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Ganta A, Merrell LA, Adams J, Konda SR, Egol KA. Retention of Antibiotic Cement Delivery Implants in Orthopedic Infection Associated With United Fractures Does Not Increase Recurrence Risk. J Orthop Trauma 2024; 38:190-195. [PMID: 38206770 DOI: 10.1097/bot.0000000000002771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/13/2024]
Abstract
OBJECTIVES To evaluate whether retention of antibiotic cement delivery devices after resolution of orthopaedic infection is associated with recurrence. METHODS DESIGN Retrospective cohort. SETTING Academic medical center. PATIENT SELECTION CRITERIA Patients with a fracture definitively treated with internal fixation that went on to unite and develop a confirmed fracture-related infection or osteomyelitis after a remote fracture surgery and had implantation of antibiotic-impregnated cement for infection management. OUTCOME MEASURES AND COMPARISONS Patients were divided into whom the antibiotic implants were retained (Retained Cohort) and whom the antibiotic implants were removed (Removed Cohort). Outcome measures included clinical infection resolution, infection recurrence, time to resolution of infection signs, symptoms and laboratory values, reoperation and readmission rates, and need for soft tissue coverage (local flap vs. free tissue transfer) because of recurrence. RESULTS Of 98 patients treated for fracture-related infection in united fractures or osteomyelitis after a remote fracture surgery, 39 (39.8%) underwent implantation of antibiotic-impregnated cement delivery devices: 21 (21.4%) beads, 7 (7.1%) rods, and 11 (11.2%) blocks. Twenty patients (51.3%) comprised the Retained Cohort and 19 patients (48.7%) comprised the Removed Cohort. There were few differences in demographics ([American Society of Anesthesiology Score, P = 0.026] and [diabetes, P = 0.047]), infection location, and pathogenic profiles. The cohorts demonstrated no difference in eventual resolution of infection (100% in the Retained Cohort, 95% in the Removed Cohort, P = 0.487) and experienced similar time to clinical infection resolution, based on signs, symptoms, and laboratory values ( P = 0.360). There was no difference in incidence of subsequent infection recurrence after clinical infection resolution (1 recurrence Retained vs. 2 recurrences Removed, P = 0.605) for those considered "cured." Compared with the Retained Cohort, the Removed Cohort underwent more reoperations (0.40 vs. 1.84 reoperations, P < 0.001) and admissions after implantation ( P < 0.001). CONCLUSIONS Retention of antibiotic-impregnated cement delivery devices in patients with orthopaedic infection after fractured bones that have healed was not associated with infection recurrence. Additional surgical intervention with the sole purpose of removing antibiotic delivery devices may not be warranted. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Abhishek Ganta
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Lauren A Merrell
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Jack Adams
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
| | - Sanjit R Konda
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
| | - Kenneth A Egol
- Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital, New York, NY; and
- Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, NY
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Scarallo L, Knafelz D, Arrigo S, Felici E, Lionetti P. Prevalence and features of chronic nonbacterial osteomyelitis in a cohort of children with inflammatory bowel diseases. Dig Liver Dis 2024; 56:537-539. [PMID: 38233314 DOI: 10.1016/j.dld.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 01/19/2024]
Affiliation(s)
- Luca Scarallo
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department Neurofarba, University of Florence, Italy
| | - Daniela Knafelz
- Pediatric Gastroenterology Unit, Bambino Gesù Hospital, Rome, Italy
| | - Serena Arrigo
- Pediatric Gastroenterology and Endoscopy Unit, IRCSS Giannina Gaslini, Genoa, Italy
| | - Enrico Felici
- Pediatrics and Pediatric Emergency Unit, Children Hospital, AO SS Antonio e Biagio e C. Arrigo, Alessandria, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital IRCCS, Florence, Italy; Department Neurofarba, University of Florence, Italy.
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Jansen RB, Nilsson J, Buch-Larsen K, Kofod T, Schwarz P. Treatment Effect of Zoledronic Acid in Chronic Non-bacterial Osteomyelitis of the Jaw: A Case Series. Calcif Tissue Int 2024; 114:129-136. [PMID: 37991563 PMCID: PMC10803718 DOI: 10.1007/s00223-023-01154-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/26/2023] [Indexed: 11/23/2023]
Abstract
Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory, osteolytic bone disorder sometimes localized to a unifocal site in the jaw, causing long-term pain and reduced function. The aim of this study was to describe the patients with CNO of the jaw, focusing on treatment with zoledronic acid for pain relief. An analysis of medical records of 24 patients with CNO of the jaw, including treatment with zoledronic acid and effects on pain relief. Descriptive statistics and nonparametric tests were used to describe the population and compare treatment effects, respectively. The average treatment period was 33.4 months (median 23; Q1 11.5; Q3 42.0) with an average of 4.1 infusions (median 3; Q1 2; Q3 5) of zoledronic acid. The average pain VAS score (visual analogue scale) was significantly reduced from 7.7 (median 8; Q1 6.5; Q3 8.5) to 2.5 points (median 2; Q1 0.5; Q3 4.5) (p < 0.001). At final visit, 46% of patients reported no pain and 38% reported a reduction of pain. At least 67% of patients had at least one episode of pain recurrence, and most patients experienced the first recurrence within a year of initial treatment. Four patients (16%) had no pain relief from the treatment. In this group of patients with CNO of the jaw, there was a positive response to treatment with zoledronic acid on pain relief, averaging 5.2 points on a pain VAS score, with 84% of patients treated experiencing either a partial or a total reduction in pain after about 2.5 years.
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Affiliation(s)
- Rasmus Bo Jansen
- Department of Endocrinology, Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark.
| | - Johanna Nilsson
- Department of Oral and Maxillofacial Surgery, Rigshospitalet Copenhagen, Denmark
| | - Kristian Buch-Larsen
- Department of Endocrinology, Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
| | - Thomas Kofod
- Department of Oral and Maxillofacial Surgery, Rigshospitalet Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Bone-Metabolic Research Unit, Rigshospitalet, Copenhagen, Denmark
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Tuon FF, Mendonça CJA, Gasperin W, Zotto WL, Sarolli BMS, da Costa Manuel JA, Cruz JAW, Soni JF. Prevalence of radiographic findings in chronic osteomyelitis. BMC Musculoskelet Disord 2024; 25:75. [PMID: 38238672 PMCID: PMC10795221 DOI: 10.1186/s12891-023-07121-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 12/14/2023] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Simple radiography in conjunction with pertinent medical history and a comprehensive physical examination is typically adequate for diagnosing chronic osteomyelitis (CO). However, radiographic manifestations of CO lack specificity; therefore, the concordance among specialists in this regard has not been systematically assessed. This study aimed to compare and evaluate the proficiency of orthopedic surgeons and radiologists in identifying radiographic indicators present in simple radiographs for diagnosing CO. METHODS This cross-sectional study was a correlational investigation utilizing plain radiographs obtained from a cohort of 60 patients diagnosed with CO. Comprehensive assessments of the demographic and clinical characteristics, comorbidities, and microbiological parameters were conducted. Additional variables included the anatomical location of the CO, existence of fistulas, disease duration, and presence of pseudoarthrosis. This study meticulously documented the presence or absence of six specific findings: bone destruction, which incorporates erosion and radiolucencies around implants; bone sclerosis; cortical thinning concomitant with erosion; cortical thickening; sequestrum formation; and soft-tissue swelling. RESULTS Most patients were men (75%), with a mean age of 45.1 years. Hematogenous etiology of CO represented 23%. Bone sclerosis (71.3%) and cortical thickening (67.7%) were the most common radiographic findings, followed by soft-tissue swelling (51.3%), sequestration (47.3%), bone destruction (33.3%), and cortical erosion (30.3%). The mean agreement was 74.2%, showing a marked disagreement rate of 25.8% among all radiographic findings. The presence or absence of soft tissue edema, a prominent radiographic finding that was more important than the other findings, showed the greatest disagreement. CONCLUSIONS Radiographic findings in CO were universally observed in all patients, demonstrating a high degree of concordance among specialists, with the exception of soft tissue swelling.
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Affiliation(s)
- Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica Do Paraná, Curitiba, PR, 80215-901, Brazil
| | | | - Wagner Gasperin
- Department of Orthopedics, Hospital de Clínicas da UFPR, Curitiba, PR, 80060-900, Brazil
| | | | | | | | - June Alisson Westarb Cruz
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica Do Paraná, Curitiba, PR, 80215-901, Brazil
| | - Jamil Faissal Soni
- Laboratory of Emerging Infectious Diseases, School of Medicine, Pontifícia Universidade Católica Do Paraná, Curitiba, PR, 80215-901, Brazil
- Department of Orthopedics, Hospital de Clínicas da UFPR, Curitiba, PR, 80060-900, Brazil
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Schmidt BM, Keeney-Bonthrone TP, Hawes AM, Karmakar M, Frydrych LM, Cinti SK, Pop-Busui R, Delano MJ. Comorbid status in patients with osteomyelitis is associated with long-term incidence of extremity amputation. BMJ Open Diabetes Res Care 2023; 11:e003611. [PMID: 38164707 PMCID: PMC10729224 DOI: 10.1136/bmjdrc-2023-003611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/14/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION Osteomyelitis is associated with significant morbidity, including amputation. There are limited data on long-term amputation rates following an osteomyelitis diagnosis. We sought to determine the incidence of amputation in patients with osteomyelitis over 2 years. RESEARCH DESIGN AND METHODS Observational cohort study of 1186 inpatients with osteomyelitis between 2004 and 2015 and stratified by osteomyelitis location status to evaluate the impact on amputation, mortality rates, readmission data, and inpatient days. RESULTS Persons with diabetes had 3.65 times greater probability of lower extremity amputation (p<0.001), readmission (p<0.001), and longer inpatient stay (p<0.001) and had higher 2-year mortality (relative risk (RR) 1.23, p=0.0027), adjusting for risk factors. Male gender (RR 1.57, p<0.001), black race (RR 1.41, p<0.05), former smoking status (RR 1.38, p<0.01), myocardial infarction (RR 1.72, p<0.001), congestive heart failure (RR 1.56, p<0.001), peripheral vascular disease (RR 2.25, p<0.001) and renal disease (RR 1.756, p<0.001) were independently associated with amputation. Male gender (RR 1.39, p<0.01), black race (RR 1.27, p<0.05), diabetes (RR 2.77, p<0.001) and peripheral vascular disease (RR 1.59, p<0.001) had increased risk of lower, not upper, extremity amputation. CONCLUSIONS Patients with osteomyelitis have higher rates of amputation and hospitalization. Clinicians must incorporate demographic and comorbid risk factors to protect against amputation.
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Affiliation(s)
- Brian M Schmidt
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Armani M Hawes
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Monika Karmakar
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Lynn M Frydrych
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Sandro K Cinti
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rodica Pop-Busui
- Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Matthew J Delano
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
- Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
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Kinamon T, Dagher M, Park L, Ruffin F, Fowler VG, Maskarinec SA. Risk Factors and Outcomes of Hematogenous Vertebral Osteomyelitis in Patients With Staphylococcus aureus Bacteremia. Clin Infect Dis 2023; 77:1226-1233. [PMID: 37747828 PMCID: PMC10640688 DOI: 10.1093/cid/ciad377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Hematogenous vertebral osteomyelitis (HVOM) is an incompletely understood complication of Staphylococcus aureus bacteremia (SAB). METHODS Eligible SAB patients with and without HVOM were prospectively enrolled from 1995 through 2019 at Duke University Health System. HVOM was diagnosed either radiographically or microbiologically. Multivariable logistic regression analysis was performed to identify clinical and microbial factors associated with HVOM risk. All bloodstream S. aureus isolates were genotyped using spa typing. RESULTS Of 3165 cases of SAB, 127 (4.0%) developed HVOM. Patients who experienced HVOM were more likely to have community-acquired SAB (30.7% vs 16.7%, P < .001), have a longer time to diagnosis of SAB (median, 5 days; interquartile range [IQR], 2-10.5 vs median, 2 days; IQR, 0-4; P < .001), and to exhibit persistent bacteremia (48.8% vs 20.6%, P < .001). A significant number of HVOM patients developed infective endocarditis (26% vs 15.2%, P = .002). Overall, 26.2% (n = 33) of SAB patients with HVOM underwent surgical intervention. Methicillin resistance (46.6% vs 41.7%, P = .318) and bacterial genotype were not associated with the development of HVOM. At the 12-month follow-up, 22% of patients with HVOM had died. Of the surviving patients, 20.4% remained on antibiotic therapy, and 29.6% had recurrence of either HVOM or SAB. CONCLUSIONS Among patients with SAB, HVOM risk was associated with clinical factors and not bacterial genotype. Despite being a rare complication of SAB, patients with HVOM had high all-cause mortality rates and healthcare resource requirements up to 1 year after their HVOM diagnosis. Close clinical monitoring is indicated in this vulnerable population.
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Affiliation(s)
- Tori Kinamon
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Michael Dagher
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Lawrence Park
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Felicia Ruffin
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Stacey A Maskarinec
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
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Dehne LM, Foertsch MJ, Droege CA, Makley AT, Mosher DR, Philpott CD, Sagi HC, Mueller EW, Droege ME. Antibiotic Duration Following Abdominal Gunshot Injuries With Associated Pelvis or Spine Involvement: A 20-Year Single-Center Experience. J Surg Res 2023; 291:97-104. [PMID: 37354706 DOI: 10.1016/j.jss.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 05/04/2023] [Accepted: 05/15/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Optimal antimicrobial prophylaxis duration following gunshot wounds (GSW) to the abdomen with an associated orthopedic fracture is unknown. This study evaluated the safety and efficacy of short versus long courses of prophylactic antibiotics following penetrating hollow viscus injury with communicating orthopedic fracture. METHODS This retrospective study included adult patients admitted to the trauma service over a 20-y period who sustained an abdominal GSW with hollow viscus injury and communicating spine or pelvic fractures. Patients were stratified into cohorts based on prophylactic antibiotic duration: short course (SC, ≤48 h) and long course (>48 h). The primary outcome was the incidence of osteomyelitis and meningitis up to 1-y postinjury. Secondary outcomes included hospital length of stay and the incidence of multidrug-resistant organisms and Clostridioides difficile infections. Risk factors for osteomyelitis and meningitis were determined. RESULTS A total of 125 patients were included with 45 (36%) in the SC group. Median prophylactic antibiotic durations were SC, 1 (interquartile range [IQR], 1-2) versus long course, 7 (IQR, 5-7) d (P < 0.001). There was no difference in osteomyelitis and meningitis incidence (2 [4.4%] versus 4 [5%], P = 0.77). Median hospital length of stay (7 [IQR, 6-11] versus 9 [IQR, 6-15] d, P = 0.072) and incidence of multidrug-resistant organisms (6 [13.3%] versus 13 [16.3%], P = 0.86) and Clostridioides difficile infections (0 [0%] versus 1 [1.3%], P = 0.77) were similar between groups. There were no independent risk factors identified for osteomyelitis or meningitis. CONCLUSIONS A shorter course of antibiotic prophylaxis ≤48 h may be adequate following abdominal GSW that traverses a hollow viscus and results in pelvic fracture or spinal column injury.
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Affiliation(s)
- Lauren Michelle Dehne
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio.
| | - Madeline Jane Foertsch
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Christopher Allen Droege
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Amy Teres Makley
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Carolyn Dosen Philpott
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Henry Claude Sagi
- Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric William Mueller
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
| | - Molly Elizabeth Droege
- Department of Pharmacy Services, UC Health - University of Cincinnati Medical Center, Cincinnati, Ohio; University of Cincinnati James L. Winkle College of Pharmacy, Cincinnati, Ohio
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Zhang H, Huang C, Bai J, Wang J. Effect of diabetic foot ulcers and other risk factors on the prevalence of lower extremity amputation: A meta-analysis. Int Wound J 2023; 20:3035-3047. [PMID: 37095728 PMCID: PMC10502264 DOI: 10.1111/iwj.14179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/26/2023] Open
Abstract
A meta-analysis study was conducted to measure the consequence of diabetic foot ulcers (DFUs) and other risk factors (RFs) on the prevalence of lower extremity amputation (LEA). A comprehensive literature inspection till February 2023 was applied and 2765 interrelated studies were reviewed. Of the 32 chosen studies enclosed, 9934 subjects were in the chosen studies' starting point, and 2906 of them were with LEA. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the effect of DFUs and other RFs on the prevalence of LEA by the continuous and dichotomous approaches and a fixed or random effect model. Male gender (OR, 1.30; 95% CI, 1.17-1.44, P < .001), smoking (OR, 1.24; 95% CI, 1.01-1.53, P = .04), previous foot ulcer (OR, 2.69; 95% CI, 1.93-3.74, P < .001), osteomyelitis (OR, 3.87; 95% CI, 2.28-6.57, P < .001), gangrene (OR, 14.45; 95% CI, 7.03-29.72, P < .001), hypertension (OR, 1.17; 95% CI, 1.03-1.33, P = .01), and white blood cells count (WBCC) (MD, 2.05; 95% CI, 1.37-2.74, P < .001) were significantly shown to be an RF in LEA in subjects with DFUs. Age (MD, 0.81; 95% CI, -0.75 to 2.37, P = .31), body mass index (MD, -0.55; 95% CI, -1.15 to 0.05, P = .07), diabetes mellitus type (OR, 0.99; 95% CI, 0.63-1.56, P = .96), and glycated haemoglobin (MD, 0.33; 95% CI, -0.15 to 0.81, P = .17) were not shown to be an RF in LEA in subjects with DFUs. Male gender, smoking, previous foot ulcer, osteomyelitis, gangrene, hypertension, and WBCC were significantly shown to be an RF in LEA in subjects with DFUs. However, age and diabetes mellitus type were not shown to be RF in LEA in subjects with DFUs. However, caused of the small sample sizes of several chosen studies for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Huiling Zhang
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
| | - Chuanwang Huang
- Department of Orthopedic SurgeryLiaocheng People's HospitalShandongChina
| | - Jie Bai
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
| | - Jing Wang
- Department of Endocrinology and MetabologyLiaocheng People's HospitalShandongChina
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Jaroenarpornwatana A, Koonalinthip N, Chawaltanpipat S, Janchai S. Is the duration of diabetic foot ulcers an independent risk factor for developing diabetic foot osteomyelitis? Foot (Edinb) 2023; 56:102000. [PMID: 36905796 DOI: 10.1016/j.foot.2023.102000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 02/16/2023] [Accepted: 03/05/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVE This study aimed to determine whether the prolonged duration of diabetic foot ulcers was associated with an increased incidence of diabetic foot osteomyelitis. STUDY DESIGN A retrospective cohort study METHODS: The medical records of all patients who participated in the diabetic foot clinic between January 2015 and December 2020 were reviewed. Patients with new diabetic foot ulcers were monitored for diabetic foot osteomyelitis. The collected data included the patient's profile, comorbidities and complications, the ulcer profile (area, depth, location, duration, number of ulcers, inflammation, and history of the previous ulcer), and outcome. Univariate and multivariate Poisson regression analyses were used to assess risk variables for diabetic foot osteomyelitis. RESULTS Eight hundred and fifty-five patients were enrolled; 78 developed diabetic foot ulcers (cumulative incidence 9% over 6 years, average annual incidence 1.5%) and among these diabetic foot ulcers, 24 developed diabetic foot osteomyelitis (cumulative incidence 30% over 6 years, average annual incidence of 5%, incidence rate 0.1/person-year). Statistically significant risk factors for the development of diabetic foot osteomyelitis were ulcers that were deep to the bone (adjusted risk ratio 2.50, p = 0.04) and inflamed wounds (adjusted risk ratio 6.20, p = 0.02). The duration of diabetic foot ulcers was not associated with diabetic foot osteomyelitis (adjusted risk ratio 1.00, p = 0.98). CONCLUSION The duration was not an associated risk factor for diabetic foot osteomyelitis, while bone-deep ulcers and inflamed ulcers were found to be significant risk factors for the development of diabetic foot osteomyelitis.
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Affiliation(s)
- Araya Jaroenarpornwatana
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross society, Bangkok, Thailand; Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nantawan Koonalinthip
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross society, Bangkok, Thailand; Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Siriporn Chawaltanpipat
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Siriporn Janchai
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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McCranie AS, Constantine RS, Lee N, Le ELH, Gehring M, Iorio ML. Risk factors associated with pressure ulcer recurrence after reconstruction: Analysis of a national database. Wound Repair Regen 2023; 31:641-646. [PMID: 37583305 DOI: 10.1111/wrr.13110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 06/27/2023] [Accepted: 07/07/2023] [Indexed: 08/17/2023]
Abstract
In this study, we sought to clarify the patient traits and comorbidities that are associated with pressure injury recurrence following pressure injury reconstruction. An insurance claims database, PearlDiver, was used to conduct a retrospective cohort study. The two cohorts included patients who underwent pressure injury reconstruction without recurrence and patients who experienced recurrence with subsequent reconstruction. Multiple logistic regression analysis was used to identify risk factors for recurrence after reconstruction. Recurrence was associated with hypoalbuminemia (p < 0.05), paraplegia (p < 0.05), and osteomyelitis (p < 0.05). In patients with osteomyelitis, primary closure was associated with recurrence (p < 0.05) while flap reconstruction was not (p > 0.05). Osteomyelitis was not associated with recurrence after flap reconstruction. Prior to reconstruction, patients with osteomyelitis and hypoalbuminemia should have their nutrition and infection optimised.
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Affiliation(s)
- Alec S McCranie
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ryan S Constantine
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nayun Lee
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elliot L H Le
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Gehring
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Matthew L Iorio
- Plastic Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Hunter S, Baker JF. Quality of life in children up to 13 years following acute haematogenous osteomyelitis. J Pediatr Orthop B 2023; 32:490-496. [PMID: 36445352 DOI: 10.1097/bpb.0000000000001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Acute haematogenous osteomyelitis (AHO) remains a cause of severe illness among children with the possibility of long-term consequences for growth and development. Previous research on sequelae from AHO rarely considers outcomes more than 2 years following treatment. This study aims to establish the quality of life of patients diagnosed with AHO in childhood up to 13 years after diagnosis, evaluating the impact on social, emotional, physical, and school function. Children treated for AHO between 2008 and 2018 at a tertiary referral centre in New Zealand were identified. Paediatric Quality of Life Inventory (PedsQL) questionnaires were conducted via phone with either the child or primary caregiver and responses analysed. Forty patients met inclusion criteria, were contactable by phone, and consented to participate. The mean age was 7 years (range 0-15) and most were female (60%). Health-related quality of life (HRQOL) was scored as a percentage with most participants scoring >80% ( n = 27). Those who do experience reduced quality of life following treatment for AHO were likely to complain of pain, stiffness, or anxiety. The impact of significant childhood illness on mental health was not adequately captured by the PedsQL but was highlighted in qualitative feedback. The majority of children treated for AHO reported excellent HRQOL up to 13 years following treatment although a negative impact on mental health was reported using qualitative analysis. A refined scoring system is needed to assess the long-term impact of musculoskeletal infection. Patient case series, Level IV.
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Affiliation(s)
- Sarah Hunter
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton
| | - Joseph F Baker
- Department of Orthopaedic Surgery, Waikato Hospital, Hamilton
- Department of Surgery, University of Auckland, Grafton, Auckland, New Zealand
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13
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McDonald ACE, Julian J, Voss LM, Boyle MJ, Crawford HA. An Update on Pediatric Acute Hematogenous Osteomyelitis in New Zealand - A Decade on. J Pediatr Orthop 2023; 43:e614-e618. [PMID: 37253712 DOI: 10.1097/bpo.0000000000002443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION New Zealand (NZ) has high rates of pediatric acute hematogenous osteomyelitis (AHO) with males and children of Pasifika and Māori ethnicity overrepresented. AIMS To update the incidence of Pediatric AHO over 10 years, identifying trends in presentation, organisms, treatment, and outcomes. METHODS A 10-year retrospective review of children aged 6 weeks to 15 years admitted with Pediatric AHO across two centers from 2008 to 2017. Demographic data, features of presentation, investigations, management, and complications were collected. Incidence was calculated from census data. Data were compared with our osteomyelitis database from the previous decade. (1). RESULTS 796 cases were identified. The incidence was 18 per 100,000 per annum. The average age was 7.7 years. Pasifika and Māori children are overrepresented (57%). 370 children (51%) came from low socioeconomic areas. Methicillin-sensitive Staphylococcus aureus was the most common pathogen (87%). Methicillin-resistant Staphylococcus aureus (MRSA) rates are low (4.4%). Forty-four (5.5%) children were admitted to the Pediatric Intensive Care Unit (PICU) with 9% mortality. The mean duration of antibiotics was 40 days. 325 children (41%) had surgery. Chronic infection has increased from 1.7% to 5.7%. CONCLUSIONS NZ has high rates of AHO, however, the incidence has decreased from the previous decade. Males, those in low socioeconomic areas, Pasifika and Māori have high disease burden. The use of MRI as a diagnostic modality has increased. Future studies should focus on improving treatment via prospective analysis and reporting long-term morbidity to improve outcomes for children with severe disease and reduce rates of chronic infection.
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Affiliation(s)
- Anna C E McDonald
- Starship Childrens Hospital, Auckland District Health Board; Department of Paediatrics, The University of Auckland Faculty of Medical and Health Sciences
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14
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Ren Y, Liu L, Sun D, Zhang Z, Li M, Lan X, Ni J, Yan MM, Huang W, Liu ZM, Peng AQ, Zhang Y, Jiang N, Song K, Huang Z, Bi Q, Zhang J, Yang Q, Yang J, Liu Y, Fu W, Tian X, Wang Y, Zhong W, Song X, Abudurexiti A, Xia Z, Jiang Q, Shi H, Liu X, Wang G, Hu Y, Zhang Y, Yin G, Fan J, Feng S, Zhou X, Li Z, He W, Weeks J, Schwarz EM, Kates SL, Huang L, Chai Y, Bin Yu MD, Xie Z, Deng Z, Xie C. Epidemiological updates of post-traumatic related limb osteomyelitis in china: a 10 years multicentre cohort study. Int J Surg 2023; 109:2721-2731. [PMID: 37247014 PMCID: PMC10498838 DOI: 10.1097/js9.0000000000000502] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/09/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Post-traumatic related limb osteomyelitis (PTRLO) is a complex bone infection. Currently, there are no available microbial data on a national scale that can guide appropriate antibiotic selection, and explore the dynamic changes in dominant pathogens over time. This study aimed to conduct a comprehensive epidemiological analysis of PTRLO in China. METHODS The study was approved by the Institutional Research Board (IRB), and 3526 PTRLO patients were identified from 212 394 traumatic limb fracture patients at 21 hospitals between 1 January 2008 and 31 December 2017. A retrospective analysis was conducted to investigate the epidemiology of PTRLO, including changes in infection rate (IR), pathogens, infection risk factors and antibiotic resistance and sensitivity. RESULTS The IR of PTRLO increased gradually from 0.93 to 2.16% (Z=14.392, P <0.001). Monomicrobial infection (82.6%) was significantly higher than polymicrobial infection (17.4%) ( P <0.001). The IR of Gram-positive (GP) and Gram-negative (GN) pathogens showed a significant increase from the lowest 0.41% to the highest 1.15% (GP) or 1.62% (GN), respectively. However, the longitudinal trend of GP vs. GN's composition did not show any significance (Z=±1.1918, P >0.05). The most prevalent GP strains were Methicillin-sensitive Staphylococcus aureus (MSSA) (17.03%), Methicillin-resistant Staphylococcus aureus (MRSA) (10.46%), E. faecalis (5.19%) and S. epidermidis (4.87%). In contrast, the dominant strains GN strains were Pseudomonas Aeruginosa (10.92%), E. cloacae (10.34%), E. coli (9.47%), Acinetobacter Baumannii (7.92%) and Klebsiella Pneumoniae (3.33%). In general, the high-risk factors for polymicrobial infection include opened-fracture (odds ratio, 2.223), hypoproteinemia (odds ratio, 2.328), and multiple fractures (odds ratio, 1.465). It is important to note that the antibiotics resistance and sensitivity analysis of the pathogens may be influenced by complications or comorbidities. CONCLUSIONS This study provides the latest data of PTRLO in China and offers trustworthy guidelines for clinical practice. (China Clinical Trials.gov number, ChiCTR1800017597).
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Affiliation(s)
- YouLiang Ren
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Lei Liu
- Department of Orthopaedics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen
- Department of Orthopaedics, West China Hospital, Sichuan University
| | - Dong Sun
- Department of Orthopaedics, First Affiliated Hospital of Army Medical University
| | - ZhengDong Zhang
- Department of Orthopaedics, West China Hospital, Sichuan University
- Department of Orthopedics, The First Affiliated Hospital of Chengdu Medical College, Chengdu
| | - Meng Li
- Department of Orthopaedics, Gansu Provincial Hospital
- Department of Orthopaedics, Lanzhou General Hospital of People’s Liberation Army, Lanzhou
| | - Xu Lan
- Department of Orthopaedics, Gansu Provincial Hospital
- Department of Orthopaedics, Lanzhou General Hospital of People’s Liberation Army, Lanzhou
| | - JiangDong Ni
- Department of Orthopaedics Surgery, Second Xiangya Hospital, Central South University, Changsha
| | - Ming-Ming Yan
- Department of Orthopaedics Surgery, Second Xiangya Hospital, Central South University, Changsha
| | - Wei Huang
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing
| | - Zi-Ming Liu
- Department of Orthopaedics, First Affiliated Hospital of Chongqing Medical University, Chongqing
- Institute of Sports Medicine Beijing Key Laboratory of Sports Injuries Peking University Third Hospital
| | - AQin Peng
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang
| | - YanLong Zhang
- Department of Orthopaedics, Third Hospital of Hebei Medical University, Shijiazhuang
| | - Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - KeGuan Song
- Third Department of Orthopaedics, First Affiliated Hospital of Harbin Medical University, Harbin
| | - ZhiPeng Huang
- Third Department of Orthopaedics, First Affiliated Hospital of Harbin Medical University, Harbin
| | - Qing Bi
- Department of Orthopaedics, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou
| | - Jun Zhang
- Department of Orthopaedics, Zhejiang Provincial People's Hospital of Hangzhou Medical College, Hangzhou
| | - Qun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian
| | - Jun Yang
- Department of Orthopaedics, First Affiliated Hospital of Dalian Medical University, Dalian
| | - Yi Liu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi
| | - Wei Fu
- Department of Orthopaedics, Affiliated Hospital of Zunyi Medical University, Zunyi
- Department of Orthopaedics, Guizhou Provincial People’s Hospital
| | | | - YuanZheng Wang
- Department of Orthopaedics, Guizhou Provincial People’s Hospital
| | - WanRun Zhong
- Department of Orthopaedics Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - XingHua Song
- Department of Orthopaedics, First Hospital of Xinjiang Medical University, Ürümqi
- Department of Spine and Joint, The Affiliated Shunde Hospital of Jinan University, Foshan
| | | | - ZhiLin Xia
- Department of Orthopaedics, Second Hospital of Beijing Municipal Corps Chinese People's Armed Police
| | - Qing Jiang
- Department of Orthopaedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School
| | - HongFei Shi
- Department of Orthopaedics, Nanjing Drum Tower Hospital, Affiliated Hospital of Nanjing University Medical School
| | - XiMing Liu
- Department of Orthopaedics, Wuhan General Hospital of People's Liberation Army, Wuhan
| | - GuoDong Wang
- Department of Orthopaedics, Wuhan General Hospital of People's Liberation Army, Wuhan
| | - YunSheng Hu
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, Xi'an
| | - YunFei Zhang
- Department of Orthopaedics, Tangdu Hospital, Fourth Military Medical University, Xi'an
| | - GuoYong Yin
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - Jin Fan
- Department of Orthopaedics, First Affiliated Hospital of Nanjing Medical University, Nanjing
| | - ShiQing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping, China
| | - XianHu Zhou
- Department of Orthopaedics, Tianjin Medical University General Hospital, Heping, China
| | - ZhengDao Li
- Department of Orthopaedics, First People’s Hospital of Xuzhou, Affiliated Hospital of China University of Mining and Technology
| | - WenBin He
- Department of Trauma Orthopaedics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai
| | - Jason Weeks
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Edward M Schwarz
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
| | - Stephen L Kates
- Department of Orthopedic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Lei Huang
- Department of Orthopaedics, Peking University Jishuitan Hospital, Beijing
| | - YiMin Chai
- Department of Orthopaedics Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine
| | - MD Bin Yu
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou
| | - Zhao Xie
- Department of Orthopaedics, First Affiliated Hospital of Army Medical University
| | - ZhongLiang Deng
- Department of Orthopaedics, Second Affiliated Hospital of Chongqing Medical University
| | - Chao Xie
- Department of Orthopaedics, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY
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15
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He Y, Liu S, Su Y. Risk factors of deep vein thrombosis in children with osteomyelitis. Ann Med 2023; 55:2249011. [PMID: 37624766 PMCID: PMC10494723 DOI: 10.1080/07853890.2023.2249011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/08/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
OBJECTIVE To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early detection and treatment of DVT. STUDY DESIGN The clinical data of nine children diagnosed with osteomyelitis and DVT between July 2012 and March 2021 were collected at our hospital, including age, sex, clinical manifestations, body temperature, coagulation function and other data, as well as the clinical data of 27 children diagnosed with osteomyelitis without DVT during the same period. Thirty-six children were divided into thrombus and thrombus-free groups. The clinical characteristics and risk factors for DVT in children with osteomyelitis were analysed. RESULTS Among the 36 children in this study, nine cases of thrombus formation mainly occurred in the femoral vein, popliteal vein and iliac vein, all near the infection site. The main clinical manifestations were lower extremity pain, swelling and pulmonary embolism in three cases. Among them, intensive care unit (ICU) admission, sepsis, higher D-dimer, higher body temperature during hospitalization, and pathogen culture showed that methicillin-resistant Staphylococcus aureus (MRSA) was associated with DVT. MRSA was the independent risk factor for DVT. CONCLUSIONS Admission to ICU, sepsis, higher D-dimer, higher body temperature during hospitalization, and MRSA are risk factors for thrombosis. MRSA is the independent risk factor for DVT. For patients with related risk factors, timely ultrasound examination of the infected site should be considered to achieve early detection and treatment.
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Affiliation(s)
- Yunjian He
- Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Shaoshan Liu
- Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Chongqing, China
| | - Yuxi Su
- Orthopedics Department, Children’s Hospital of Chongqing Medical University, Chongqing, China
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
- National Clinical Research Center for Child Health and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Jiangxi Hospital Affiliated Children’s Hospital of Chongqing Medical University, Chongqing, China
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Campbell JI, Shanahan KH, Bartick M, Ali M, Goldmann D, Shaikh N, Allende-Richter S. Racial and Ethnic Differences in Length of Stay for US Children Hospitalized for Acute Osteomyelitis. J Pediatr 2023; 259:113424. [PMID: 37084849 PMCID: PMC10527861 DOI: 10.1016/j.jpeds.2023.113424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/02/2022] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVE To examine the associations between race and ethnicity and length of stay (LOS) for US children with acute osteomyelitis. STUDY DESIGN Using the Kids' Inpatient Database, we conducted a cross-sectional study of children <21 years old hospitalized in 2016 or 2019 with acute osteomyelitis. Using survey-weighted negative binomial regression, we modeled LOS by race and ethnicity, adjusting for clinical and hospital characteristics and socioeconomic status. Secondary outcomes included prolonged LOS, defined as LOS of >7 days (equivalent to LOS in the highest quartile). RESULTS We identified 2388 children discharged with acute osteomyelitis. The median LOS was 5 days (IQR, 3-7). Compared with White children, children of Black race (adjusted incidence rate ratio [aIRR] 1.15; 95% CI, 1.05-1.27), Hispanic ethnicity (aIRR 1.11; 95% CI, 1.02-1.21), and other race and ethnicity (aIRR 1.12; 95% CI, 1.01-1.23) had a significantly longer LOS. The odds of Black children experiencing prolonged LOS was 46% higher compared with White children (aOR, 1.46; 95% CI, 1.01-2.11). CONCLUSIONS Children of Black race, Hispanic ethnicity, and other race and ethnicity with acute osteomyelitis experienced longer LOS than White children. Elucidating the mechanisms underlying these race- and ethnicity-based differences, including social drivers such as access to care, structural racism, and bias in provision of inpatient care, may improve management and outcomes for children with acute osteomyelitis.
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Affiliation(s)
- Jeffrey I Campbell
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | | | - Melissa Bartick
- Department of Medicine, Mount Auburn Hospital, Cambridge, MA
| | - Mohsin Ali
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Don Goldmann
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA
| | - Nadia Shaikh
- Department of Pediatrics, University of Illinois College of Medicine at Peoria, Peoria, IL
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17
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Dunnam G, Thornton JK, Pulido-Landinez M. Characterization of an Emerging Enterococcus cecorum Outbreak Causing Severe Systemic Disease with Concurrent Leg Problems in a Broiler Integrator in the Southern United States. Avian Dis 2023; 67:137-144. [PMID: 37556292 DOI: 10.1637/aviandiseases-d-22-00085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/20/2023] [Indexed: 08/11/2023]
Abstract
Enterococcus cecorum has been associated mainly with osteomyelitis of the free thoracic vertebra in chickens. However, there are reports of E. cecorum producing septicemic lesions and having tropism for cartilages, resulting in the presentation of femoral head necrosis and synovitis. This paper discusses the presentation of E. cecorum as it relates to an outbreak in one vertical integrator where the main lesions were related to septicemia. Using a convenience sampling method, 100 broiler chicken cases received at the Poultry Research and Diagnostic Laboratory of Mississippi State University from April to December of 2021 were analyzed. The peak in cases was observed from June to August. The average age of broilers was 21 days with a range of 15-31 days. Most of these cases were related to systemic disease and leg problems, with gross lesions including characteristic pericarditis along with perihepatitis, osteomyelitis, and arthritis. In six of the 100 cases, E cecorum was isolated from the free thoracic vertebra, with the remaining being recovered from various other locations including liver, pericardium, hock/joint, femoral head, and bone marrow. Enterococcus cecorum identification was performed by using Vitek matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. These results were then sent to the research-use only SARAMIS database for analysis. Once the spectra of the isolates were imported, the relative and absolute taxonomy were analyzed. Two super spectrums and three clusters by homology were identified. The minimal inhibitory concentrations obtained by antimicrobial sensitivity tests were analyzed using WHONET Microbiology Laboratory Database Software. No isolates were pan-susceptible, 80% of isolates were noted to be resistant to ≥3 classes of antibiotics and, in general, isolates exhibited a high degree of variability when examining antimicrobial resistance patterns.
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Affiliation(s)
- Gunnar Dunnam
- Mississippi State University, College of Veterinary Medicine, Poultry Research and Diagnostic Laboratory, 39208
| | - Jay Kay Thornton
- Mississippi State University, College of Veterinary Medicine, Poultry Research and Diagnostic Laboratory, 39208
| | - Martha Pulido-Landinez
- Mississippi State University, College of Veterinary Medicine, Poultry Research and Diagnostic Laboratory, 39208,
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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19
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Hunter S, Crawford H, Baker JF. Ten-year Review of Acute Pediatric Hematogenous Osteomyelitis at a New Zealand Tertiary Referral Center. J Pediatr Orthop 2023; 43:e396-e401. [PMID: 36882888 DOI: 10.1097/bpo.0000000000002385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Acute hematogenous osteomyelitis (AHO) remains a cause of severe illness among children with the possibility of long-term consequences for growth and development. Recent research has highlighted an unusually high burden of disease in the New Zealand population compared with other Western regions. We have sought to identify trends in presentation, diagnosis, and management of AHO, with added focus on ethnicity and access to health care. METHODS A 10-year retrospective review of all patients <16 years with presumed AHO presenting to a tertiary referral center between 2008 and 2018 was performed. RESULTS One hundred fifty-one cases met inclusion criteria. The median age was 8 years with a male predominance (69.5%). Staphylococcus aureus was the most common pathogen using traditional laboratory culture method (84%). The number of cases per year decreased from 2008 to 2018. Assessment using New Zealand deprivation scores showed Māori children were most likely to experience socioeconomic hardship ( P ≤0.01). Median distance traveled by families to first hospital consult was 26 km (range 1 to 178 km). Delayed presentation was associated with need for prolonged antibiotic therapy. Incidence of disease varied by ethnicity with 1:9000 cases per year for New Zealand European, 1:6500 for Pacific, and 1:4000 for Māori. Overall recurrence rate was 11%. CONCLUSIONS The incidence of AHO in New Zealand is concerningly high within Māori and Pacific populations. Future health interventions should consider environmental, socioeconomic, and microbiological trends in the burden of disease. LEVEL OF EVIDENCE Retrospective study, Level III.
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Affiliation(s)
- Sarah Hunter
- University of Auckland, Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Haemish Crawford
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Joseph F Baker
- University of Auckland, Department of Orthopaedic Surgery, Waikato Hospital, Hamilton, New Zealand
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Lu S, Wang L, Luo W, Wang G, Zhu Z, Liu Y, Gao H, Fu C, Ren J, Zhang Y, Zhang Y. Analysis of the epidemiological status, microbiology, treatment methods and financial burden of hematogenous osteomyelitis based on 259 patients in Northwest China. Front Endocrinol (Lausanne) 2023; 13:1097147. [PMID: 36686458 PMCID: PMC9846127 DOI: 10.3389/fendo.2022.1097147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
Background The incidence of hematogenous osteomyelitis is on the rise, and the prognosis is poor. There has been no large-scale epidemiological analysis of hematogenous osteomyelitis in the world, and the treatment method is still controversial. Methods A retrospective case study method was used to collect and analyze clinical data obtained from patients with hematogenous osteomyelitis in a tertiary hospital in Northwest China from January 1, 2011, to December 31, 2020. The aim of this study was to investigate the epidemiological status, microbiological characteristics, treatment and financial burden of hematogenous osteomyelitis in Northwest China to explore the therapeutic effects of different treatment methods, elucidate the epidemiological characteristics of hematogenous osteomyelitis and to provide a basis for the choice of treatment. Results We included 259 patients with hematogenous osteomyelitis, including 96 patients with acute hematogenous osteomyelitis and 163 patients with chronic hematogenous osteomyelitis. The cause of the disease was not obvious in most patients, the sex ratio of males to females was 1.98, and the three most common infected sites were the tibia, femur and phalanx. Regarding preoperative serum inflammatory markers, the rate of positivity for ESR was the highest at 67.58%. Among pathogenic microorganisms, Staphylococcus aureus was the most common. Regarding the financial burden, the median total cost per patient was 25,754 RMB, and medications accounted for the largest proportion of the main costs. Conclusions The most common pathogen associated with HO infection was MSSA. Oxacillin has good PK and PD and is recommended as the first-line drug. Some blood-borne bone infections may lead to complications, such as pulmonary infection through bacteremia, which requires early detection to avoid a missed diagnosis. Regarding surgical intervention, debridement plus absorbable calcium sulfate bone cement and calcium sulfate calcium phosphate bone cement exclusion have achieved good therapeutic effects, but they are worthy of further in-depth research. Regarding the financial burden, the median total cost per patient was 25,754 RMB. The financial burden of blood-borne osteomyelitis was lower than that of traumatic osteomyelitis. Among the main costs, drugs accounted for the largest proportion.
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Affiliation(s)
- Shuaikun Lu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Linhu Wang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Wen Luo
- Department of Ultrasound, Xijing Hospital, Air Force Medical University, Xi’an, China
| | - Guoliang Wang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Zhenfeng Zhu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yunyan Liu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Hao Gao
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Congxiao Fu
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Jun Ren
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yunfei Zhang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
| | - Yong Zhang
- Department of Orthopaedics, Tangdu Hospital, Air Force Medical University, Xi’an, China
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Macias D, Jeong SS, Van Swol JM, Moore JD, Brennan EA, Raymond M, Nguyen SA, Rizk HG. Trends and Outcomes of Fungal Temporal Bone Osteomyelitis: A Scoping Review. Otol Neurotol 2022; 43:1095-1107. [PMID: 36351221 DOI: 10.1097/mao.0000000000003714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Temporal bone osteomyelitis is an invasive infection most often caused by bacteria and associated with high mortality. Fungal etiologies are rare and little is known of the predictors of disease severity and outcomes in fungal temporal bone osteomyelitis. MATERIALS AND METHODS A scoping review was performed to determine what is known from the literature on how clinical, diagnostic, and treatment characteristics relate to patient outcomes in fungal temporal bone osteomyelitis. Using PRISMA guidelines, three databases were searched to identify all published cases of fungal temporal bone osteomyelitis. Data were extracted from each study, including clinical, diagnostic, and treatment characteristics, and outcomes. RESULTS Sixty-eight studies comprising 74 individual cases of fungal temporal bone osteomyelitis were included. All studies were case reports. There were high rates of diabetes, facial nerve palsy, infectious complications, and need for surgical intervention, as well as a significant delay in the evaluation and diagnosis of fungal temporal bone osteomyelitis. Disease recovery was greater in patients presenting with otorrhea, comorbid diabetes, and in those without facial nerve palsy. DISCUSSION Many of the defining characteristics of fungal temporal bone osteomyelitis remain unknown, and future reports should focus on determining factors that improve timely diagnosis and treatment of fungal TBO in addition to identifying prognostic indicators for outcomes and survival.
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Affiliation(s)
- David Macias
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | - Seth S Jeong
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | | | - Jeremy D Moore
- College of Medicine, Medical University of South Carolina
| | - Emily A Brennan
- MUSC Libraries, Medical University of South Carolina, Charleston, South Carolina
| | - Mallory Raymond
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | - Shaun A Nguyen
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
| | - Habib G Rizk
- Department of Otolaryngology-Head & Neck Surgery, Medical University of South Carolina
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22
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Vij N, Singleton I, Kang P, Esparza M, Burns J, Belthur MV. Clinical Scores Predict Acute and Chronic Complications in Pediatric Osteomyelitis: An External Validation. J Pediatr Orthop 2022; 42:341-346. [PMID: 35405715 DOI: 10.1097/bpo.0000000000002159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pediatric acute hematogenous osteomyelitis (AHO) outcomes are highly dependent on the disease severity. Recently, the A-SCORE and C-SCORE, were proposed as predictors of an acute complicated course and chronic morbidity, respectively. The purpose of this study was to externally validate the A-SCORE and C-SCORE at a single institution. METHODS This IRB-approved retrospective chart review included AHO patients admitted at a tertiary referral hospital between October 1, 2015 and December 31, 2019. The inclusion criteria were ages 0 to 18 and clinical response to treatment. The exclusion criteria were immunocompromised status or penetrating inoculation. RESULTS The A-SCORE demonstrated an area under the receiver operator curve (ROC area) of >86% with regards to all acute complications. It also demonstrated sensitivities >85% and specificities >92% at the cut-off of 4 (Youden index) for all acute complications. The C-SCORE demonstrated an ROC area of 100% with regards to chronic osteomyelitis. It also demonstrated sensitivities >70% and specificities >93% for the chronic morbidity variables seen in our population at the cut-off of 3 (Youden index.). CONCLUSIONS These novel composite clinical scores, in combination with clinical judgment, could help guide early care decisions. The A-SCORE and C-SCORE are useful risk stratification tools in the management of pediatric AHO and in predicting acute complicated courses or chronic sequelae of AHO, respectively. These scoring systems, if integrated into standardized pediatric AHO guidelines, can allow clinicians to stratify the AHO population and guide clinical decision making. LEVEL OF EVIDENCE Level III (prognostic study, retrospective chart review).
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Affiliation(s)
- Neeraj Vij
- University of Arizona College of Medicine
| | - Ian Singleton
- San Francisco Orthopedic Residency Program, San Francisco, CA
| | - Paul Kang
- Department of Epidemiology and Biostatistics, University of Arizona College of Public Health
| | - Melissa Esparza
- Phoenix Children's Hospital Department of Orthopedics, Phoenix, AZ
| | - Jessica Burns
- Phoenix Children's Hospital Department of Orthopedics, Phoenix, AZ
| | - Mohan V Belthur
- Phoenix Children's Hospital Department of Orthopedics, Phoenix, AZ
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Walter N, Rupp M, Baertl S, Hinterberger T, Alt V. Prevalence of psychological comorbidities in bone infection. J Psychosom Res 2022; 157:110806. [PMID: 35367917 DOI: 10.1016/j.jpsychores.2022.110806] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 03/25/2022] [Accepted: 03/28/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Bone infections represent a major complication in orthopedic and trauma surgery. Concomitant psychological disorders can significantly influence treatment outcomes. However, these are often overlooked. Therefore, we aimed to determine the nationwide epidemiology of fracture-related infection (FRI) and osteomyelitis in combination with psychological comorbidities. METHODS A dataset provided by the Federal Statistical Office (Destatis) consisting of annual, Germany-wide ICD-10 diagnosis codes from 2009 to 2019 was analysed. Incidences of the codes "T84.6, infection and inflammatory reaction due to internal fixation device" and "M86.-, osteomyelitis" were quantified. Proportions of secondary diagnoses of the chapter F of the ICD-10 were determined. RESULTS Incidences were 19.1/100,000 inhabitants for osteomyelitis and 10.5/100,000 inhabitants for FRI. Patients with psychological comorbidities constituted 14.6% of osteomyelitis cases and 26.5% of FRI cases, respectively. Between 2009 through 2019, the proportion of patients with a concomitant "F" diagnoses of the ICD-10 increased by 27.3% for osteomyelitis and by 24.1% for FRI. Most prevalent secondary diagnoses were organic, including symptomatic, mental disorders (F0), affective disorder (F3) and mental and behavioral disorders due to psychoactive substance use (F1), whereby the latter decreased over the years. CONCLUSION The implementation of prevention strategies, interdisciplinary approaches and psychological support in orthopaedics and trauma surgery is warranted.
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Affiliation(s)
- Nike Walter
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany; Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany.
| | - Markus Rupp
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Baertl
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Thilo Hinterberger
- Department for Psychosomatic Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Volker Alt
- Department for Trauma Surgery, University Hospital Regensburg, Regensburg, Germany
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Jeyanthi JC, Yi KM, Allen Jr JC, Gera SK, Mahadev A. Epidemiology and outcome of septic arthritis in childhood: a 16-year experience and review of literature. Singapore Med J 2022; 63:256-262. [PMID: 36043293 PMCID: PMC9297189 DOI: 10.11622/smedj.2020140] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Septic arthritis (SA) is a devastating infection with a high rate of sequelae. The aim of this retrospective study was to determine the epidemiology, clinically significant sequelae and risk factors for developing these sequelae in children admitted to our hospital with SA. METHODS Patients with bacteriologically and/or radiologically confirmed SA from January 1999 to December 2014 were identified from discharge and laboratory records. Data was collected through a retrospective review of the case notes. RESULTS A total of 75 patients (62.7% male) met the inclusion criteria. The median age at presentation was six years (range two weeks to 15 years), and six patients were neonates. Microbiologic aetiology was determined in 40 (53.3%) patients, with Staphylococcus aureus being the most common organism. 68.0% of the patients underwent arthrotomy, and the average hospital stay was 15.3 days. Sequelae of SA were observed in nine patients on follow-up. Univariate and multivariate statistical analyses showed that young age, pyogenic bacterial isolation and concomitant osteomyelitis were significant risk factors for developing sequelae. CONCLUSION Our study demonstrated that young age, pyogenic bacterial isolation and concomitant osteomyelitis are associated with a high risk of sequelae. Timely microbiologic diagnosis by novel polymerase chain reaction methods and the use of magnetic resonance imaging in high-risk children to identify adjacent infection could possibly prevent lifelong disabling sequelae in SA.
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Affiliation(s)
| | - Khin Myo Yi
- Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore
| | | | - Sumanth Kumar Gera
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore
| | - Arjandas Mahadev
- Department of Orthopaedic Surgery, KK Women’s and Children’s Hospital, Singapore
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Suresh A, Joshi A, Desai AK, Juturu U, Kurian DJ, Jain P, Kulkarni RD, Kumar N. OUP accepted manuscript. Med Mycol 2022; 60:6514531. [PMID: 35076069 PMCID: PMC8822410 DOI: 10.1093/mmy/myab082] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 12/16/2021] [Accepted: 12/22/2021] [Indexed: 11/14/2022] Open
Abstract
Invasive fungal co-infections with COVID-19 are currently being reported at an alarming rate. Our study explores the importance of early identification of the disease, probable etiopathogenesis, clinical and radiological features and a treatment protocol for COVID-19 Associated Fungal Osteomyelitis of Jaws and Sinuses (CAFOJS). A one-year prospective study from June 2020 to May 2021 was conducted among CAFOJS diagnosed patients at a tertiary care center in South India. Demographic details, COVID-19 infection and treatment history, time taken for initiation of symptoms after COVID-19 diagnosis, medical history and clinical features were recorded. All patients were managed with a standard diagnostic and intervention protocol which included pre-operative and post-operative administration of Inj. Amphotericin B 50 mg (liposomal), early aggressive surgical debridement and tab. Posaconazole GR 300 mg OD for 90 days after discharge. Thirty-nine (78%) patients were diagnosed with CAFOJS out of 50 osteomyelitis patients. 35 patients (90%) were diabetic and 21 patients (54%) were known to receive steroids during the COVID-19 treatment. Sole existence of Mucorales spp. was seen in 30 patients (77%), Aspergillus fumigatus in 2 patients (5%), Curvularia spp. in 2 patients (5%). Concomitant existence of Mucorales and Aspergillus fumigatus was reported in two patients (5%) and Candida albicans in three patients (8%). Patients underwent treatment with standard protocol and no recurrence noted. CAFOJS is a clinical entity with aggressive presentation and warrants early diagnosis and treatment.
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Affiliation(s)
- Amal Suresh
- To whom correspondence should be addressed. Amal Suresh, Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India. Tel: +91 9686721200; E-mail:
| | - Abhijit Joshi
- Additional Professor, Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
| | - Anil Kumar Desai
- Professor and Head, Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
| | - Uday Juturu
- Resident, Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
| | - Denis Jacob Kurian
- Resident, Department of Oral and Maxillofacial Surgery, SDM Craniofacial Surgery and Research Centre, SDM College of Dental Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
| | - Pavithra Jain
- Assistant Professor, Department of Microbiology, SDM College of Medical Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
| | - R D Kulkarni
- Professor and Head, Department of Microbiology, SDM College of Medical Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
| | - Niranjan Kumar
- Professor and Head, Department of Plastic and Reconstructive Surgery, SDM College of Medical Sciences and Hospital, A Constituent Unit of Shri Dharmasthala Manjunatheshwara University, Dharwad, 580009, Karnataka, India
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Martín Espín I, Murias Loza S, Lacasta Plasin C, Niño Saco MD, Alcolea Sánchez A, de Ceano-Vivas la Calle M. Characteristics of Upper Limb Osteoarticular Infections at the Emergency Department of a Tertiary University Hospital in Spain. Pediatr Emerg Care 2022; 38:e251-e253. [PMID: 32925699 DOI: 10.1097/pec.0000000000002238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Osteoarticular infections are infrequent in pediatric patients, although their incidence seems to be increasing. They usually affect children younger than 5 years and tend to localize in the lower limbs. Because of their nonspecific symptoms, especially at onset, a timely diagnosis is difficult to achieve, with the subsequent risk of a delay in treatment. We hereby report the management of osteoarticular infections in our pediatric emergency department. METHODS This is a retrospective descriptive study of patients diagnosed with osteoarticular upper limb infection in the pediatric emergency department of a tertiary hospital from January 2011 to December 2016. RESULTS From an initial global sample of 170 patients diagnosed with osteomyelitis or septic arthritis at any location at the pediatric emergency department, 32 children (18.82%) with upper limb involvement were included in the study. Of them, 22 were male and the mean age at diagnosis was 14.5 months (interquartile range, 2-106). Eighteen patients (56%) were diagnosed with septic arthritis, and 14 (44%) had a diagnosis of osteomyelitis.The most frequent symptom was pain (50%). More than one third of patients (11) had received a different diagnosis in a previous hospital visit. A traumatic etiology was suspected in 7 cases (21%).Regarding acute phase reactants, the mean value for C-reactive protein was 21.3 mg/L, and erythrocyte sedimentation rate was elevated in 27 cases (84%). In 28 patients, blood cultures were obtained, 24 of which came back negative. All children received antibiotic treatment and achieved a full recovery. CONCLUSIONS One third of patients were misdiagnosed at the first consultation, which stresses the importance of a high clinical suspicion to avoid delays in diagnosis and treatment of osteoarticular infections. This study also shows a lower mean age of children with upper limb infection as compared with those with lower limb infection. All patients recovered fully with oral antibiotics.
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Affiliation(s)
| | - Sara Murias Loza
- Unit of Pediatric Rheumatology, University Hospital La Paz, Madrid, Spain
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Abstract
OBJECTIVES Acute osteomyelitis is a challenging diagnosis to make in the pediatric emergency department (ED), in part because of variability in its presentation. There are limited data detailing the presenting features of pediatric osteomyelitis, factors that are essential to understand to inform diagnostic decision making. We sought to describe relevant clinical data that contributed to the diagnosis of acute osteomyelitis in children presenting to a pediatric ED. METHODS This was a 10-year retrospective cohort study of patients 18 years or younger diagnosed with acute osteomyelitis in the ED of a large tertiary care children's hospital. Collected data included demographics, clinical history, patient-reported symptoms, vital signs, physical examination findings, and results of basic laboratory, microbiologic, and imaging studies. Descriptive statistics were used to summarize key findings. RESULTS Two hundred eleven cases of acute osteomyelitis were identified during the study period. The median age was 8.4 years, with 61.1% male. One hundred twenty-seven patients (60.2%) presented to care more than once before being diagnosed. Common symptoms included pain (94.3%), functional limitation (83.9%), and fever (76.3%). Common examination findings included functional limitation (78.2%), focal tenderness (73.5%), and swelling (52.1%). One hundred seventeen patients (55.5%) were febrile during their ED evaluation. Elevated C-reactive protein (>0.8 mg/dL, 92.9%) and erythrocyte sedimentation rate (>10 mm/h, 94.3%) were the most sensitive laboratory markers. CONCLUSIONS Fever may be absent in up to a quarter of pediatric patients with acute osteomyelitis. Although highly sensitive, inflammatory marker elevations were more modest than those reported previously in cases of pediatric septic arthritis.
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Affiliation(s)
- Alexander M Stephan
- From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine
| | - Anna Faino
- Seattle Children's Research Institute, Seattle Children's Hospital, Seattle, Washington
| | - Derya Caglar
- From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine
| | - Eileen J Klein
- From the Division of Emergency Medicine, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine
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Çiçek SÖ, Şahin N, Karaman ZF, Taşkın SN, Kısaarslan AP, Gündüz Z, Poyrazoğlu MH, Düşünsel R. The Possible Relationship Between Familial Mediterranean Fever and Chronic Nonbacterial Osteomyelitis: Coincidence or Coexistence? J Clin Rheumatol 2021; 27:e342-e348. [PMID: 32541616 DOI: 10.1097/rhu.0000000000001431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/OBJECTIVES Chronic nonbacterial osteomyelitis (CNO) is an inflammatory disease characterized by recurrent attacks and remissions due to sterile bone inflammation. The CNO may be accompanied by various inflammatory diseases. The aims of our study were to determine the clinical, laboratory, and radiological characteristics of children with CNO, and to investigate the possible effect of concomitant diseases on the course of CNO. METHODS Twenty-three patients who were diagnosed with CNO between 2012 and 2019 were analyzed. Demographic characteristics, clinical courses, laboratory and imaging findings, and concomitant diseases were recorded. The characteristics of the CNO patients with and without concomitant diseases were compared. RESULTS The mean ± SD age of patients at the time of diagnosis and the last follow-up was 10.46 ± 4.1 and 12.47 ± 4.47 years, respectively. The median (range) time interval between disease onset and diagnosis was 5.33 (1-55) months. The mean ± SD duration of disease was 24.71 ± 16.76 months. Twelve patients (52.2%) were male. The most commonly affected areas were femur (74%), tibia/fibula (74%), and pelvis (52.2%). Age at symptom onset, age at diagnosis, mean number of lesions, presence of sacroiliitis, acute phase reactants at the start of disease, clinical and radiological remission rates, and treatment responses were not significantly different between the 13 patients with concomitant diseases and those without. Eight patients (34.8%) had familial Mediterranean fever (FMF), and all of them had exon 10 mutations. Four patients (17.4%) had juvenile spondylarthritis, one had inflammatory bowel disease, and one had psoriatic arthritis as concomitant diseases. Clinical remission was achieved in 19 patients (82.6%) and complete remission in 11 patients (47.8%) at the time of follow-up. CONCLUSIONS In our cohort, half of the patients with CNO had concomitant diseases, with FMF being the most common. We think that the coexistence of FMF and CNO is not a coincidental one and that both may result due to an abnormality of a common pathogenetic pathway.
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Affiliation(s)
| | - Nihal Şahin
- From the Departments of Pediatric Rheumatology
| | | | | | | | - Zübeyde Gündüz
- Department of Pediatric Rheumatology, Acıbadem Hospital, Kayseri, Turkey
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Rask DMG, Wingfield J, Elrick B, Chen C, Lalka A, Sibbel SE, Scott FA. Seymour Fractures: A Retrospective Review of Infection Rates, Treatment and Timing of Antibiotic Administration. Pediatr Emerg Care 2021; 37:e1299-e1302. [PMID: 32149995 DOI: 10.1097/pec.0000000000002009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Seymour fractures are important to recognize and treat promptly because injuries may result in growth disturbance, nail deformity, or infection. We hypothesize that the administration of antibiotics within 24 hours of injury will be associated with a decreased rate of infection. METHODS Patients younger than 18 years were included if clinical examination and radiographs demonstrated a Seymour fracture. The timing of antibiotic administration and treatment details were reviewed. The presence of superficial infections or radiographic evidence of osteomyelitis was recorded. RESULTS A total of 52 patients with 54 fracture that had greater than 30 days of follow-up and were included in data analysis. The average age at the time of injury was 10.2 years. Thirty-four (63%) of 54 patients were most commonly injured secondary to a crush type mechanism. The overall infection rate was 27.3% (15/54 fractures). Among the 29 fractures that received antibiotics within 24 hours of injury, 2 infections (6.9%) were noted at final follow-up. Delayed administration of antibiotics beyond 24 hours postinjury was observed in 17 fractures and was associated with an increased infection rate of 76.5% (13/17, P = 0.000). CONCLUSIONS Early administration of antibiotics within 24 hours of injury is associated with a reduction in the development of infections. Patients with delayed antibiotic administration may be at high risk for early superficial infection or osteomyelitis. This study highlights the importance of early identification and appropriate treatment of Seymour fractures including the prompt administration of antibiotics following injury.
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Affiliation(s)
| | - Jessica Wingfield
- From the Department of Orthopedics, School of Medicine, University of Colorado, Aurora, CO
| | - Bryant Elrick
- From the Department of Orthopedics, School of Medicine, University of Colorado, Aurora, CO
| | - Christopher Chen
- From the Department of Orthopedics, School of Medicine, University of Colorado, Aurora, CO
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Serota DP, Tookes HE, Hervera B, Gayle BM, Roeck CR, Suarez E, Forrest DW, Kolber MA, Bartholomew TS, Rodriguez AE, Doblecki-Lewis S. Harm reduction for the treatment of patients with severe injection-related infections: description of the Jackson SIRI Team. Ann Med 2021; 53:1960-1968. [PMID: 34726095 PMCID: PMC8567885 DOI: 10.1080/07853890.2021.1993326] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/08/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Hospitalizations for severe injection-related infections (SIRI), such as endocarditis, osteomyelitis, and skin and soft tissue infections (SSTI) are increasingly common. People who inject drugs (PWID) experiencing SIRIs often receive inadequate substance use disorder (SUD) treatment and lack of access to harm reduction services. This translates into lengthy hospitalizations with high rates of patient-directed discharge, readmissions, and post-hospitalization mortality. The purpose of this study was to describe the development of an integrated "SIRI Team" and its initial barriers and facilitators to success. MATERIALS AND METHODS The Jackson SIRI Team was developed to improve both hospital and patient-level outcomes for individuals hospitalized with SIRIs at Jackson Memorial Hospital, a 1550-bed public hospital in Miami, Florida, United States. The SIRI Team provides integrated infectious disease and SUD treatment across the healthcare system starting from the inpatient setting and continuing for 90-days post-hospital discharge. The team uses a harm reduction approach, provides care coordination, focuses on access to medications for opioid use disorder (MOUD), and utilizes a variety of infection and addiction treatment modalities to suit each individual patient. RESULTS Over the initial 8-months of the SIRI Team, 21 patients were treated with 20 surviving until discharge. Infections included osteomyelitis, endocarditis, bacteraemia/fungemia, SSTIs, and septic arthritis. All patients had OUD and 95% used stimulants. All patients were discharged on MOUD and 95% completed their prescribed antibiotic course. At 90-days post-discharge, 25% had been readmitted and 70% reported taking MOUD. CONCLUSIONS A model of integrated infectious disease and SUD care for the treatment of SIRIs has the potential to improve infection and addiction outcomes. Providing attentive, patient-centered care, using a harm reduction approach can facilitate engagement of this marginalized population with the healthcare system.KEY MESSAGESIntegrated infectious disease and addiction treatment is a novel approach to treating severe injection-related infections.Harm reduction should be applied to treating patients with severe injection-related infections with a goal of facilitating antibiotic completion, remission from substance use disorder, and reducing hospital readmissions.
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Affiliation(s)
- David P. Serota
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hansel E. Tookes
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Belén Hervera
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Babley M. Gayle
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Cara R. Roeck
- Jackson Memorial Hospital, Jackson Health System, Miami, FL, USA
| | - Edward Suarez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - David W. Forrest
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael A. Kolber
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Tyler S. Bartholomew
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Allan E. Rodriguez
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Susanne Doblecki-Lewis
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Conan Y, Laurent E, Belin Y, Lacasse M, Amelot A, Mulleman D, Rosset P, Bernard L, Grammatico-Guillon L. Large increase of vertebral osteomyelitis in France: a 2010-2019 cross-sectional study. Epidemiol Infect 2021; 149:e227. [PMID: 34612186 PMCID: PMC8569834 DOI: 10.1017/s0950268821002181] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/13/2021] [Accepted: 09/28/2021] [Indexed: 12/17/2022] Open
Abstract
Vertebral osteomyelitis (VO) represents 4-10% of bone and joint infections. In Western countries, its incidence seems to increase, simultaneously with an increasing number of comorbidities among an ageing population. This study aimed to assess the evolution of VO epidemiology in France over the 2010-2019 decade. A nationwide cross-sectional study was conducted using the French hospital discharge data collected through the French diagnosis-related groups 'Programme de Médicalisation des Systèmes d'Information'. VOs were detected with a previously validated case definition using International Classification of Diseases 10 (ICD-10) codes, implemented with the French current procedural terminology codes. The study population included all patients hospitalised in France during the 2010-2019 decade, aged 15 years old and more. Patient and hospital stay characteristics and their evolutions were described. During the study period, 42 105 patients were hospitalised for VO in France involving 60 878 hospital stays. The mean VO incidence was 7.8/100 000 over the study period, increasing from 6.1/100 000 in 2010 to 11.3/100 000 in 2019. The mean age was 64.8 years old and the sex ratio was 1.56. There were 31 341 (74.4%) patients with at least one comorbidity and 3059 (7.3%) deceased during their hospital stay. Even if rare, device-associated VOs (4450 hospital stays, 7.3%) highly increased over the period. The reliability of the method, based upon an exhaustive database and a validated case definition, provided an effective tool to compare data over time in real-life conditions to regularly update the epidemiology of VO.
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Affiliation(s)
- Yoann Conan
- Department of Public Health, Unit of Clinical Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France
- Department of Infectious Diseases, Teaching Hospital of Tours, Tours, France
- Medical School, University of Tours, Tours, France
| | - Emeline Laurent
- Department of Public Health, Unit of Clinical Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France
- Research Unit EA7505 (Education Ethique et Santé), University of Tours, Tours, France
| | - Yannick Belin
- Department of Public Health, Unit of Clinical Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France
- Medical School, University of Tours, Tours, France
| | - Marion Lacasse
- Department of Infectious Diseases, Teaching Hospital of Tours, Tours, France
- Medical School, University of Tours, Tours, France
| | - Aymeric Amelot
- Department of Neurosurgery, Teaching Hospital of Tours, Tours, France
| | - Denis Mulleman
- Medical School, University of Tours, Tours, France
- Department of Rheumatology, Teaching Hospital of Tours, Tours, France
- Reference Centre for Complex Bone and Joint Infections of Western France (CRIOGO), Tours, France
| | - Philippe Rosset
- Medical School, University of Tours, Tours, France
- Department of Orthopaedic Surgery, Teaching Hospital of Tours, Tours, France
- Reference Centre for Complex Bone and Joint Infections of Western France (CRIOGO), Tours, France
| | - Louis Bernard
- Department of Infectious Diseases, Teaching Hospital of Tours, Tours, France
- Medical School, University of Tours, Tours, France
- Reference Centre for Complex Bone and Joint Infections of Western France (CRIOGO), Tours, France
| | - Leslie Grammatico-Guillon
- Department of Public Health, Unit of Clinical Epidemiology (EpiDcliC), Teaching Hospital of Tours, Tours, France
- Medical School, University of Tours, Tours, France
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Yang J, Huang J, Wei S, Zhou X, Nong Y, Sun J, Zhai Z, Li W, Lu W. Urine Albumin-Creatinine ratio is associated with prognosis in patients with diabetic foot osteomyelitis. Diabetes Res Clin Pract 2021; 180:109043. [PMID: 34508738 DOI: 10.1016/j.diabres.2021.109043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/10/2021] [Accepted: 09/06/2021] [Indexed: 12/26/2022]
Abstract
AIMS We aimed to explore the association between albuminuria and clinical outcomes in patients with diabetic foot osteomyelitis (DFO). METHODS This is an observational retrospective study and a total of 202 inpatients with DFO were eligible for inclusion in our study. Based on urine albumin-creatinine ratio (UACR), the patients were divided into three groups: normoalbuminuria group, microalbuminuria group and macroalbuminuria group. The data collected include demographics data, laboratory data, clinical diagnostic data, diabetic foot examination and clinical visit data. The association was then evaluated between albuminuria and all-cause mortality, major cardiovascular adverse events (MACE) and mixed endpoint events. RESULTS The mean age was 60.3 years, 62.9% were male and 45.05% were urinary protein-positive. The incidence rates of all-cause mortality, MACE and mixed endpoint events related to elevated UACR were significantly increased in patients with DFO (all P for trend < 0.01). After adjusting for confounders, compared with normoalbuminuria group, the risk of all-cause mortality, MACE and mixed endpoint events in the microalbuminuria group increased by 81.8%, 135.4% and 136.4%, respectively. The risk of all-cause mortality, MACE and mixed endpoint events in the macroalbuminuria group increased by 246.2%, 145.1% and 252.3%, respectively. The population attributable risk percentage (PAR%) suggested that 50.16% of all-cause mortality, 47.85% of MACE and 59.11% of mixed endpoint events could be attributed to the elevated UACR. Meanwhile, compared with normoalbuminuria, those with microalbuminuria or macroalbuminuria have lower apoA1 and ABI, higher SCr and higher incidence rate of CHD, hindfoot infection and severe infection (all P < 0.05). CONCLUSIONS In patients with DFO, the UACR level is associated with all-cause mortality, MACE and mixed endpoint events and elevated UACR levels increase the risk of all-cause mortality, MACE and mixed endpoint events.
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Affiliation(s)
- Jianrong Yang
- Department of Hepatobiliary Surgery, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Jianhao Huang
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Suosu Wei
- Editorial Board of Chinese Journal of New Clinical Medicine, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Xing Zhou
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Yuechou Nong
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Jingxia Sun
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Zhenwei Zhai
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Weiwei Li
- The Office of Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China
| | - Wensheng Lu
- Department of Endocrinology and Metabolism, Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi 530021, PR China.
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Kolov G, Grytsay M, Tsokalo V, Fishchuk L, Rossokha Z. VARIANTS OF IL1 (C3954T, RS1143634), PON1 (C108T, RS705379) GENES AS PROGNOSTIC MARKERS OF OSTEOMYELITIS RISK AND ITS COMPLICATIONS. Georgian Med News 2021:93-98. [PMID: 34628386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aim of the work was to study the effect of IL1Β (C3954T, rs1143634), PON1 (C108T, rs705379) gene variants on the risk of bacterial osteomyelitis development and its complicated course. The study involved 56 patients with osteomyelitis - 20 with not complicated (non-recurrent) course after treatment and 36 with complicated (recurrent) course. The data of population frequencies for the European population, obtained from the open database of "1000 Genomes project", were used as a control group. There was significantly increased distribution frequency of genotype 3954TT of IL1Β in patients with uncomplicated course compared to the control group (χ2=6.05, p=0.014, OR=4.99 (1.55-16.07)). And was found increased of minor genotype 108TT of PON1 frequency in patients with osteomyelitis compared to control group (χ2=4.38, p=0.036, OR=1.85(1.03-3.33)). There were found gender differences in the clinical effects of IL1Β gene variant: in men, the prevalence of genotype 3954CC was significantly to be increased in the patient with complicated osteomyelitis; genotype 3954CT was associated with a reduced risk of osteomyelitis and its complications developing, while in women was found the association of genotype 3954TT with an uncomplicated course of the disease. In conclusion, this study suggests that the variants of IL1В and PON1 genes associated with the risk of developing bacterial osteomyelitis and its complicated course and can be used as a prognostic marker for developing personalized prevention strategies.
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Affiliation(s)
- G Kolov
- 1State Institution "Institute of Traumatology and Orthopedics of National Academy of Medical Sciences of Ukraine", Kyiv; Ukraine
| | - M Grytsay
- 1State Institution "Institute of Traumatology and Orthopedics of National Academy of Medical Sciences of Ukraine", Kyiv; Ukraine
| | - V Tsokalo
- 1State Institution "Institute of Traumatology and Orthopedics of National Academy of Medical Sciences of Ukraine", Kyiv; Ukraine
| | - L Fishchuk
- 2State Institution "Reference-centre for Molecular Diagnostic of Public Health Ministry of Ukraine", Kyiv, Ukraine
| | - Z Rossokha
- 2State Institution "Reference-centre for Molecular Diagnostic of Public Health Ministry of Ukraine", Kyiv, Ukraine
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Abstract
BACKGROUND While the majority of pediatric osteomyelitis cases are acute in nature, a significant subset present with prolonged symptoms often associated with substantial morbidity. Little data exist to guide clinicians in the management of these infections. We sought to describe the epidemiology, clinical features and management of chronic osteomyelitis (CO) in children. METHODS We reviewed hospital admissions for CO from 2011 to 2018 at Texas Children's Hospital. Cases were included if symptoms lasted ≥28 days on presentation. Cases were classified as those associated with: (1) a contiguous focus of infection; (2) penetrating trauma; (3) orthopedic hardware; (4) postacute CO (PACO, those occurring after ≥28 days of therapy for acute osteomyelitis); and (5) primary hematogenous CO. RESULTS One hundred fourteen cases met inclusion criteria. The median patient age was 11.8 years and 35.9% had comorbidities. 70.2% of patients underwent ≥1 surgical procedure. A microbiologic etiology was identified in 72.8% of cases and Staphylococcus aureus was most common (39.4%). Contiguous focus of infection was more often associated with polymicrobial disease with or without Pseudomonas. Postacute CO was caused by S. aureus in 95%. The median duration of total therapy was 210 days. 26.3% of patients experienced treatment failure of which 46% underwent repeat hospital admission/surgery. There was no association between duration of intravenous therapy for CO and treatment failure. CONCLUSIONS Children with CO represent a diverse group both in terms of pathogenesis and microbiology. Pathogenesis and clinical presentation can provide clues to microbiologic etiology. Prolonged intravenous therapy does not appear to improve outcomes in CO.
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Affiliation(s)
- J Chase McNeil
- From the Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
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Zhang LX, Wang YT, Zhao J, Li Y, Chen HL. Sex Differences in Osteomyelitis of the Foot in Persons With Diabetes Mellitus: A Meta-Analysis. Wound Manag Prev 2021; 67:19-25. [PMID: 34283801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Osteomyelitis of the foot is a risk factor for amputation in persons with diabetes mellitus. There is some evidence to suggest that patient sex affects the risk of diabetes-related foot complications. PURPOSE To examine the effect of sex on osteomyelitis risk in patients with diabetic foot disease. METHODS Systematic searches of PubMed and the China National Knowledge Infrastructure were performed from inception through May 2020 using the terms "diabetic foot" and "osteomyelitis." Original research studies including persons with diabetes mellitus, diabetic foot disease, or ulcers as well as reports of osteomyelitis were included. Study quality was assessed according to the Newcastle-Ottawa Scale. The pooled odds ratio (OR) and 95% confidence interval (CI) for osteomyelitis were calculated by sex. RESULTS Nine (9) studies from 6 countries involving 2583 patients met the inclusion criteria for analysis. No significant publication bias was observed. The average age of patients was 65.2 years, and 32.03% of men and 30.0% of women were diagnosed with osteomyelitis. The pooled OR was 1.14 (95% CI, 0.94-1.38; P = .76). Regression analysis (t = -0.61; P > .561) showed no association between the incidence of osteomyelitis and ORs. CONCLUSION This meta-analysis suggests that patient sex does not affect the odds of having osteomyelitis among persons with diabetes and diabetic foot disease or ulcers.
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Affiliation(s)
- Le-Xuan Zhang
- Nantong University, Nantong City, Jiangsu Province, China
| | - Yu-Ting Wang
- Nantong University, Nantong City, Jiangsu Province, China
| | - Jun Zhao
- Nantong University, Nantong City, Jiangsu Province, China
| | - Yang Li
- Nantong University, Nantong City, Jiangsu Province, China
| | - Hong-Lin Chen
- Nantong University, Nantong City, Jiangsu Province, China
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Banza MI, Kapessa ND, Mukakala AK, Ngoie CN, N´Dwala YTB, Cabala VDPK, Kasanga TK, Unen EW. [Osteoarticular infections in patients with sickle cell disease in Lubumbashi: epidemiological study focusing on etiology and management]. Pan Afr Med J 2021; 38:77. [PMID: 33889243 PMCID: PMC8033183 DOI: 10.11604/pamj.2021.38.77.21484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 12/31/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION infections are the leading cause of morbidity and mortality in patients with sickle cell disease, especially before age 5 years. The purpose of this study was to highlight the epidemiological features, etiologies and management of osteoarticular infections in patients with sickle cell disease in Lubumbashi. METHODS we conducted a descriptive, cross-sectional and retrospective study at the Research Center for Sickle Cell Disease in Lubumbashi (RCSCDL) over a three-year period from June 2014 to June 2017. It included all patients with sickle cell disease on follow up at the RCSCDL who developed osteoarticular infection. Data were obtained from a survey form. Parameters were patient's age, age at first visit, sex, reason for consultation, history, physical signs, diagnosis, paraclinical assessment and treatment. RESULTS we identified 35 cases of osteoarticular infections out of a total of 380 cases of sickle-cell disease, reflecting a rate of 9.2%. The most affected age group was people under 5 years of age (37.1%); the average age was 10.9±9.5 years ranging from 8 months and 37 years. There was a slight female predominance (51.4% of cases; sex ratio 1.06 in favor of women). Most patients with osteoarticular infection had a history of transfusion (16.6%) and splenectomy (8.6%). The most common reason for consulting was limb pain (84%); 20 patients (57.1%) had bulbar conjunctival icterus and 26 (74.3%) were pale. Clinical examination showed limb swelling and wound in 27 patients (77.1%) and 19 patients (54.3%), respectively. Clinical palpation of the splenomegaly was performed in 6 patients (17.1%). Three types of osteoarticular infections were detected. They were dominated by osteomyelitis (24 cases; 68.57%) followed by osteitis (7 cases; 20%) and suppurative arthritis (4 cases; 11.43%). Out of 24 cases of osteomyelitis, 18 were acute (75%) and 6 were chronic (25%), of which 4 had a hyperostosing behaviour and 2 a fistulising behaviour. Tibia was the most affected bone (18 cases), X-ray mainly showed osteolysis (27 cases; 77.1%) and then periosteolysis (15 cases; 42.9%). Homozygous sickle cell disease was found in 88.6% of cases. Hemoculture was performed in 17 out the 35 patients and salmonella was isolated in 15 out of 17 cultures (88.23%). Pyoculture was performed in 10 patients; it isolated other germs. Assessment of inflammation was performed in 21 patients: 15 had hyperleukocytosis, 13 pathological white blood cell formula , all had increased sedimentation rate (greater than 20mm in the 1st hour). With respect to immunization schedule, 62.86% of patients received EPI vaccines while patients with sickle cell disease who needed specific vaccine had an adherence rate of 17.14%. With respect to therapy, all of our patients received medical treatment; 6 patients underwent sequestrectomy (17.14%) while the majority of patients (25 cases) underwent orthopedic treatment. Conclusion: bone infection in patients with sickle cell disease is a worryng issue in our poor environment where there isn't a specific vaccine for patients with sickle cell disease.
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Affiliation(s)
- Manix Ilunga Banza
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
| | - Nathalie Dinganga Kapessa
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
| | - Augustin Kibonge Mukakala
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université Officielle de Bukavu, Bukavu, République Démocratique du Congo
| | - Christelle Ngoie Ngoie
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
| | - Yannick Tietie Ben N´Dwala
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
| | - Vincent De Paul Kaoma Cabala
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
| | - Trésor Kibangula Kasanga
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
| | - Erick Wakunga Unen
- Département de Chirurgie, Cliniques Universitaires de Lubumbashi, Faculté de Médecine, Université de Lubumbashi, Lubumbashi, Haut Katanga, République Démocratique du Congo
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Gamalero L, Belot A, Zajc Avramovic M, Giani T, Filocamo G, Guleria S, Ferrara G, Minoia F, Hofer M, Larbre JP, Aureal M, Toplak N, Avcin T, Chighizola CB, Cimaz R. Chronic non-bacterial osteomyelitis: a retrospective international study on clinical manifestations and response to treatment. Clin Exp Rheumatol 2020; 38:1255-1262. [PMID: 32828142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Chronic non-bacterial osteomyelitis (CNO) is a rare non-infectious bone inflammatory disorder; when multifocal, it is referred to as Chronic Recurrent Multifocal Osteomyelitis (CRMO). This study evaluates the demographic, clinical and radiological characteristics of a multi-centre cohort of patients with CNO/CRMO. METHODS Demographic and clinical data of patients with an established diagnosis of CNO/CRMO followed at paediatric rheumatology centres across Europe (Italy, France, Slovenia) and India were retrospectively collected. RESULTS There were no demographic differences across countries, but time to diagnosis was significantly longer in India (p=0.041). Pain was almost invariably present at disease onset; functional impairment was more frequent among Italian and Slovenian patients (p=0.001). The number of sites of bone involvement was similar between genders and countries, with long bone metaphises being the most common site. Raised acute phase reactants, detected in >50% of patients, were not associated with clinical manifestations or response to treatment. Comorbidities, evinced in 37% of patients, were equally distributed between genders and nationalities. Imaging approach was similar across countries, without any association between radiological findings and clinical manifestations. NSAIDs were almost invariably used as first-line treatment, but response rate was significantly lower in Italy (p=0.02). Methotrexate was used in 28% of case, with an overall rate of response of 82%. Health conditions and rate of permanent deformities were similar across different countries. CONCLUSIONS The differences in clinical presentation, radiological features and response to treatment described in this multinational cohort of CNO/CRMO might provide novel insights into this still elusive disease.
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Affiliation(s)
| | - Alexandre Belot
- Paediatric Rheumatology, Nephrology, Dermatology Unit, National Reference Centre for Rheumatism and Systemic Autoimmune Diseases in Children RAISE, Hospices Civils de Lyon, France
| | - Mojca Zajc Avramovic
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Teresa Giani
- Rheumatology Unit, Azienda Ospedaliero Universitaria Meyer, Florence, and University of Siena, Italy
| | - Giovanni Filocamo
- Paediatric Rheumatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sandesh Guleria
- Paediatric Allergy Immunology Unit, Advanced Paediatrics Center, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Giovanna Ferrara
- Santa Maria Annunziata Hospital, ASL Toscana Centro, Florence, Italy
| | - Francesca Minoia
- Paediatric Rheumatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michael Hofer
- Paediatric Unit, Centre Multisite Romand de Rhumatologie Pediatrique/Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | | | | | - Natasa Toplak
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Tadej Avcin
- Department of Allergology, Rheumatology and Clinical Immunology, University Children's Hospital, University Medical Centre Ljubljana, Slovenia
| | - Cecilia Beatrice Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
| | - Rolando Cimaz
- Department of Clinical Sciences and Community Health, University of Milan, and Paediatric Rheumatology Unit, ASST G. Pini & CTO, Milan, Italy
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Johnson SC, Kosut J, Ching N. Disseminated Cat Scratch Disease in Pediatric Patients in Hawai'i. Hawaii J Health Soc Welf 2020; 79:64-70. [PMID: 32490388 PMCID: PMC7260883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cat scratch disease is known to be a generally benign, self-resolving illness associated with non-specific symptoms, including lymphadenopathy, fever, fatigue, anorexia, and headaches. However, it can also cause disseminated disease with a wide range of manifestations, including liver and spleen microabscesses, osteomyelitis, encephalitis, and uveitis. Eighteen pediatric cases of disseminated cat scratch disease at a single center in Hawai'i are described. This case series emphasizes the importance of disease recognition and use of appropriate diagnostic tools and disease management. The disease burden of pediatric patients with disseminated cat scratch disease in the state of Hawai'i has a high incidence and should be considered in pediatric patients with prolonged febrile illnesses.
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Affiliation(s)
| | - Jessica Kosut
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
| | - Natascha Ching
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawai‘i at Mānoa, Honolulu, HI
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Clerc A, Zeller V, Marmor S, Senneville E, Marchou B, Laurent F, Lucht F, Desplaces N, Lustig S, Chidiac C, Ferry T. Hematogenous osteomyelitis in childhood can relapse many years later into adulthood: A retrospective multicentric cohort study in France. Medicine (Baltimore) 2020; 99:e19617. [PMID: 32443285 PMCID: PMC7254121 DOI: 10.1097/md.0000000000019617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To describe the epidemiological, clinical, laboratory, and radiological features and the management of adult patients who experienced a relapse between 2003 and 2015 of an acute hematogenous osteomyelitis acquired in childhood.A retrospective multicentric cohort study was conducted in 5 centers in France.Thirty-seven patients were included. The median age was 40 years (28-56), and 26 (70%) were male. The first site of infection was the distal femur (n = 23, 62%). The median time between the osteomyelitis in childhood and the relapse in adulthood was 26 years (13-45). Thirty-four (92%) patients reported inflammatory local clinical manifestations, 17 (46%) draining fistula, 10 (27%) fever. Most patients had intramedullary gadolinium deposition (with or without abscess) on magnetic resonance imaging. Most relapses were monomicrobial infections (82%). Staphylococcus aureus was the most commonly found microorganism (82%), expressing a small colony variant phenotype in 3 cases. Most patients (97%) had a surgical treatment, and the median duration of antibiotics for the relapse was 12 weeks. All patients had a favorable outcome, no patient died and no further relapse occurred. We count 2 femoral fractures on osteotomy site.Osteomyelitis in childhood can relapse later in adulthood, especially in patients with lack of care during the initial episode. Osteotomy and prolonged antimicrobial therapy are required for clinical remission.
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Affiliation(s)
- Axelle Clerc
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04
- Université Claude Bernard 1, Lyon
| | - Valerie Zeller
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris
| | - Simon Marmor
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris
| | - Eric Senneville
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Gustave Dron, Tourcoing
| | - Bruno Marchou
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse
| | - Frederic Laurent
- Université Claude Bernard 1, Lyon
- Laboratoire de Bactériologie, Hospices Civils de Lyon - Hôpital de la Croix-Rousse, Lyon
| | - Frederic Lucht
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne
| | - Nicole Desplaces
- Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris
| | - Sebastien Lustig
- Service de Chirurgie Orthopédique, Hospices Civils de Lyon - Hôpital de la Croix-Rousse, Lyon, France
| | - Christian Chidiac
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04
- Université Claude Bernard 1, Lyon
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04
- Université Claude Bernard 1, Lyon
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Black C, Fan KL, Defazio MV, Luvisa K, Reynolds K, Kotha VS, Attinger CE, Evans KK. Limb Salvage Rates and Functional Outcomes Using a Longitudinal Slit Arteriotomy End-to-Side Anastomosis for Limb-Threatening Defects in a High-Risk Patient Population. Plast Reconstr Surg 2020; 145:1302-1312. [PMID: 32332556 DOI: 10.1097/prs.0000000000006791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Limb salvage techniques using free tissue transfer in patients with chronic wounds caused by longstanding osteomyelitis, diabetes, and peripheral vascular disease are technically challenging. The longitudinal slit arteriotomy end-to-side anastomosis is the authors' preferred technique because it is the least invasive arteriotomy and is especially important for diseased recipient arteries. The authors reviewed highly comorbid patients who underwent free tissue transfer with this technique to understand the success rates, overall outcomes, and long-term limb salvage rates. METHODS A retrospective review was performed to analyze outcomes of free tissue transfer using longitudinal slit arteriotomy end-to-side anastomosis between 2012 and 2018 performed by the senior surgeon (K.K.E.). RESULTS One hundred fifteen free flaps were identified. Patients were, on average, 55.9 years old, with a body mass index of 29.2 kg/m. Comorbidities included osteomyelitis (83.5 percent), hypertension (60.9 percent), tobacco use (46.1 percent), diabetes (44.3 percent), peripheral vascular disease (44.3 percent), hypercoagulability (35.7 percent), and arterial calcifications (17.4 percent). Overall flap success was 93.0 percent; 27.8 percent required reoperation perioperatively because of complications. On univariate analysis, diabetes mellitus, hypertension, and hypercoagulability were significantly associated with eventual amputation (p < 0.05). Multivariate analysis showed that intraoperative thrombosis and take back was independently associated with flap failure. There was an overall limb salvage rate of 83.5 percent, and of those salvaged, 92.7 percent were ambulating without a prosthesis at a mean follow-up of 1.53 years. CONCLUSIONS This is the largest series of longitudinal slit arteriotomy end-to-side anastomosis for patients undergoing free tissue transfer for limb-threatening defects in the compromised host. Overall flap success, limb salvage rates, and functional outcomes are high using this technique. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.
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Affiliation(s)
- Cara Black
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Kenneth L Fan
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Michael V Defazio
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Kyle Luvisa
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Kyle Reynolds
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Vikas S Kotha
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Christopher E Attinger
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
| | - Karen K Evans
- From the Departments of Plastic and Reconstructive Surgery and Vascular Surgery, MedStar Georgetown University Hospital; Georgetown University School of Medicine; and the University of Texas M. D. Anderson Cancer Center
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Jump RLP, Wilson BM, Baechle D, Briggs JM, Banks RE, Song S, Zappernick T, Perez F. Risk Factors and Mortality Rates Associated With Invasive Group B Streptococcus Infections Among Patients in the US Veterans Health Administration. JAMA Netw Open 2019; 2:e1918324. [PMID: 31880800 PMCID: PMC6991221 DOI: 10.1001/jamanetworkopen.2019.18324] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE The incidence of invasive infections caused by group B Streptococcus (GBS) continues to increase in the United States. Although diabetes is a key risk factor for invasive GBS, the influence of long-term glycemic control is not well characterized; other risk factors and mortality rates associated with specific types of invasive GBS infections are unknown. OBJECTIVE To investigate risk factors and mortality rates associated with specific invasive GBS infectious syndromes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used US Veterans Health Administration data to assess active users of the Veterans Affairs health care system between January 1, 2008, and December 31, 2017. Data analysis was conducted from April 2018 to August 2019. EXPOSURES Invasive GBS infections. MAIN OUTCOMES AND MEASURES The specific types of infectious syndromes and comorbid conditions among patients with an invasive GBS infection were evaluated. RESULTS Between 2008 and 2017, 5175 patients in the Veterans Affairs health care system experienced 5497 invasive GBS infections (5027 [97.1%] men, 3737 [72.2%] white, and 4545 [87.8%] non-Latino); all-cause 30-day mortality was 8.7% (451 of 5175). The most frequently observed infections were osteomyelitis (1171 [21.3%]), bacteremia without focus (1009 [18.4%]), skin or soft-tissue infections (919 [16.7%]), and pneumonia or empyema (694 [12.6%]). All-cause 30-day mortality following the index infection for each patient was highest among patients with peritonitis (38 of 138 [27.5%]) and pneumonia or empyema (116 of 664 [17.5%]) and lowest among those with osteomyelitis (15 of 1075 [1.4%]) or joint infection (17 of 501 [3.4%]). The most common comorbid conditions among patients with invasive GBS infections were diabetes (3364 [65.0%]), obesity (2669 [51.6%]), and chronic heart conditions (1633 [31.6%]). From 2008 to 2017, the incidence of invasive GBS infections increased from 9.23 to 11.67 cases per 100 000 person-years (P = .049). Stratification by body mass index showed the highest incidence of infections among patients at the extremes of body mass index (body mass index <18.5, 25.1 cases per 100 000 person-years; body mass index ≥40, 31.0 cases per 100 000 person-years). The incidence among patients with diabetes and poor long-term glycemic control (ie, hemoglobin A1c ≥9.5%) was 4-fold greater than among patients with diabetes and good glycemic control (ie, hemoglobin A1c <7.5%) (78.3 cases vs 19.0 cases per 100 000 person-years; unadjusted incident rate ratio, 4.1; 95% CI, 3.7-4.4; P < .001). CONCLUSIONS AND RELEVANCE In this cohort study, comorbid conditions and 30-day mortality varied among types of invasive GBS infections. Obesity and poor long-term glycemic control were associated with invasive GBS infections. Efforts to reverse the trend of an increased incidence of invasive GBS infections should continue to support reducing obesity and focus on improving glycemic control.
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Affiliation(s)
- Robin L. P. Jump
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Specialty Care Center of Innovation, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brigid M. Wilson
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Daniel Baechle
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Janet M. Briggs
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Richard E. Banks
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Sunah Song
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Cleveland Institute for Computational Biology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Taissa Zappernick
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
| | - Federico Perez
- Geriatric Research Education and Clinical Center, VA Northeast Ohio Healthcare System, Cleveland
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Abstract
Background Cemento-osseous dysplasia (COD) is a fibro-osseous jaw bone lesion. The affected bone in COD progressively becomes sclerotic, poorly vascularized and susceptible to secondary osteomyelitis. Objective To provide a clinico-pathologic appraisal of COD in a South African patient population. Methods Archived records of 133 patients diagnosed with COD were reviewed for patient demographics, COD location, COD type, osteomyelitis or simple bone cyst secondary to COD. Results The mean age was 53.4 ± 13.5 years with a 94.7% female predilection. COD mainly affected the mandible (57.1%), followed by involvement of both jaws (38.3%) and maxilla (4.5%). Florid COD was the most prevalent (69.9%), followed by focal COD (18%) and periapical COD (12%). Florid COD showed a clear trend of increasing with age, peaking in the sixth decade and decreasing thereafter. Osteomyelitis and simple bone cyst presented as complications of COD in 74.4% and 5.3% of cases respectively, while 21.8% of all cases of jaw osteomyelitis during the study period were secondary to COD. Conclusion A higher frequency of jaw osteomyelitis secondary to COD was found compared to previous studies. No significant association was shown between any of the COD types and secondary osteomyelitis.
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Affiliation(s)
- Mouna M Benaessa
- Department of Oral Pathology, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Farzana Mahomed
- Department of Oral Pathology, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sizakele P Ngwenya
- Department of Oral Pathology, School of Oral Health Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Al-Mayouf SM, Almutairi A, Albrawi S, Fathalla BM, Alzyoud R, AlEnazi A, Abu-Shukair M, Alwahadneh A, Alsonbul A, Zlenti M, Khawaja E, Abushhaiwia A, Khawaja K, AlMosawi Z, Madan W, Almuatiri M, Almuatiri N. Pattern and diagnostic evaluation of systemic autoinflammatory diseases other than familial Mediterranean fever among Arab children: a multicenter study from the Pediatric Rheumatology Arab Group (PRAG). Rheumatol Int 2019; 40:49-56. [PMID: 31741047 DOI: 10.1007/s00296-019-04478-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 11/08/2019] [Indexed: 01/30/2023]
Abstract
To define the spectrum and phenotypic characteristics of systemic autoinflammatory diseases (SAIDs) other than familial Mediterranean fever (FMF) in Arab children and to delineate diagnostic evaluation. Data retrospectively collected on patients with clinical and/or genetically proven SAIDs other than FMF at 10 tertiary Arab pediatric rheumatology clinics from 1990 to 2018. The collected data comprised the clinical findings and diagnostic evaluation including genetic testing, the provided treatment and the accrual damage related to SAIDs. A total of 144 patients (93 female) with a median age at onset of 2.5 (range 0.1-12) years were enrolled. The initial diagnosis was inaccurate in 49.3%. Consanguinity rate among parents was 74.6%. The median time-to-diagnosis for all SAIDs was 2.5 (range 0.1-10) years. There were 104 patients (72.2%) with a confirmed diagnosis and 40 patients with suspected SAIDs. Seventy-two had monogenic and 66 patients with multifactorial SAIDs while six patients had undifferentiated SAIDs. The most frequent monogenic SAIDs were LACC1 mediated monogenic disorders (n = 23) followed by CAPS (12), TRAPS (12), HIDS (12), and Majeed's syndrome (6). The most frequent multifactorial SAIDs was CRMO (34), followed by PFAPA (18), and early onset sarcoidosis (EOS) (14). Genetic analysis was performed in 69 patients; 50 patients had genetically confirmed disease. Corticosteroid used for 93 patients while biologic agents for 96 patients. Overall, growth failure was the most frequent accrual damage (36%), followed by cognitive impairment (13%). There were three deaths because of infection. This study shows a heterogenous spectrum of SAIDs with a high number of genetically confirmed monogenic diseases; notably, LACC1 associated diseases. Hopefully, this work will be the first step for a prospective registry for SAIDs in Arab countries.
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MESH Headings
- Acne Vulgaris/diagnosis
- Acne Vulgaris/drug therapy
- Acne Vulgaris/epidemiology
- Acne Vulgaris/physiopathology
- Adolescent
- Anemia, Dyserythropoietic, Congenital/diagnosis
- Anemia, Dyserythropoietic, Congenital/drug therapy
- Anemia, Dyserythropoietic, Congenital/epidemiology
- Anemia, Dyserythropoietic, Congenital/physiopathology
- Antirheumatic Agents/therapeutic use
- Arabs
- Arthritis/diagnosis
- Arthritis/drug therapy
- Arthritis/epidemiology
- Arthritis/physiopathology
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/drug therapy
- Arthritis, Infectious/epidemiology
- Arthritis, Infectious/physiopathology
- Arthritis, Juvenile/drug therapy
- Arthritis, Juvenile/epidemiology
- Arthritis, Juvenile/genetics
- Arthritis, Juvenile/physiopathology
- Bahrain/epidemiology
- Child
- Child, Preschool
- Consanguinity
- Crohn Disease/drug therapy
- Crohn Disease/epidemiology
- Crohn Disease/genetics
- Crohn Disease/physiopathology
- Cross-Sectional Studies
- Cryopyrin-Associated Periodic Syndromes/diagnosis
- Cryopyrin-Associated Periodic Syndromes/drug therapy
- Cryopyrin-Associated Periodic Syndromes/epidemiology
- Cryopyrin-Associated Periodic Syndromes/physiopathology
- Diagnostic Errors
- Female
- Fever/diagnosis
- Fever/drug therapy
- Fever/epidemiology
- Fever/physiopathology
- Hereditary Autoinflammatory Diseases/diagnosis
- Hereditary Autoinflammatory Diseases/drug therapy
- Hereditary Autoinflammatory Diseases/epidemiology
- Hereditary Autoinflammatory Diseases/physiopathology
- Humans
- Immunologic Deficiency Syndromes/diagnosis
- Immunologic Deficiency Syndromes/drug therapy
- Immunologic Deficiency Syndromes/epidemiology
- Immunologic Deficiency Syndromes/physiopathology
- Infant
- Intracellular Signaling Peptides and Proteins/genetics
- Jordan/epidemiology
- Kuwait/epidemiology
- Libya/epidemiology
- Male
- Mevalonate Kinase Deficiency/diagnosis
- Mevalonate Kinase Deficiency/drug therapy
- Mevalonate Kinase Deficiency/epidemiology
- Mevalonate Kinase Deficiency/physiopathology
- Oman/epidemiology
- Osteomyelitis/diagnosis
- Osteomyelitis/drug therapy
- Osteomyelitis/epidemiology
- Osteomyelitis/physiopathology
- Pyoderma Gangrenosum/diagnosis
- Pyoderma Gangrenosum/drug therapy
- Pyoderma Gangrenosum/epidemiology
- Pyoderma Gangrenosum/physiopathology
- Retrospective Studies
- Sarcoidosis/diagnosis
- Sarcoidosis/drug therapy
- Sarcoidosis/epidemiology
- Sarcoidosis/physiopathology
- Saudi Arabia/epidemiology
- Synovitis/diagnosis
- Synovitis/drug therapy
- Synovitis/epidemiology
- Synovitis/physiopathology
- United Arab Emirates/epidemiology
- Uveitis/diagnosis
- Uveitis/drug therapy
- Uveitis/epidemiology
- Uveitis/physiopathology
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Affiliation(s)
- Sulaiman M Al-Mayouf
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Po Box 3354, Riyadh, 11211, Saudi Arabia.
| | - Abdulaziz Almutairi
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Po Box 3354, Riyadh, 11211, Saudi Arabia
| | | | - Basil M Fathalla
- Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | | | | | | | - Abdullah Alsonbul
- Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Alfaisal University, Po Box 3354, Riyadh, 11211, Saudi Arabia
| | | | | | | | | | | | - Wafa Madan
- Salmaniya Medical Complex, Manama, Bahrain
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Abstract
Staphylococcus aureus causes various infections, including skin and soft tissue infections and pneumonia via both, community-associated and nosocomial infection. These infectious diseases can lead to bacteremia, and may subsequently result in metastatic infections in several cases. Metastatic infections are critical complications in patients with S. aureus bacteremia, since the optimal duration of the antimicrobial treatment differs in patients with and without metastatic infection. Notably, two weeks of antimicrobial treatment is recommended in case of uncomplicated S. aureus bacteremia, whereas in patients with S. aureus bacteremia-associated endocarditis or vertebral osteomyelitis, six weeks of antimicrobial administration is vital. In addition, misdiagnosis or insufficient treatment in metastatic infection is associated with poor prognosis, functional disability, and relapse. Although echocardiography is recommended to examine endocarditis in the patients with S. aureus bacteremia, it remains unclear which patients should undergo additional examinations, such as CT and MRI, to detect the presence of other metastatic infections. Clinical studies have revealed that permanent foreign body and persistent bacteremia are predictive factors for metastatic infections, and experimental studies have demonstrated that the virulence factors of S. aureus, such as fnbA and clfA, are associated with endocarditis; however, these factors are not proven to increase the risk of metastatic infections. In this review, we assessed the incidence, predictive factors, diagnosis, and treatment for metastatic infections during S. aureus bacteremia.
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Affiliation(s)
- Tetsuya Horino
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan.
| | - Seiji Hori
- Department of Infectious Diseases and Infection Control, Jikei University School of Medicine, Japan
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Restelli U, Bonfanti M, Croce D, Grau S, Metallidis S, Moreno Guillén S, Pacelli V, Rizzardini G, Soro M, Vozikis A, Gray A. Organisational and financial consequences of the early discharge of patients treated for acute bacterial skin and skin structure infection and osteomyelitis in infectious disease departments in Greece, Italy and Spain: a scenario analysis. BMJ Open 2019; 9:e031356. [PMID: 31515433 PMCID: PMC6747647 DOI: 10.1136/bmjopen-2019-031356] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE The aim of the analysis is to assess the organisational and economic consequences of adopting an early discharge strategy for the treatment of acute bacterial skin and skin structure infection (ABSSSI) and osteomyelitis within infectious disease departments. SETTING Infectious disease departments in Greece, Italy and Spain. PARTICIPANTS No patients were involved in the analysis performed. INTERVENTIONS An analytic framework was developed to consider two alternative scenarios: standard hospitalisation care or an early discharge strategy for patients hospitalised due to ABSSSI and osteomyelitis, from the perspective of the National Health Services of Greece, Italy and Spain. The variables considered were: the number of annual hospitalisations eligible for early discharge, the antibiotic treatments considered (ie, oral antibiotics and intravenous long-acting antibiotics), diagnosis-related group (DRG) reimbursements, number of days of hospitalisation, incidence and costs of hospital-acquired infections, additional follow-up visits and intravenous administrations. Data were based on published literature and expert opinions. PRIMARY AND SECONDARY OUTCOME MEASURES Number of days of hospitalisation avoided and direct medical costs avoided. RESULTS The total number of days of hospitalisation avoided on a yearly basis would be between 2216 and 5595 in Greece (-8/-21 hospital beds), between 15 848 and 38 444 in Italy (-57/-135 hospital beds) and between 7529 and 23 520 in Spain (-27/-85 hospital beds). From an economic perspective, the impact of the early discharge scenario is a reduction between €45 036 and €149 552 in Greece, a reduction between €182 132 and €437 990 in Italy and a reduction between €292 284 and €884 035 in Spain. CONCLUSIONS The early discharge strategy presented would have a positive organisational impact on National Health Services, leading to potential savings in beds, and to a reduction of hospital-acquired infections and costs.
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Affiliation(s)
- Umberto Restelli
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marzia Bonfanti
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Davide Croce
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Barcelona, Spain
| | - Symeon Metallidis
- Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Santiago Moreno Guillén
- Department of Infectious Diseases, Hospital Ramón y Cajal, University of Alcalá, Madrid, Spain
| | - Valeria Pacelli
- Center for Health Economics, Social and Health Care Management, LIUC-Università Cattaneo, Castellanza, Italy
| | - Giuliano Rizzardini
- Department of Infectious Diseases, ASST Fatebenefratelli Sacco University Hospital, Milan, Italy
- School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marco Soro
- Global HEOR, Angelini, Roma, Lazio, Italy
| | - Athanasios Vozikis
- Laboratory of Health Economics and Management, University of Piraeus, Piraeus, Greece
| | - Alastair Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Waibel FWA, Uçkay I, Sairanen K, Waibel L, Berli MC, Böni T, Gariani K, Lipsky BA. Diabetic calcaneal osteomyelitis. Infez Med 2019; 27:225-238. [PMID: 31545766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Diabetic foot infection (DFI), a multi-facetted disease requiring a multidisciplinary approach for successful treatment, mostly affects the forefoot. Calcaneal osteomyelitis (CO) is an uncommon presentation of DFI with a somewhat different epidemiology, clinical features, and approach to management. These patients, compared to those with non-calcaneal DFI, more often require special surgical techniques and off-loading approaches. In this narrative review targeted to non-surgical clinicians, we explore how CO differs from other types of DFI affecting other anatomical locations. Based on our review of the literature and personal experience, we also highlight important issues regarding the management of CO osteomyelitis, including the need for specialized surgical approaches.
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Affiliation(s)
- Felix W A Waibel
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Ilker Uçkay
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland; Infectiology, Balgrist University Hospital, Zurich, Switzerland
| | - Kati Sairanen
- Unit for Clinical and Applied Research, Balgrist University Hospital, Zurich, Switzerland
| | - Lorenz Waibel
- Department of Radiology, University Hospital Freiburg, Germany
| | - Martin C Berli
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Thomas Böni
- Department of Orthopedic Surgery, Balgrist University Hospital, Zurich, Switzerland
| | - Karim Gariani
- Service of Diabetology and Endocrinology, Geneva University Hospitals, Switzerland
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Abstract
UNLABELLED This study estimated the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults. Osteonecrosis was approximately 10 times more common than in previous studies. The strongest risk factors were dialysis, hip fracture, osteomyelitis, and organ transplantation, but only hip fractures could have contributed substantially to the disease burden. INTRODUCTION The aim of this study was to estimate the incidence of osteonecrosis in a Swedish, nationwide cohort of older adults and in a large number of risk groups in that cohort. METHODS In this retrospective cohort study, we included everyone who was aged 50 years or older and who was living in Sweden on 31 December 2005. We used Swedish national databases to collect data about prescription medication use, diagnosed medical conditions, and performed medical and surgical procedures. The study outcome was diagnosis of primary or secondary osteonecrosis at any skeletal site. The strength of risk factors was assessed using age- and sex-standardized incidence ratios (SIRs). RESULTS The study cohort comprised 3,338,463 adults. The 10-year risk of osteonecrosis was 0.4% (n = 13,425), and the incidence rate was 4.7 cases/10000 person-years (95% confidence interval [CI], 4.6 to 4.7 cases). The strongest risk factors for osteonecrosis were hip fracture (SIR, 7.98; 95% CI, 7.69-8.27), solid organ transplantation (SIR, 7.14; 95% CI, 5.59-8.99), dialysis (SIR, 6.65; 95% CI, 5.62-7.81), and osteomyelitis (SIR, 6.43; 95% CI, 5.70-7.23). A history of hip fracture was present in 21.7% of cases of osteonecrosis, but osteomyelitis, dialysis, and solid organ transplantation were present in only 0.5 to 2% of cases. CONCLUSIONS Osteonecrosis was approximately 10 times more common than a small number of previous population-based studies have suggested. The strongest risk factors for osteonecrosis were dialysis, hip fracture, osteomyelitis, and solid organ transplantation, but only hip fractures could have contributed substantially to the disease burden.
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Affiliation(s)
- J Bergman
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden
| | - A Nordström
- Department of Public Health and Clinical Medicine, Unit of Occupational and Environmental Medicine, Umeå University, 90187, Umeå, Sweden
- School of Sport Sciences, UiT Arctic University of Norway, Postboks 1621, 9509, Alta, Norway
| | - P Nordström
- Department of Community Medicine and Rehabilitation, Unit of Geriatric Medicine, Umeå University, 90187, Umeå, Sweden.
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Abstract
Chronic non-bacterial osteomyelitis (CNO) is a rare auto-inflammatory bone disorder, with a prevalence of around one in a million patients. In the more severe form, it is referred to as chronic recurrent multifocal osteomyelitis (CRMO). We present the current knowledge on epidemiology, pathophysiology as well as diagnostic options and treatment regimens. CNO/CRMO most commonly affects children and lesions are often seen in the metaphyseal plates of the long bones, but cases have been described affecting all age groups as well as lesions in almost every bone. It is, therefore, a disease that clinicians can encounter in many different settings. Diagnosis is mainly a matter of exclusion from differential diagnoses such as bacterial osteomyelitis and cancer. Magnetic resonance imaging is the best radiological method for diagnosis coupled with a low-grade inflammation and a history of recurring episodes. Treatment is based on case reports and consists of alleviating symptoms with non-steroidal anti-inflammatory drugs since the disease is often self-limiting. Recently, more active treatments using either bisphosphonates or biological treatment are becoming more common, to prevent long term bone damage. In general, due to its rarity, much remains unclear regarding CNO/CRMO. We review the known literature on CNO/CRMO and propose areas of interest as well as possible ways to make current diagnostic criteria more detailed. We also find unifocal cases of the jaw to be a possible sub-type that may need its own set of criteria.
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Affiliation(s)
- Kristian Buch
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne Cathrine Baun Thuesen
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Charlotte Brøns
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Peter Schwarz
- Department of Endocrinology, Diabetes and Bone-metabolic Research Unit, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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Xing K, Huang G, Hua S, Xu G, Li M. Systematic review of randomized controlled trials on antibiotic treatment for osteomyelitis in diabetes. Diabet Med 2019; 36:546-556. [PMID: 30785639 DOI: 10.1111/dme.13935] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2019] [Indexed: 12/28/2022]
Abstract
AIM To evaluate the efficacy of antibiotic therapy in osteomyelitis treatment among people with diabetes. METHODS A systematic search of PubMed, EMBASE, AMED, Web of Science, the WHO trial registry, Cochrane library databases, and ClinicalTrials.gov, in addition to hand-searching, was undertaken in July 2018. Two reviewers independently extracted data. The studies' methodological quality was assessed using the modified Jadad scale. Descriptive analysis was performed. RESULTS Seven randomized controlled trials, with 393 participants in total, were included. The antibiotic regimens, treatments and follow-up durations varied among the trials. The total scores showed that the overall methodological quality of the seven studies was high, despite two studies showing some flaws in double-blinding and withdrawals/drop-outs. Of four studies comparing different antibiotic regimens, three implied a similar remission effect, while one implied that ertapenem ± vancomycin treatment showed a higher remission rate than tigecycline treatment; this conclusion was not robust because of low power and small sample size. In the other three studies, which included two different doses of ciprofloxacin, an antibiotics group and a conservative surgical group, and two durations of the same antibiotic strategy, no significant differences in remission were reported between the groups. No difference was observed in the analyses of microbiological outcomes, superinfections and relapse, except adverse events. CONCLUSIONS There is no definitive evidence supporting the superiority of any particular antibiotic agent, dose, or administration duration in the treatment of osteomyelitis in diabetes. As the included studies had some flaws and limitations, further research is necessary.
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Affiliation(s)
- K Xing
- Department of Orthopaedic Oncology, Honghui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, Shaanxi, China
| | - G Huang
- Department of Orthopaedic Oncology, Honghui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, Shaanxi, China
| | - S Hua
- Department of Rheumatism and Immunity Branch, Xi an No. 5 Hospital, Xi'an, Shaanxi, China
| | - G Xu
- Department of Neurosurgery, First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China
| | - M Li
- Department of Paediatric Orthopedics, Honghui Hospital, Xi'an Jiaotong University, College of Medicine, Xi'an, Shaanxi, China
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