No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Acute bone and joint infections in children and therapeutic options
Abstract
Osteomyelitis and septic arthritis show similar problems in diagnosis and treatment. The majority of bone or joint infections are caused by spread of the bacteria through the bloodstream or occasionally by entry of organisms through an open wound, by puncture or by extension of infection from adjacent tissue. The most common causative organism is Staphylococcus aureus but many other organisms may be responsible for a bone or joint infections. Successful treatment of osteomyelitis and septic arthritis in infancy and childhood depends on early recognition and prompt institution of therapy. Inappropriate or delayed treatment may result in chronic osteomyelitis or irreversible joint destruction. This article reviews current information regarding pathogenesis, epidemiology and microbiology of pediatric osteomyelitis and septic arthritis and the clinical presentation, diagnosis and treatment of these infections.
... These events can injure the brachial plexus, resulting in the involvement of the upper part of the arm or, more rarely, the forearm and hand. Arthro-osteomyelitis occurs rarely in the neonatal [10][11][12] and infantile periods and is mostly due to bacterial infections , mainly with Staph. aureus, Group-B Streptococcus, and E. coli. ...
... This is because transphyseal blood vessel continuity between the metaphysis and epiphysis allows the infection to reach the joint space and vice versa. Studies have shown that 76% [12], 70% [13], 47% [14], and 28% [15] of osteomyelitis cases are associated with septic arthritis. In infants, the signs or symptoms of arthro-osteomyelitis are usually not specific. ...
... Inadequate treatment at that stage led to chronic osteomyelitis of the ilium. In the literature, S. aureus has been implicated as the most frequent infective organism, about 40% of patients [2, 6, 7]. Less commonly, the infection is due to Staphylococcus epidermidis, Haemophilus influenza and group B Streptococ- cus [8], Escherichia coli, and other gram-negative organisms in the neonatal period. ...
... But, in our case, when she presented with gluteal syndrome at the age of 1 month, she was not given a course of antibiotics, which could be the reason behind the progression to chronic osteomyelitis. The treatment of chronic pelvic osteomyelitis requires intravenous antibiotics with appropriate sensitivity studies and thorough debridement [6]. Muhdi et al. [10] described six cases of chronic osteomyelitis of the ilium among which two were due to hematogenous spread. ...
Bone and joint infections are rare in the neonatal period. They often present with pseudo paralysis of the affected limb due to pain and discomfort caused by movement. The existence of a concomitant neuropathy is a rare and insufficiently understood phenomenon with few cases described. The authors report the case of a 7-week infant, born prematurely and with Staphylococcus aureus neonatal sepsis, who presented to the emergency room with a paretic right upper limb. Osteoarticular infection complicated with brachial plexus neuropathy was considered and MRI and electromyography the confirmed diagnosis. There was a good outcome after antibiotic treatment and functional rehabilitation.
Acute osteomyelitis in neonates, although rare, represents a diagnostic and therapeutic challenge. We herein report an extremely rare case of congenital nonsyphilitic iliac bone osteomyelitis caused by methicilline-sensitive Staphylococcus aureus and presenting with gluteal syndrome in a near-term infant. To our knowledge, this represents the second report with iliac osteomyelitis and the first report with gluteal syndrome in neonatal period. A high index of suspicion is necessary to make an early diagnosis. Early diagnosis is essential to prevent catastrophic sequelae in such cases. We report this case because of its unusual clinical presentation and rarity.
To describe bacteriologic epidemiology of bone and joint infections, a total of 52 osteomyelitis, 52 arthritis and 20 osteoarthritis of children aged one month to 15 years during a one-year period (2001) were included in a retrospective unicentric review. The mean age was 3,9 ±3,6 years. Fever and pain were the most common clinical symptoms. The site of infection was single in 95%, involving lower extremities in 80%. Bone scintigraphy was abnormal in 71% of osteomyelitis. Positive cultures was obtained in 29% of all cases (blood cultures: 20%, aspiration cultures: 29%), but in 42% of cases which have both blood and aspiration cultures. Thirty-six bacteria were identified: 19 Staphylococcus (14 aureus), ten Streptococcus (four pneumoniae), three Salmonella, three Kingella kingae, one Moraxella. All the isolates were susceptible to the empiric antibiotic therapy. Outcome was good in 100% of osteomyelitis and in 96% of arthritis.
Unlabelled:
Gram-positive bacteria, notably coagulase negative staphylococci, have become an important cause of infection in neonates. Furthermore, many of these pathogens are now resistant to multiple antibacterial agents. Teicoplanin, a glycopeptide antibiotic, is active against a broad range of Gram-positive pathogens, including methicillin-resistant staphylococci. It has advantages over vancomycin in terms of tolerability, with a lower propensity to cause nephrotoxicity and anaphylactoid-like reactions, and in terms of ease of administration and monitoring requirements. The clinical utility of teicoplanin in neonates with Gram-positive infections has been investigated in several noncomparative studies. Clinical and bacteriological response rates in 173 neonates treated with teicoplanin 8-10 mg/kg intravenously or intramuscularly once daily after a loading-dose regimen of 10-20 mg/kg per day have ranged from 80%-100% and 83%-100%, respectively. Few adverse events related to teicoplanin have been reported in this patient population.
Conclusion:
Teicoplanin (8-10 mg/kg) administered intravenously or intramuscularly once daily after a loading-dose regimen of 15-20 mg/kg per day appears to be an effective and well tolerated treatment for Gram-positive infections in neonates.
To examine the natural history, clinical manifestations, laboratory changes and outcomes of children with culture-negative osteomyelitis and to compare findings with cases of culture-positive infection treated during the same time period.
Retrospective review of consecutive admissions for osteomyelitis during the 4-year period 1998 through 2001, with a minimum follow-up of 1 year.
A single urban children's hospital with a large orthopedic referral service. CLINICAL AND LABORATORY MEASURES: Age, gender, predisposing factors, clinical manifestations, maximum temperature, duration of pain, bone involved, laboratory changes, results of cultures from infected bone and blood and outcome after treatment.
A total of 85 patients fulfilled study criteria, of whom 40 were culture-negative. Compared with culture-positive cases, culture-negative osteomyelitis patients were less likely to have antecedent trauma (P = 0.0357) and overlying skin changes (P = 0.0001), duration of pain and other symptoms was longer (P = 0.0396) and skeletal residua were rare. They were also older, with this difference approaching statistical significance (P = 0.0586).
Children with culture-negative osteomyelitis present initially differently from culture-positive cases and can be managed as presumed staphylococcal disease with excellent long term results.
Septic arthritis in children remains a serious disease with the potential for significant systemic and musculoskeletal morbidity. Staphlococcus aureus is the most common cause of bone and joint infections in all age groups. Microbial invasion of the synovial space occurs typically results from hematogenous seeding. Diagnosis in neonates and young infants can be difficult since the clinical signs are much less specific in these age groups. Early diagnosis by needle aspiration of the affected joint and prompt initiation of appropriate antimicrobial therapy in conjunction with drainage of the affected joint is critical to avoid destruction of the articular cartilage and prevent disability. Septic arthritis in infants and children should always be managed by a pediatrician in close consultation with an orthopedic surgeon. Empiric antibiotic regimens should always include adequate anti-staphylococcal coverage. Antibiotic treatment should be started with appropriate doses of intravenous antibiotics. Switch to oral antibiotic therapy can be made when patient demonstrates clinical improvement. A minimum of 3-4 weeks of therapy is recommended. Close follow-up is warranted to monitor the growth of the affected limb until skeletal maturity.
Septic arthritis in children can be difficult to diagnose and may be associated with severe morbidity. A majority of apparent septic arthritis cases may have negative culture, thereby creating a dilemma regarding treatment. The medical charts of 209 children with the diagnosis of septic arthritis were retrospectively reviewed to evaluate the differences between culture-negative (n = 64) and culture-positive (n = 145) cases. Demographic data, clinical manifestations, treatment, and outcome were analyzed. Laboratory data recorded included white blood cell count, erythrocyte sedimentation rate, C-reactive protein, imaging studies, and culture results. Patients with culture-negative arthritis had a significantly lower incidence of fever (56.3% vs 70.3%, p=0.047), local pain or tenderness (42.2% vs 69.7%, p=0.0001), changes in the overlying skin (45.3% vs 62.1%, p=0.024), motion limitation (25.0% vs 42.8%, p=0.014), and osteomyelitis (25.0% vs 40.7%, p=0.029). Culture-negative patients had a longer duration of symptoms or signs before diagnosis (10.1 +/- 8.9 days vs 6.5 +/- 5.7 days, p=0.046) and a shorter antimicrobial course (24.5 +/- 5.1 days vs 35.7 +/- 8.1 days, p=0.001). Children with culture-negative septic arthritis had a lower prevalence of residual joint dysfunction at 6 months after treatment (3.1% vs 11.7%, p=0.046). In conclusion, children with culture-negative septic arthritis have milder clinical manifestations, earlier response to treatment, and a better outcome than those with culture-positive disease.
Staphylococcus aureus remains one of the most common and troublesome microorganisms causing disease in humans, despite the development of effective antibiotics. Linezolid is a member of a new class of synthetic antibiotics called oxazolidinones, introduced into therapy due to the increasing resistance of Gram-positive pathogens to traditional antibiotics. Information about the pharmacokinetics and tolerability profile of linezolid in the pediatric population mostly derive from adult studies and especially in the neonatal field relatively few data are available. Here we summarize linezolid's characteristics and report data available in the literature regarding linezolid use in newborns and children. For this purpose, a Medline search was performed between 1990 and 2006 involving the term "linezolid" combined with the terms "newborn", "infant", "child", "pediatrics". Additional information was obtained from Reactions Weekly.