and in workers. A search was carried out for articles published in PubMed, Web of Science and Scopus, between 1 January 2000 and 31 October 2021, using the descriptor hospital exposure assessment bacteria. This bibliographic research found a total of 13 articles. Bacteria transmission occurs mainly due to the contact between healthcare workers and patients or through the handling of/contact with contaminated instruments or surfaces. The most common bacterial contaminants are Escherichia coli, Pseudomonas aeruginosa, Staphylococcus spp., Staphylococcus aureus and Micrococcus luteus, and the principal health effects of these contaminants are hospital-acquired infections and infections in immunocompromised people. A tight control of the disinfection methods is thus required, and its frequency must be increased to remove the microbial contamination of wards, surfaces and equipment. A better understanding of seasonal variations is important to prevent peaks of contamination.
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Abstract
BACKGROUND Pediatric musculoskeletal infection (MSKI) is a bacterial infection of the bone, joint, and/or muscle that can be difficult to diagnose. The Kocher and Caird algorithms were developed to distinguish septic arthritis (SA) from transient synovitis (TS) in the hip. These algorithms have been applied to all patients presenting with painful, swollen monoarticular joints regardless of suspicion for SA. The aim of this analysis was to assess the test performance of Kocher and Caird to distinguish MSKI among all pediatric patients presenting with monoarticular joint pain. A secondary aim was to validate the original algorithms. METHODS We conducted a secondary analysis of a prospective cohort study evaluating the test performance of procalcitonin for suspected SA in a pediatric emergency department. Patients aged 0 to 16 years old who presented with a painful or swollen monoarticular joint were considered for enrollment. We compared the test performance of the traditional algorithms in an expanded population of MSKI versus alternate joint pain using sensitivity, specificity, and area under the curve (AUC). As a sensitivity analysis, missing data for predictors like temperature, erythrocyte sedimentation rate, C-reactive protein, and inability to bear weight were multiply imputed using the Stata program, mi impute, for changed equations. RESULTS The Caird algorithm had better test performance compared to the Kocher in all populations. Both algorithms were most discriminative in comparing SA to TS in all joints (AUC: 0.84 Caird and 0.75 Kocher). However, the Caird criteria performed almost as well discriminating MSKI from other causes of monoarticular joint pain in all joints (AUC: 0.79; 95% confidence interval: 0.72, 0.85) and nonhip joints (AUC: 0.80; 95% confidence interval: 0.71, 0.88). CONCLUSION Based on the findings of this study, it is clinically reasonable to apply the Caird algorithm to pediatric patients presenting with monoarticular joint pain of medium and large joints such as the knee, ankle, shoulder, elbow, and wrist, in addition to the hip. LEVEL OF EVIDENCE Level III-retrospective study of novel applications of SA algorithms.
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Diamond S, Vallejo JG, McNeil JC. Microbiology and Treatment Outcomes of Community-Acquired Hematogenous Osteoarticular Infections in Infants ≤12 Months of Age. J Pediatr 2022; 241:242-246.e1. [PMID: 34626668 DOI: 10.1016/j.jpeds.2021.09.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/20/2021] [Accepted: 09/30/2021] [Indexed: 10/20/2022]
Abstract
We investigated the microbiology, management, and orthopedic outcomes of osteoarticular infections in infants age ≤1 year at our institution. Among 87 patients, Staphylococcus aureus was the most common pathogen (44.8%), followed by group B Streptococcus. Twenty-nine patients (33%), with a median age of 9.2 months, were transitioned to oral antibiotic therapy after ≤14 days of parenteral therapy; orthopedic outcomes were similar to those with prolonged parenteral therapy.
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Affiliation(s)
- Sarah Diamond
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Jesus G Vallejo
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
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Alcobendas RM, Núñez E, Calvo C. Minimally invasive management of pediatric osteoarticular infections. Front Pediatr 2022; 10:1017035. [PMID: 36440331 PMCID: PMC9692125 DOI: 10.3389/fped.2022.1017035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Esmeralda Núñez
- Pediatrics Department, Hospital Materno-Infantil, Málaga, Spain
| | - Cristina Calvo
- Pediatric Infectious Diseases Department, Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain.,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain.,CIBER Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
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Ohta E, Setoue T, Ito K, Kojima K, Kodera T, Onda Y, Kawano H, Niimi T, Kakura H, Nagamitsu S. Septic arthritis in childhood: A 24-year review. Pediatr Int 2022; 64:e14993. [PMID: 34528332 DOI: 10.1111/ped.14993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND We investigated the pathogenic, clinical, and laboratory characteristics of children diagnosed with septic arthritis (SA) during the past 24 years and identified the risk factors for SA-related sequelae. METHODS We retrospectively reviewed the records of patients admitted to Fukuoka University Hospital from 1997 to 2020. Causative pathogens were compared between the first (1997-2008) and second (2009-2020) periods. We also compared the clinical and laboratory characteristics in patients with known or unknown pathogens, and in patients with or without sequelae. RESULTS A total of 37 patients with SA were identified, including 28 patients (76%) in the first period and nine patients (24%) in the second period. Sixteen of 37 patients (43%) were younger than 2 years, including two neonates. Pathogens were identified in 25 (68%) of 37 patients. Patients with known pathogens had a significantly higher C-reactive protein level on admission than those with unknown pathogens (P < 0.05). The predominant pathogen was Staphylococcus aureus (38%, 14/37). Although S. aureus and Hemophilus influenzae type b (Hib) were predominant pathogens in the first period, Hib was not found in the second period. Six (16%) of 37 patients with SA experienced sequelae. Moreover, the risk factors for the development of sequelae were significantly associated with infection at age <1 month and delayed surgical treatment (>4 days). CONCLUSIONS The incidence of SA had decreased dramatically in the second period, and Hib was no longer the predominant pathogen. Earlier surgical drainage should be performed in neonates with SA.
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Affiliation(s)
- Eiji Ohta
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Takashi Setoue
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Kazutoshi Ito
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kanako Kojima
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Tatsurou Kodera
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Yasuhiro Onda
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hiroyasu Kawano
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Toshikazu Niimi
- Division of Neonatology, Center for Maternal, Fetal and Neonatal Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Hiroya Kakura
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
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Darbà J, Marsà A. Hospital care and medical costs of septic arthritis in Spain: a retrospective multicenter analysis. J Med Econ 2022; 25:381-385. [PMID: 35236216 DOI: 10.1080/13696998.2022.2049149] [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] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to review the characteristics of patients admitted with septic arthritis in Spanish hospitals and to measure the associated direct medical costs. METHODS Hospital admission records of patients with septic arthritis as a primary diagnosis registered between 2010 and 2019 were evaluated in a retrospective study. Admission cost in the database is based on the diagnosis-related group-based hospital payment systems, determined by the Spanish Ministry of Health. RESULTS Files from 16,438 patients were evaluated; median age was 56 years and 62.8% of patients were males. Staphylococcus was the most frequently registered pathogen, and 2.7% of admissions registered an antibiotic-resistant infection. Median hospitalization time was 14 days for adult patients and 8 days for children, with an in-hospital mortality rate of 3.7% for adult patients, and no deaths registered in children. The median length of intensive care unit (ICU) stay was 3 days. The mean admission cost was €6,382 per patient, with no significant differences between age groups. Admission costs increased significantly with the length of hospital stay. The total medical cost reached 12.7 million euros per year, considering all patients in the database. CONCLUSIONS This study provides new data on the medical costs of septic arthritis in Spain, providing a basis for the revision of resource allocation decisions in order to reduce the burden of this condition at the healthcare system level. Further research will be required to quantify the total burden associated with this condition.
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Affiliation(s)
- Josep Darbà
- Department of Economics, Universitat de Barcelona, Barcelona, Spain
| | - Alicia Marsà
- Department of Health Economics, BCN Health Economics & Outcomes Research S.L, Barcelona, Spain
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Masci D, Rubino C, Basile M, Indolfi G, Trapani S. When the limp has a dietary cause: A retrospective study on scurvy in a tertiary Italian pediatric hospital. Front Pediatr 2022; 10:981908. [PMID: 36186634 PMCID: PMC9519129 DOI: 10.3389/fped.2022.981908] [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: 06/29/2022] [Accepted: 08/18/2022] [Indexed: 11/13/2022] Open
Abstract
The limping child frequently represents a diagnostic challenge. The differential diagnosis is broad and should include vitamin C deficiency. Scurvy, resulting from vitamin C deficiency, is the oldest-known nutritional disorder. Despite its rarity in developed countries, scurvy has been increasingly reported in recent years in pediatric patients, particularly those with autism or neurological disabilities. In the present retrospective study, we describe the clinical, laboratory, and radiological features of 8 patients diagnosed with scurvy in the Pediatrics Unit of Meyer Children's University Hospital, between January 2016 and December 2021. The majority (87%) were males, and the median age was 3.7 years. Half of the patients had comorbidities known to be risk factors for scurvy, while the remaining patients were previously healthy. All the children were admitted for musculoskeletal symptoms, ranging from lower limb pain (87%) to overt limping (87%). Mucocutaneous involvement was observed in 75% cases. Microcytic anemia and elevated inflammatory markers were common laboratory findings. Bone radiographs, performed on all patients, were often interpreted as normal at first, with osteopenia (62%) as the most frequent finding; notably, after re-examination, they were reported as consistent with scurvy in four patients. The most common magnetic resonance imaging findings were multifocal symmetrical increased signal on STIR sequence within metaphysis, with varying degrees of bone marrow enhancement, adjacent periosteal elevation and soft tissue swelling. Differential diagnosis was challenging and frequently required invasive diagnostic procedures like bone marrow biopsy, performed in the first three patients of our series. The median time frame between clinical onset and the final diagnosis was 35 days. Notably, the interval times between admission and diagnosis become progressively shorter during the study period, ranging from 44 to 2 days. Treatment with oral vitamin C led to improvement/resolution of symptoms in all cases. In conclusion, scurvy should be considered in the differential diagnosis in a limping child, performing a detailed dietary history and careful physical examination, looking for mucocutaneous lesions. A quick and correct diagnostic path avoids invasive diagnostic procedures and reduces the risk of long-term complications.
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Affiliation(s)
- Daniela Masci
- Post-graduate School of Pediatrics, University of Florence, Florence, Italy
| | - Chiara Rubino
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy
| | - Massimo Basile
- Radiology Unit, Meyer Children's University Hospital, Florence, Italy
| | - Giuseppe Indolfi
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.,Department of NEUROFARBA, University of Florence, Florence, Italy
| | - Sandra Trapani
- Pediatric Unit, Meyer Children's University Hospital, Florence, Italy.,Department of Health Sciences, Meyer Children's University Hospital, University of Florence, Florence, Italy
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Trivellas A, Brodke D, Hu V, de St Maurice A, Krogstad P, Silva M, Thompson RM. The utility of echocardiography in paediatric patients with musculoskeletal infections and bacteremia. J Child Orthop 2021; 15:577-582. [PMID: 34987668 PMCID: PMC8670541 DOI: 10.1302/1863-2548.15.210110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/07/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The clinical utility of echocardiography in the setting of a positive blood culture in paediatric patients presenting with osteomyelitis (OM) and/or septic arthritis (SA). METHODS Retrospective review between 2013 and 2019: Patients < 18 years with OM, SA or combined infection (OM+SA) were included. Patients were excluded for immunodeficiency, loss of follow-up or penetrating infection. Charts with positive blood cultures were reviewed for echocardiography on that admission. Demographic variables were compared utilizing the Student's t-test and Fisher's exact test. A multivariable linear regression model was constructed to examine the association between echocardiography and length of stay, controlling for age, sex, fever, white blood cell (WBC) on admission, antibiotic administration and surgery performed. RESULTS Of 157 patients with OM, SA or combined infection, 44 had a positive blood culture. In all, 26 had an echocardiogram, and none showed endocarditis. Echocardiography was independently associated with a 6.2-day length of stay increase. WBC count and surgical intervention demonstrated a trend toward significance in length of stay, with each WBC unit increase associated with a 0.53-day increase. Surgical intervention was associated with an average 6.3-day length of stay decrease. CONCLUSION No patient had a positive echocardiogram, and no changes in management were initiated. However, an echocardiogram increased stay by 6.2 days. In addition to costs associated with increased stay, patients were billed between $1460 and $1700 per echocardiogram. The utility of echocardiograms in the setting of bacteremia associated with musculoskeletal infections in the paediatric population should be re-examined, and guidelines should be updated to reflect the cost-benefit analysis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andromahi Trivellas
- Department of Orthopaedic Surgery, University of California, Los Angeles, California, United States,Correspondence should be sent to Andromahi Trivellas, Department of Orthopaedic Surgery, University of California, Los Angeles, California, United States. E-mail:
| | - Dane Brodke
- Department of Orthopaedic Surgery, University of California, Los Angeles, California, United States
| | - Vivian Hu
- David Geffen School of Medicine University of California, Los Angeles, California, United States
| | - Annabelle de St Maurice
- David Geffen School of Medicine University of California, Los Angeles, California, United States
| | - Paul Krogstad
- David Geffen School of Medicine University of California, Los Angeles, California, United States
| | - Mauricio Silva
- Renee Meyer Luskin Children’s Clinic, Orthopaedic Institute for Children, University of California, Los Angeles, California, United States
| | - Rachel M. Thompson
- Renee Meyer Luskin Children’s Clinic, Orthopaedic Institute for Children, University of California, Los Angeles, California, United States
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Predicting adjacent infections in pediatric septic arthritis: Do predictive criteria extrapolate across geographic regions?: Predicting Periarticular Infection in the Southeast. J Orthop 2021; 28:53-57. [PMID: 34840482 DOI: 10.1016/j.jor.2021.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/08/2021] [Accepted: 11/03/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose This study aims to assess previously determined predictive criteria for presence of adjacent infection in septic arthritis within a Southeastern United States (US) pediatric population. Results The sensitivity, specificity, positive predictive value, and negative predictive value of the Rosenfeld criteria were: 91.7%, 22.7%, 39.3%, and 83.3%, respectively. The patients with periarticular infection were more likely to have positive blood cultures than those with isolated septic arthritis. There was no difference in likelihood of secondary surgical intervention. Conclusions Previously defined criteria to predict adjacent infection in pediatric septic arthritis did not demonstrate external validity in a Southeastern US pediatric population.
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Jain MJ, Bradko V, Zhu H, Inneh I, Shinava VR. Pediatric osteoarticular infection: trend in surgically treated patients and association of methicillin-resistant Staphylococcus aureus with requirement of secondary procedures. J Pediatr Orthop B 2021; 30:579-584. [PMID: 33038147 DOI: 10.1097/bpb.0000000000000819] [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] [Indexed: 11/25/2022]
Abstract
Acute pediatric osteoarticular infection demonstrates variability in both presentation and response to treatment. Many respond to antibiotics ± single operation, while some require multiple surgeries. Currently, it is difficult to predict who may require additional procedures. Infections due to methicillin-resistant Staphylococcus aureus (MRSA) have been associated with more complications. The purpose of this study is to determine MRSA trends and degree of association with the occurrence of multiple procedures. We performed a retrospective analysis of surgically treated pediatric (1 month-18 years) patients for acute osteomyelitis and septic arthritis at a tertiary children's hospital from 2003-2017. The cohort was divided into single-procedure and multiple-procedure groups. A total of 753 patients were studied with a mean age of 7.05 years (2.4 months-17.9 years). We identified 645/753 (85.6%) patients who were treated with a single-procedure and 108/753 (14.4%) patients who required multiple- procedures. The lower extremity (hip, knee, tibia, and femur) was most commonly involved. The epidemiologic trend runs almost parallel between two groups with a peak in 2009. The odds ratio for multiple-procedures was 2.0 [95% confidence interval (CI), 1.2-3.1; P = 0.002] with dual infection (osteomyelitis + septic arthritis), 2.6 (95% CI, 1.6-4.4; P = 0.001) with high-risk conditions and 4.6 (95% CI, 3.0-7.1; P < 0.001) if MRSA was present. MRSA significantly predicts the requirement of additional operative procedures for the treatment of osteoarticular infections in children. Besides clinical deterioration and other markers, the presence of MRSA can be a considerable indicator for a planned secondary-procedure. Level III retrospective cohort study.
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Affiliation(s)
- Mohit J Jain
- Department of Pediatric Orthopedic Surgery, Texas Children's Hospital
- Department of Orthopedic Surgery, Baylor College of Medicine
| | - Viachaslau Bradko
- Department of Pediatric Orthopedic Surgery, Texas Children's Hospital
- Department of Orthopedic Surgery, Baylor College of Medicine
| | - Huirong Zhu
- Outcomes and Statistical Services, Texas Children's Hospital, Houston, Texas, USA
| | - Ifeoma Inneh
- Department of Pediatric Orthopedic Surgery, Texas Children's Hospital
- Department of Orthopedic Surgery, Baylor College of Medicine
| | - Vinitha R Shinava
- Department of Pediatric Orthopedic Surgery, Texas Children's Hospital
- Department of Orthopedic Surgery, Baylor College of Medicine
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Gamalero L, Ferrara G, Giani T, Cimaz R. Acute Arthritis in Children: How to Discern between Septic and Non-Septic Arthritis? CHILDREN (BASEL, SWITZERLAND) 2021; 8:912. [PMID: 34682177 PMCID: PMC8535083 DOI: 10.3390/children8100912] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/27/2021] [Accepted: 10/07/2021] [Indexed: 12/03/2022]
Abstract
The term septic arthritis refers to an infection of the synovial space. This is an infrequent condition in healthy children, but it should be considered a medical emergency potentially leading to irreversible articular damage. Therefore, prompt diagnosis and antimicrobial treatment play a crucial role in improving the prognosis. Although septic arthritis is the most common cause of acute arthritis, many other diseases may mimic a similar clinical picture, constituting a diagnostic challenge for the clinician who first approaches the patient. Herein we analyze the main features of septic arthritis, offering an overview of the main conditions involved in the differential diagnosis and suggesting a diagnostic workup plan.
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Affiliation(s)
- Lisa Gamalero
- Department of Medicine, University of Udine, 33100 Udine, Italy;
| | | | - Teresa Giani
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
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Diagnosis and Management of Osteomyelitis in Children. Curr Infect Dis Rep 2021. [DOI: 10.1007/s11908-021-00763-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Good JJ, Rabener MJ, Fisher GW. Using a decision tool to evaluate for osteomyelitis in children. JAAPA 2021; 34:29-32. [PMID: 34582383 DOI: 10.1097/01.jaa.0000750960.75057.e1] [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: 11/26/2022]
Abstract
ABSTRACT Osteomyelitis is a common occurrence in children and typically has a prolonged treatment course involving multiple specialties. Historically, the long bones are most commonly affected and Staphylococcus aureus is the primary causative organism.This case shows the value of using the Kocher criteria and acute phase reactant C-reactive protein as diagnostic tools that can be used to advocate MRI to rule out this potentially devastating process.
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Affiliation(s)
- Jason J Good
- Jason J. Good practices in the ED at Wright-Patterson Medical Center, Wright Patterson AFB, Ohio. Michael J. Rabener is program director of the US Air Force Emergency Medicine PA DSc residency at the San Antonio (Tex.) Military Medical Center. Geoffrey W. Fisher practices as a Battalion Flight Surgeon with the 2-10 Aviation Helicopter Battalion, 10th Calvary Brigade, Fort Drum, New York. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Gopikrishnan KGP, Chandher KN, Jagadeeswari S. A CASE OF NEONATAL OSTEOMYELITIS. GOMAL JOURNAL OF MEDICAL SCIENCES 2021. [DOI: 10.46903/gjms/19.03.1032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Acute hematogenous osteomyelitis of neonatal origin is very rare in clinical studies. Early diagnosis and treatment are important to decrease the morbidity. The aim is to provide a reference case for medical practitioners for early diagnosis and treatment of cases like this with symptoms, signs, blood investigations, radiological studies and blood culture outcomes. There have not been any adverse sequelae after effective antibiotic therapy. Timely diagnosis and management of neonatal osteomyelitis are of significant importance.
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Musso P, Parigi S, Bossi G, Marseglia GL, Galli L, Chiappini E. Epidemiology and Management of Acute Hematogenous Osteomyelitis, Neonatal Osteomyelitis and Spondylodiscitis in a Third Level Paediatric Center. CHILDREN-BASEL 2021; 8:children8080616. [PMID: 34438507 PMCID: PMC8391380 DOI: 10.3390/children8080616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/12/2023]
Abstract
Acute hematogenous osteomyelitis (AHOM) is a rare pathology in pediatric population. The aim of this study is to analyse the epidemiological data and the management, compared to European Society for Paediatric Infectious Disease (ESPID, European Society for Pediatric Infectious Diseases) guidelines 2017 of 216 children with AHOM, divided in three cohorts (neonatal-onset osteomyelitis, those with vertebral involvement and other types of osteomyelitis). We conducted a retrospective single center study, evaluating data from all the children (aged 0–18 years) consecutively admitted to the Meyer Children’s Hospital, during a period of ten years (1 January 2010–31 December 2019). Isolation of pathogen was possible in 65 patients and S. aureus was the most frequently involved (43/65 children). Magnetic Resonance Imaging (MRI, magnetic resonance imaging) was performed in 201/216 cases and was compatible with osteomyelitis in 185/201 of these children (92.03%). In the neonatal-onset osteomyelitis group the percentage of diagnostic ultrasound for osteomyelitis was 36.36% significantly higher than the other groups. The median duration of total antibiotic therapy was 37.5 days. In total, 186/199 children recovered without complications. The present study delineates three heterogeneous cohorts of patients. S. aureus is confirmed as the first pathogen for isolation in all three groups analysed. MRI represent a gold standard for diagnosis. Longer duration of antibiotics treatment was performed in neonatal and spondylodiscitis group, compared to the other types of osteomyelitis.
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Affiliation(s)
- Paola Musso
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (G.B.); (G.L.M.)
- Correspondence:
| | - Sara Parigi
- Department of Health Sciences, University of Florence, 50100 Florence, Italy; (S.P.); (L.G.); (E.C.)
| | - Grazia Bossi
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (G.B.); (G.L.M.)
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (G.B.); (G.L.M.)
| | - Luisa Galli
- Department of Health Sciences, University of Florence, 50100 Florence, Italy; (S.P.); (L.G.); (E.C.)
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, 50100 Florence, Italy; (S.P.); (L.G.); (E.C.)
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Shaikh N, Umscheid J, Rizvi S, Bhatt P, Vasudeva R, Yagnik P, Bhatt N, Donda K, Dapaah-Siakwan F. National Trends of Acute Osteomyelitis and Peripherally Inserted Central Catheters in Children. Hosp Pediatr 2021; 11:662-670. [PMID: 34187789 DOI: 10.1542/hpeds.2020-005794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Although a growing body of evidence suggests that early transition to oral antimicrobial therapy is equally efficacious to prolonged intravenous antibiotics for treatment of acute pediatric osteomyelitis, little is known about the pediatric trends in peripherally inserted central catheter (PICC) placements. Using a national database, we examined incidence rates of pediatric hospitalizations for acute osteomyelitis in the United States from 2007 through 2016, as well as the trends in PICC placement, length of stay (LOS), and cost associated with these hospitalizations. METHODS This was a retrospective, serial cross-sectional study of the National Inpatient Sample database from 2007 through 2016. Patients ≤18 years of age with acute osteomyelitis were identified by using appropriate diagnostic codes. Outcomes measured included PICC placement rate, LOS, and inflation-adjusted hospitalization costs. Weighted analysis was reported, and a hierarchical regression model was used to analyze predictors. RESULTS The annual incidence of acute osteomyelitis increased from 1.0 to 1.8 per 100 000 children from 2007 to 08 to 2015 to 16 (P < .0001), whereas PICC placement rates decreased from 58.8% to 5.9% (P < .0001). Overall, changes in LOS and inflation-adjusted hospital costs were not statistically significant. PICC placements and sepsis were important predictors of increased LOS and hospital costs. CONCLUSIONS Although PICC placement rates for acute osteomyelitis significantly decreased in the face of increased incidence of acute osteomyelitis in children, LOS and hospital costs for all hospitalizations remained stable. However, patients receiving PICC placements had longer LOS. Further studies are needed to explore the long-term outcomes of reduced PICC use.
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Affiliation(s)
- Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Illinois;
| | - Jacob Umscheid
- School of Medicine, University of Kansas, Wichita, Kansas
| | - Syed Rizvi
- Department of Pediatrics, St. Louis University, St. Louis, Missouri
| | - Parth Bhatt
- United Hospital Center, Bridgeport, West Virginia
| | | | - Priyank Yagnik
- School of Medicine, University of Kansas, Wichita, Kansas
| | - Neel Bhatt
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, Washington
| | - Keyur Donda
- Department of Pediatrics, University of South Florida, Tampa, Florida; and
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Henry M, Lundy FH. Oral Antibiotic Management of Acute Osteomyelitis of the Hand: Outcomes and Cost Comparison to Standard Intravenous Regimen. Hand (N Y) 2021; 16:535-541. [PMID: 34260293 PMCID: PMC8283108 DOI: 10.1177/1558944719873145] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Acute, direct inoculation osteomyelitis of the hand has traditionally been managed by intravenous antibiotics. With proven high levels of bone and joint penetration, specific oral antimicrobials may deliver clinical efficacy but at substantially lower cost. Methods: Sixty-nine adult patients with surgically proven acute, direct inoculation osteomyelitis of the hand were evaluated for clinical response on a 6-week postdebridement regimen of susceptibility-matched oral antibiotics. Inclusion required gross purulence and bone loss demonstrated at the initial debridement and radiographic evidence of bone loss. Excluded were 2 patients with extreme medical comorbidities. There were 53 men and 16 women with a mean age of 46 years. Mean follow-up was 16 weeks (±10). The cost model for the outpatient oral antibiotic treatment was intentionally maximized using Walgreen's undiscounted cash price. The cost model for the traditional intravenous treatment regimen was intentionally minimized using the fully discounted Medicare fee schedule. Results: All patients achieved resolution of osteomyelitis by clinical and radiographic criteria. In addition, 7 patients underwent successful subsequent osteosynthesis procedures at the previously affected site without reactivation. The mean postdebridement direct cost of care per patient in the study cohort was $482.85, the cost of the antibiotic alone. The postdebridement direct cost of care per patient on a regimen of vancomycin 1.5 g every 12 hours via peripherally inserted central catheter line was $21 646.90. Conclusions: Acute, direct inoculation osteomyelitis of the hand can be successfully managed on oral antibiotic agents with substantial direct and indirect cost savings.
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Affiliation(s)
- Mark Henry
- Hand & Wrist Center of Houston, TX, USA,Mark Henry, Hand & Wrist Center of Houston, 1200 Binz Street, 13th Floor, Houston, TX 77006, USA.
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Schuler R, Ehrhardt H, Zimmer KP, Berthold D, Trauth J, Fölsch C, Waitz M. Newborn Septic Arthritis-A Rare Presentation of Late-Onset Group B Streptococcal Disease: Case Report and Short Review of the Literature. AJP Rep 2021; 11:e123-e126. [PMID: 34603843 PMCID: PMC8483893 DOI: 10.1055/s-0041-1735633] [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: 04/13/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022] Open
Abstract
Group B Streptococcus (GBS) disease is a leading cause of invasive bacterial infections among neonates. We present the case of an 11-day-old neonate with septic arthritis as a rare presentation of late-onset disease (LOD) with a favorable short-term outcome. GBS is a leading cause of neonatal infection. Early-onset disease (EOD) is defined as infection from birth to 6 days of age, while LOD occurs from 7 days to approximately 3 months of age. EOD is acquired through vertical transmission and can be reduced through application of intrapartum antibiotic prophylaxis (IAP). LOD can be acquired from the mother or from environmental sources, unlikely to be prevented by IAP. The most common presentation of EOD is bacteremia (83%), pneumonia (9%), and meningitis (7%). While the clinical picture in both EOD and LOD frequently resembles in LOD hamatogenous spreading may predispose neonates to present with uncommon organ manifestation other than the classic systemic signs of sepsis, for example, septic arthritis. Herein, we report on the management and outcome of a term neonate with late onset GqBS bacteremia and subtle clinical symptoms of septic monoarthritis.
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Affiliation(s)
- Rahel Schuler
- Department of General Pediatrics and Neonatology, Justus Liebig University, Giessen, Germany
| | - Harald Ehrhardt
- Department of General Pediatrics and Neonatology, Justus Liebig University, Giessen, Germany
| | - Klaus-Peter Zimmer
- Department of General Pediatrics and Neonatology, Justus Liebig University, Giessen, Germany
| | - Daniel Berthold
- Department of Diagnostic and Interventional Radiology, University Hospital Giessen, Justus Liebig University, Giessen, Germany
| | - Janina Trauth
- Department of Medicine II, Section of Infectious Diseases, Justus Liebig University, Giessen, Germany
| | - Christian Fölsch
- Department of Orthopaedic Surgery, Justus-Liebig-University, Giessen, Germany
| | - Markus Waitz
- Department of General Pediatrics and Neonatology, Justus Liebig University, Giessen, Germany
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