Article

Acute Bacterial Osteoarticular Infections: Eight-Year Analysis of C-Reactive Protein for Oral Step-Down Therapy

Department of Pediatrics, Division of Infectious Diseases, Naval Medical Center, San Diego, 34800 Bob Wilson Dr, San Diego, CA 92134. .
PEDIATRICS (Impact Factor: 5.47). 09/2012; 130(4):e821-8. DOI: 10.1542/peds.2012-0220
Source: PubMed

ABSTRACT

One of the most important decisions in the treatment of osteoarticular infections is the time at which parenteral therapy can be changed to oral therapy. C-reactive protein (CRP) is an acute inflammatory indicator with a half-life of 19 hours and thus can be helpful in assessing the adequacy of therapy for bacterial infections. At our institution, a combination of CRP and clinical findings is used to determine the transition to oral therapy.
A search of 8 years of electronic records identified children with osteoarticular infections. Only children with culture-positive acute bacterial arthritis (ABA) or acute bacterial osteomyelitis (ABO) were studied further. A primary chart review of demographic and clinical data was conducted, and a secondary chart review of complicated outcomes was performed.
Of 194 total patients, complicated outcomes occurred in 40, of which 35 were prolonged therapy. Only 1 microbiologic failure occurred, presumably due to a retained intra-articular fragment of infected bone. CRP was highest initially among patients with simultaneous ABO + ABA and among those with complicated outcomes, and was lower at the transition to oral therapy in the complicated outcome group (1.5 vs 2.1 mg/dL; P = .012).
The combination of clinical findings and CRP is a useful tool to transition children with osteoarticular infections to oral therapy. Complicated outcomes were associated with higher early CRP at diagnosis and lower CRP at the end of parenteral therapy, suggesting that clinicians were more conservative with prolonged initial parenteral therapy in this group.

Full-text preview

Available from: pediatrics.aappublications.org
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The goal of our work was to study the changes in the bone tissue, bone marrow and surrounding tissues in animals during early stages of experimental osteomyelitis. Osteomyelitis was simulated in 30 infants rabbits aged 3-4 months whose body weight accounted 1200-1600 grams through the insertion of 5-6 million of aurococcus into the marrow channel of a shinbone. The study of bone marrow, bone tissue and surrounding tissue was conducted 30 minutes, 6, 12, 24, 48 and 60 hours after the contamination with the help of light and electronic (transmission and scanning) microscopy. It was proved that the first changes are characterized by the evident changes in the vessel's walls which cause the swelling of bone marrow and suppurative inflammation in the bone tissue occurs only in the end of the 3d day of the experiment. These data confirm the necessity of osteoperfortation during the first 24 hours of contamination in order to remove the swelling and to correct vessel disorders.
    Full-text · Article · Aug 2013 · Bosnian journal of basic medical sciences / Udruzenje basicnih mediciniskih znanosti = Association of Basic Medical Sciences
  • [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.
    No preview · Article · Oct 2013 · The Journal of infection
  • [Show abstract] [Hide abstract]
    ABSTRACT: Recent advances in the evaluation and treatment of children with musculoskeletal infection are focused upon improvements in diagnosis and treatment according to evidence-based clinical practice guidelines. Osteomyelitis, septic arthritis, and pyomyositis demonstrate a wide range of clinical severity, which creates the need for a collaborative multidisciplinary approach to treatment. Important elements in caring for children with these conditions include an organized framework for initial and advanced diagnostic imaging and laboratory evaluation, an efficient method of delivering antibiotic therapy and surgical intervention whenever necessary, and an orientation toward continuity of care to ensure that excellent long-term clinical outcomes are achieved. As we approach an era of cost containment in modern healthcare, clinicians will seek evidence that justifies early transition to oral antibiotic therapy and hospital discharge for these children while continuing to ensure their safety and reduce the risk of readmission because of residual or recurrent infection. The current epidemiology of pediatric musculoskeletal infection is affected by the spectrum of causative organisms that are reported in various communities. Methicillin-sensitive and Methicillin-resistant Staphylococcus aureus remain the most common pathogens responsible for invasive infections but vary substantially as to their relative incidence, depending on the geographical location of the reporting institution.
    No preview · Article · Nov 2013 · Current Orthopaedic Practice
Show more