Pediatric pneumococcal bone and joint infections. The Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG).

Children's Hospital and University of California, San Diego, California, USA.
PEDIATRICS (Impact Factor: 5.3). 01/1999; 102(6):1376-82.
Source: PubMed

ABSTRACT To describe the clinical and microbiological characteristics of infants and children with bone and joint infections caused by penicillin-susceptible and penicillin-nonsusceptible strains of Streptococcus pneumoniae.
Multicenter, prospective patient accrual; retrospective chart review of identified patients.
Eight children's hospitals in the United States.
Forty-two children with bone and/or joint infections prospectively enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study from September 1, 1993 to August 31, 1996.
Data were collected on multiple variables, including age, gender, race, days of symptoms before and during hospitalization, antibiotic and surgical therapy, laboratory and imaging studies.
Of the 42 children enrolled (21 bone, 21 joint infections), 14 had isolates that were not susceptible to penicillin. Eight of 16 (50%) strains isolated from children who received antibiotics within 4 weeks before hospitalization were not susceptible to penicillin, compared with 4 of 15 (27%) strains isolated from children without previous antibiotic exposure. Clinical response to therapy was similar between children infected by penicillin-susceptible strains compared with those infected by penicillin-nonsusceptible strains, including duration of hospitalization (9.1 days vs 11.2 days), days of intravenous antibiotic therapy (25.3 days vs 24.6 days), days of fever (3.6 days vs 3.1 days), and sequelae (14% vs 7%). The most commonly prescribed single agents for parenteral therapy in definitive treatment were ceftriaxone (36%), penicillin (15%), and clindamycin (15%). Oral therapy followed parenteral therapy in 56% of children. The mean (+/- standard deviation) duration of total antibiotic therapy in children with osteomyelitis was 57.5 +/- 48.6 days (range, 23-196 days) and 29.2 +/- 11.8 days (range, 12-67 days) for arthritis. Late sequelae (long-term destructive changes of the bone or joint) were documented in 5 (12%) children, 4 with osteomyelitis, and 1 with arthritis. Sequelae occurred in 30% of children with long bone osteomyelitis associated with infection in the adjacent joint. The age of children with sequelae was younger than those without sequelae (6.4 months vs 18.6 months).
The demographic characteristics and anatomic sites of infection in our patients were similar to previously published series collected from single institutions before the emergence of significant antibiotic resistance in S pneumoniae. Our analysis suggests that children infected by penicillin-nonsusceptible strains have a similar clinical response to therapy when compared with children infected by penicillin-susceptible strains.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Las infecciones osteoarticulares (IOA) son poco frecuentes en pediatría. Existe controversia acerca de la óptima duración y la vía de administración de la terapia antimicrobiana. Objetivo: Caracterizar y describir la evolución y complicaciones en niños con IOA que recibieron 7 días iniciales de terapia endovenosa, completando 4 a 6 semanas de terapia total. Pacientes y Métodos: Estudio descriptivo, que incluyó a 70 niños con diagnóstico de IOA, entre marzo de 2003 y diciembre de 2004 en un hospital pediátrico, quienes recibieron tratamiento endovenoso abreviado a 7 días, seguido de terapia oral por 3 a 5 semanas. Resultados: La incidencia de IOA fue de 1,8: 10.000 niños bajo 15 años de edad. El promedio de edad fue 6,4 ± 4,4 años. Sesenta por ciento presentaba artritis séptica, 36% osteomielitis y 4% osteoartritis. En 80% la infección se localizó en extremidades inferiores. Los cultivos fueron positivos en 59%. En 46,5% se aisló Staphylococcus aureus. Siete niños evolucionaron con dolor persistente o elevación significativa de PCR y requirieron prolongar la terapia endovenosa y/o total, sin presentar complicaciones a corto plazo. Conclusiones: Siete días de terapia antimicrobiana intravenosa parece ser efectivo y recomendable para el tratamiento, en su fase inicial, de las infecciones osteo-articulares.
    Revista chilena de infectologia: organo oficial de la Sociedad Chilena de Infectologia 02/2008; 25(1):30-36. DOI:10.4067/S0716-10182008000100007 · 0.50 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The epidemiology and clinical manifestations of osteoarticular infections are changing primarily as a result of the emergence of community-acquired methicillin-resistant Staphylococcus aureus infections. Multifocal disease, venous thrombosis and pathologic fractures are manifestations of CA-MRSA osteomyelitis. MRI is the diagnostic imaging modality of choice for musculoskeletal infections. Nafcillin/oxacillin or cefazolin remains the antibiotic of choice for treating infections caused by MSSA. A β-lactam antibiotic is recommended for Kingella kingae. Vancomycin and clindamycin are the first line agents for treating osteomyelitis caused by CA-MRSA. A short course of parenteral antibiotics followed by appropriate oral antibiotics is equivalent to total course of parenteral antibiotics for most patients and avoids the risks associated with PICCs. Surgical drainage of subperiosteal abscesses and surrounding pyomyositis is common with S. aureus clones currently circulating. Collaboration with hematologists for managing patients with venous thromboses is recommended.
    The Journal of infection 10/2013; DOI:10.1016/j.jinf.2013.09.014 · 4.02 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Invasive pneumococcal disease (IPD) is a major cause of pediatric morbidity and mortality in resource-rich and low and middle-income countries (LMICs). Streptococcus pneumoniae can cause a wide spectrum of invasive and non-invasive disease. In resource-rich countries, implementation of 7-valent pneumococcal conjugate vaccine (PCV7) has been a significant public health achievement. Dramatic decrease in pediatric IPD incidence occurred after PCV7 implementation, but emergence of multi-drug-resistant non-vaccine serotypes (especially 19A) remains a concern. The recently introduced 13-valent PCV (PCV13) has the potential to further reduce the burden of IPD due to serotypes not contained in PCV7. Given the diversity of pneumococcal serotypes and the possibility of serotype replacement disease, innovative approaches to development of pneumococcal vaccines are needed. Continued surveillance of pneumococcal serotypes and antimicrobial resistance is crucial to evaluate the impact of PCV13 vaccine. Improved access to PCVs is crucial to reduce morbidity and mortality related to IPD in LMIC.
    09/2013; 1(3). DOI:10.1007/s40124-013-0021-9