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Royer J, Castel LC, Lefevre Y, Pfirrmann C, Lalioui A, Harper L, Angelliaume A. Risk of repeated drainage in pediatric septic arthritis: patient or method? J Pediatr Orthop B 2024; 33:374-378. [PMID: 37610092 DOI: 10.1097/bpb.0000000000001119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
How drainage of septic arthritis should be performed remains controversial. The aim of the present study was to compare arthrocentesis (Ac) using double intra-articular needle lavage to arthrotomy (At) as first-line drainage treatment for pediatric hip and knee septic arthritis. The secondary objective was to identify risk factors of second articular drainage. A retrospective review of medical records of children with knee and hip septic arthritis was conducted. Inclusion criteria were: children treated for septic arthritis between 2014 and 2020 with a positive culture of joint fluid. Clinical, biological, radiographical and ultrasound data were recorded at presentation and during follow-up. Patients were divided into 2 groups according to the type of drainage performed: Ac or At. 25 hips and 44 knees were included, 42 treated by Ac (15 hips, 27 knees) and 27 by At (10 hips, 17 knees). There is no significant difference between Ac and At regarding the need for repeated drainage and Ac nor At was reported as risk factor for repeated drainage. The presence of associated musculoskeletal infection (MSI) was a significant risk factor of repeated drainage [odds ratio = 11.8; 95% confidence interval = 1.2-114.2; P < 0.001]. Significantly more associated MSI ( P < 0.001), level I virulence germs ( P < 0.001) and positive blood culture (<0.001) were found in patients who underwent repeated drainage. There was no significant difference between Ac and At regarding rate of repeated drainage. The risk factors for repeated drainage were: associated with MSI, virulent germs and positive blood culture.
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Affiliation(s)
- Julia Royer
- Department of Pediatric Surgery, Pellegrin University Hospital, Bordeaux
| | | | - Yan Lefevre
- Department of Pediatric Surgery, Pellegrin University Hospital, Bordeaux
| | - Clémence Pfirrmann
- Department of Pediatric Surgery, Pellegrin University Hospital, Bordeaux
| | - Abdelfetah Lalioui
- Department of Pediatric Surgery, Pellegrin University Hospital, Bordeaux
| | - Luke Harper
- Department of Pediatric Surgery, Pellegrin University Hospital, Bordeaux
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Sun K, Zhang C, Mao Z, Wang C, Zhu H, Sun H, Wang K, Cheng W. Clinical characteristics of neonatal and infant osteomyelitis and septic arthritis: a multicenter retrospective study. J Pediatr (Rio J) 2024:S0021-7557(24)00032-9. [PMID: 38642591 DOI: 10.1016/j.jped.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. METHODS A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. RESULTS Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). CONCLUSION Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.
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Affiliation(s)
- Keming Sun
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China
| | - Chunxu Zhang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China
| | - Ziwen Mao
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China; Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Zhengzhou, Henan, China
| | - Chen Wang
- Hebei Children's Hospital, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, China
| | - Hua Zhu
- Hebei Children's Hospital, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, China
| | - Huiqing Sun
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Neonatology, Zhengzhou, Henan, China
| | - Kang Wang
- Hebei Children's Hospital, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, China
| | - Weyland Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China; Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Zhengzhou, Henan, China.
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3
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Iseri Nepesov M, Kilic O, Sali E, Yesil E, Akar A, Kaman A, Metin Akcan O, Kilic Cil M, Ozlu C, Lacinel Gurlevik S, Ulusoy E, Cetin BS, Akici N, Cakir D, Uslu Aygun FD, Hancerli CO, Tekin Yilmaz A, Alkan G, Uygun H, Bucak IH, Bursal B, Celik T, Sutcu M, Oz FN, Gayretli Aydin ZG, Karbuz A, Akturk H, Kepenekli E, Emiroglu M, Oncel S, Nuhoglu C, Korucu IH, Incesu M, Kaya A, Bombaci H, Dinleyici M, Carman KB, Duman M, Turel O, Yilmaz D, Alabaz D, Belet N, Tanir G, Turgut M, Celebi S, Kuyucu N, Arisoy ES, Durmaz G, Kaya M, Kara A, Dinleyici EC. Pathogens in Pediatric Septic Arthritis: A Multi-Center Study in Turkiye (PEDSART Study). CHILDREN (BASEL, SWITZERLAND) 2024; 11:134. [PMID: 38275444 PMCID: PMC10813905 DOI: 10.3390/children11010134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES Septic arthritis (SA) is a serious bacterial infection that must be treated efficiently and timely. The large number of culture-negative cases makes local epidemiological data important. Accordingly, this study aimed to evaluate the etiology, clinical characteristics, and therapeutic approach of SA in children in Turkiye, emphasizing the role of real-time polymerase chain reaction (PCR) techniques in the diagnosis. METHODS In this multi-center, prospective study, children hospitalized due to SA between February 2018 and July 2020 in 23 hospitals in 14 cities in Turkiye were included. Clinical, demographic, laboratory, and radiological findings were assessed, and real-time PCR was performed using synovial fluid samples. RESULTS Seventy-five children aged between 3 and 204 months diagnosed with acute SA were enrolled. Joint pain was the main complaint at admission, and the most commonly involved joints were the knees in 58 patients (77.4%). The combination of synovial fluid culture and real-time PCR detected causative bacteria in 33 patients (44%). In 14 (18.7%) patients, the etiological agent was demonstrated using only PCR. The most commonly isolated etiologic agent was Staphylococcus aureus, which was detected in 22 (29.3%) patients, while Streptococcus pyogenes was found in 4 (5.3%) patients and Kingella kingae in 3 (4%) patients. Streptococcus pyogenes and Kingella kingae were detected using only PCR. Most patients (81.3%) received combination therapy with multiple agents, and the most commonly used combination was glycopeptides plus third-generation cephalosporin. CONCLUSIONS Staphylococcus aureus is the main pathogen in pediatric SA, and with the use of advanced diagnostic approaches, such as real-time PCR, the chance of diagnosis increases, especially in cases due to Kingella kingae and Streptococcus pyogenes.
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Affiliation(s)
- Merve Iseri Nepesov
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye; (M.I.N.); (O.K.)
| | - Omer Kilic
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye; (M.I.N.); (O.K.)
| | - Enes Sali
- Department of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
| | - Edanur Yesil
- Department of Pediatric Infectious Diseases, Mersin City Hospital, Mersin 33240, Türkiye
| | - Asuman Akar
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin 33110, Türkiye
| | - Ayse Kaman
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Ozge Metin Akcan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye
| | - Merve Kilic Cil
- Department of Pediatric Infectious Diseases, Adana City Hospital, Adana 01230, Türkiye
| | - Canan Ozlu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35210, Türkiye
| | - Sibel Lacinel Gurlevik
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye
| | - Emel Ulusoy
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Health Sciences Izmir Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir 35210, Türkiye
| | - Benhur Sirvan Cetin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Erciyes University, Kayseri 38030, Türkiye
| | - Narin Akici
- Department of Pediatrics, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Deniz Cakir
- Department of Pediatric Infectious Diseases, Umraniye Training and Research Hospital, Istanbul 34764, Türkiye
| | - Fatma Deniz Uslu Aygun
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Cerrahpaşa University, Istanbul 34098, Türkiye
| | - Cafer Ozgur Hancerli
- Department of Orthopedics and Traumatology, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul 34303, Türkiye
| | - Ayse Tekin Yilmaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Gulsum Alkan
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya 42130, Türkiye
| | - Hatice Uygun
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Ibrahim Hakan Bucak
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Burcu Bursal
- Department of Pediatrics, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul 34303, Türkiye
| | - Taylan Celik
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale 17020, Türkiye
| | - Murat Sutcu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Istinye University, Istanbul 34010, Türkiye
| | - Fatma Nur Oz
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Zeynep Gokce Gayretli Aydin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon 61080, Türkiye
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Tascioglu City Hospital, Istanbul 34384, Türkiye
| | - Hacer Akturk
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Koc University, Istanbul 34010, Türkiye
| | - Eda Kepenekli
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Marmara University, Istanbul 34854, Türkiye
| | - Melike Emiroglu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Selcuk University, Konya 42130, Türkiye
| | - Selim Oncel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Cagatay Nuhoglu
- Department of Pediatrics, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Ismail Hakki Korucu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Necmettin Erbakan University, Konya 42090, Türkiye
| | - Mustafa Incesu
- Department of Orthopedics and Traumatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Ahmet Kaya
- Department of Orthopedics and Traumatology, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Hasan Bombaci
- Department of Orthopedics and Traumatology, University of Health Sciences, Haydarpaşa Numune Training and Research Hospital, Istanbul 34668, Türkiye
| | - Meltem Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Kursat Bora Carman
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Murat Duman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35160, Türkiye
| | - Ozden Turel
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Medeniyet University, Istanbul 34700, Türkiye
| | - Dilek Yilmaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Health Sciences, Izmir Tepecik Training and Research Hospital, Izmir 35020, Türkiye
| | - Derya Alabaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana 01330, Türkiye
| | - Nursen Belet
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Dokuz Eylul University, Izmir 35210, Türkiye
| | - Gonul Tanir
- Department of Pediatric Infectious Diseases, Dr. Sami Ulus Maternity and Children’s Training and Research Hospital, Ankara 06080, Türkiye
| | - Mehmet Turgut
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Adıyaman University, Adıyaman 02040, Türkiye
| | - Solmaz Celebi
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Uludag University, Bursa 16059, Türkiye
| | - Necdet Kuyucu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Mersin University, Mersin 33110, Türkiye
| | - Emin Sami Arisoy
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Kocaeli University, İzmit 41001, Türkiye
| | - Gul Durmaz
- Department of Microbiology, Faculty of Medicine, Eskişehir Osmangazi University, Eskisehir 26040, Türkiye
| | - Mucahit Kaya
- Diagen Biotechnological Systems Healthcare and Automation Company, Ankara 06070, Türkiye
| | - Ates Kara
- Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara 06230, Türkiye
| | - Ener Cagri Dinleyici
- Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir 26040, Türkiye
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Nathani HR, Samal S. Septic Arthritis Associated With Hip Joint Subluxation and Epiphyseal Plate Deformation as a Sequala of Sickle Cell Anemia. Cureus 2023; 15:e48103. [PMID: 38046768 PMCID: PMC10691398 DOI: 10.7759/cureus.48103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/01/2023] [Indexed: 12/05/2023] Open
Abstract
This case report emphasizes the critical nature of septic arthritis in pediatric patients, particularly its predilection for large joints like the hip. It underscores the importance of rapid diagnosis and early intervention to preserve joint function. The case involves a six-year-old patient with sickle cell anemia who presented with persistent hip pain and hip subluxation and underwent hip joint arthrotomy. Clinical findings revealed limited mobility, weakness, and radiographic abnormalities. Comprehensive rehabilitation resulted in significant improvements in pain, mobility, and function. The key takeaway is the pivotal role of early diagnosis and comprehensive rehabilitation in managing septic arthritis in pediatric patients, especially those with underlying conditions like sickle cell anemia.
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Affiliation(s)
- Harsh R Nathani
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Subrat Samal
- Department of Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhang HT, Li C, Huang YZ, Huang Y. Meta-analysis of serum procalcitonin diagnostic test accuracy for osteomyelitis and septic arthritis in children. J Pediatr Orthop B 2023; 32:481-489. [PMID: 36421016 PMCID: PMC10371063 DOI: 10.1097/bpb.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/14/2022] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to evaluate the sensitivity, specificity, and predictive value of serum procalcitonin (PCT) for osteomyelitis and septic arthritis in children. PubMed, EMBase, and Cochrane Library were searched until 10 August 2021, for eligible literature focusing on PCT for the diagnosis of osteomyelitis and septic arthritis. Four articles with six studies were included in the diagnostic meta-analysis, a total of 654 children were examined for bacterial cultures in PCT, osteomyelitis, and septic arthritis. The results of diagnostic meta-analysis showed that the PCT had a sensitivity of 0.72, 95% confidence interval (CI) (0.65-0.79), specificity of 0.90, 95% CI (0.87-0.93), positive likelihood ratio (LR) of 3.87, 95% CI (2.53-5.90), negative LR of 0.39, 95% CI (0.22-0.70), and diagnostic odds ratio was 13.13, 95% CI (6.46-26.66), for the detection of osteomyelitis and septic arthritis using bacterial culture as the gold standard. Based on the summary receiver operating characteristic curve of PCT, it was found that the area under the curve of PCT was 0.88. In the evaluation of publication bias, the result of the regression line test showed that there was not publication bias (bias = 13.72; 95% CI, -1.84 to 29.28; P = 0.07). This study provided systematic review of the published literature on the diagnosis of osteomyelitis and septic arthritis in children using PCT, which may serve as a biomarker for diagnosis of osteomyelitis, but it has no direct evidences to support the diagnosis of septic arthritis. However, the specific optimal cutoff value of PCT and specific population still needed to be verified by large sample studies.
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Affiliation(s)
- Hai-Tao Zhang
- Department of Spinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine
- Department of Spinal Surgery, Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Chao Li
- Department of Spinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine
- Department of Spinal Surgery, Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Yi-Zheng Huang
- Department of Spinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine
- Department of Spinal Surgery, Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
| | - Yong Huang
- Department of Spinal Surgery, Hubei Provincial Hospital of Traditional Chinese Medicine
- Department of Spinal Surgery, Hubei Province Academy of Traditional Chinese Medicine, Wuhan, China
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Sander E. Septic Arthritis of the Elbow in a Premature Neonate: An Uncommon Disease in an Uncommon Location. Pediatr Ann 2023; 52:e292-e296. [PMID: 37561826 DOI: 10.3928/19382359-20230613-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Septic arthritis (SA) is an infrequent diagnosis in the neonate. This case illustrates the presentation of SA within the elbow, an atypical location for neonatal SA. SA should be considered in any neonate with joint swelling, as symptoms are often subtle. Constitutional symptoms of infection, including fever, may not be present in the neonate. Staphylococcus aureus is the most common etiologic organism, and neonatal SA is often caused by hematogenous spread partially due to unique neonatal intraosseous anatomy. Joint aspiration can provide a definitive diagnosis and aid in targeted antimicrobial therapy. Other laboratory tests, including C-reactive protein and erythrocyte sedimentation rate, can aid in diagnosis. Ultrasound and magnetic resonance imaging can demonstrate joint effusion along with osteomyelitis, which is often seen concurrently with neonatal SA. There are no definitive guidelines for the treatment of neonatal SA. Conservative therapy with antimicrobials along with surgical intervention are the mainstays of treatment. Prompt diagnosis and treatment are crucial to decrease permanent joint damage. [Pediatr Ann. 2023;52(8):e292-e296.].
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O’Donnell JM, Ekunseitan E, Swarup I. Factors associated with subsequent surgery after septic arthritis of the knee in children. World J Clin Pediatr 2023; 12:38-44. [PMID: 37034431 PMCID: PMC10075021 DOI: 10.5409/wjcp.v12.i2.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/13/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Septic arthritis of the knee in children is a challenging problem. Surgical debridement is an established treatment, but there is a paucity of literature on long-term prognosis.
AIM To determine the rates and factors associated with return to surgery (RTS) and readmission after index surgical debridement for septic arthritis of the knee in children.
METHODS This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project (HCUP). We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017. Demographic data included age, gender, race, hospital type and insurance type. Clinical data including index admission length of stay (LOS) and Charlson Comorbidity Index (CCI) were available from the HCUP database. Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed.
RESULTS Nine-hundred thirty-two cases of pediatric septic knee were included. This cohort was 62.3% male, with mean age of 9.0 (± 6.1) years. Approximately 46% of patients were white and approximately half had Medicaid insurance. Thirty-six patients (3.6%) required RTS at a minimum of 2 year after index surgery, and 172 patients (18.5%) were readmitted at any point. The mean readmission LOS was 11.6(± 11.3) d. Higher CCI was associated with RTS (P = 0.041). There were no significant associations in age, gender, race, insurance type, or type of hospital to which patients presented. Multivariate analysis showed that both increased CCI (P = 0.008) and shorter LOS (P = 0.019) were predictive of RTS.
CONCLUSION Septic arthritis of the knee is an important condition in children. The CCI was associated with RTS at a minimum of 2 years after index procedure. No association was found with age, gender, race, insurance type, or hospital type. Shorter LOS and CCI were associated with RTS in multivariate analysis. Overall, risk of subsequent surgery and readmission after pediatric septic knee arthritis is low, and CCI and shorter LOS are predictive of RTS.
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Affiliation(s)
- Jennifer Marie O’Donnell
- Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, United States
| | - Ernest Ekunseitan
- Medical School, University of California San Francisco, San Francisco, CA 94143, United States
| | - Ishaan Swarup
- Pediatric Orthopaedic Surgery, UCSF Benioff Children’s Hospital, Oakland, CA 94609, United States
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Yıldız K, Makav M, Adalı Y, Bulut M. Therapeutic Effects of Boric Acid in a Septic Arthritis Model Induced by Escherichia coli in Rats. Biol Trace Elem Res 2022; 200:4762-4770. [PMID: 35034263 DOI: 10.1007/s12011-021-03065-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/10/2021] [Indexed: 01/09/2023]
Abstract
The study aimed to evaluate the therapeutic effect of boric acid (BA) in experimentally induced septic arthritis. A total of 30 rats, 6 rats in each group (5 groups), were used in the study. No treatment was applied to the rats in the control group. Only BA was administered intraperitoneally (IP) to the rats in the bor group. Escherichia coli was administered at a single dose of 25 μL, 1 × 1010 cfu/rat from the right foot pad of the rats, via intra-articular route, to the mice in the arthritis, arthritis-bor, and arthritis-antb groups. Then, BA at a dose of 50 mg/kg and cefazolin at a dose of 25 mg/kg were administered to the rats in the arthritis-bor and arthritis-antb groups, respectively, for 7 days via the IP route. At the end of the study, all animals were euthanized following the ethical rules. Blood and tissue samples were taken from the rats for biochemical and histopathological analyses. The levels of GSH, MDA, Endoglin, Endocan, and TNF-β markers were measured in the blood samples taken. A significant decrease was observed in MDA and Endoglin levels in the boric acid-administered group compared with the arthritis group, while a significant increase was observed at the GSH level. Histopathologically, it was determined that the reactive surrounding tissue response in the bor group was significantly reduced. As a result, a significant decrease in inflammation was found biochemically and histopathologically in the groups treated with BA.
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Affiliation(s)
- Kadri Yıldız
- Orthopeadia and Traumatology Department, Kafkas University Medical School, Ana Kampüs, 36000, Kars, Turkey.
| | - Mustafa Makav
- Physiology Department, Kafkas University Veterinary School, Kars, Turkey
| | - Yasemen Adalı
- Department of Pathology, Faculty of Medicine, Izmir University of Economics, İzmir, Turkey
| | - Menekşe Bulut
- Food Engineering Department, Faculty of Engineering, Igdır University, Igdır, Turkey
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Delayed Diagnosis of Pediatric Sternoclavicular Joint Infections and Clavicular Osteomyelitis During the COVID-19 Pandemic: A Report of 3 Cases. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202209000-00011. [PMID: 36166203 PMCID: PMC9519139 DOI: 10.5435/jaaosglobal-d-21-00302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 08/01/2022] [Indexed: 11/29/2022]
Abstract
Sternoclavicular joint infections and osteomyelitis of the clavicle are extremely rare infections, especially in the pediatric population. Early signs of these infections are nonspecific and can be mistaken for common upper respiratory infections such as COVID-19 and influenza. Rapid diagnosis and treatment are critical for preventing potentially fatal complications such as mediastinitis. We present three cases of sternoclavicular joint infections in the past year during the COVID-19 pandemic. All three patients had delayed diagnoses likely secondary to COVID-19 workup. Each patient underwent surgical irrigation and débridement. Two of three patients required multiple surgeries and prolonged antibiotic courses. Placement of antibiotic-impregnated calcium sulfate beads into the surgical site cleared the infection in all cases where they were used. All three patients made a full recovery; however, the severity of their situations should not be overlooked. Children presenting to the hospital with chest pain, fever, and shortness of breath should not simply be discharged based on a negative COVID-19 test or other viral assays. A higher index of suspicion for bacterial infections such as clavicular osteomyelitis is important. Close attention must be placed on the physical examination to locate potential areas of concentrated pain, erythema, or swelling to prompt advanced imaging if necessary.
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Zandi R, Talebi S, Sheibani S, Ehsani A. Klebsiella pneumoniae and Enterobacter cloacae Induced Septic Arthritis in a Healthy Adolescent: A Rare Case Report. Hip Pelvis 2022; 34:185-190. [PMID: 36299475 PMCID: PMC9577308 DOI: 10.5371/hp.2022.34.3.185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/16/2022] [Accepted: 05/26/2022] [Indexed: 11/07/2022] Open
Abstract
Septic arthritis (SA) is a joint inflammation that develops secondary to infectious causes. SA in children is associated with a high rate of morbidity and mortality; therefore, it is regarded as an orthopedic emergency. Because SA of the hip joint usually mimics other musculoskeletal diseases, diagnosis remains challenging. Although this lesion usually shows a good outcome, treatment at an inappropriate time, neglect, or inadequate treatment could lead to poor outcomes. We report on the case of a healthy adolescent who complained of episodes of fever and chills, weight loss, pain in his left hip, and limping. After performing necessary workups, two differential diagnoses of tumor and SA were made. The results of Gram stain and culture of the synovial fluid after surgical excision showed Klebsiella pneumoniae and Enterobacter cloacae complex. To the best of our knowledge, this is the first report of SA due to co-infection with K. pneumoniae and E. cloacae in a healthy patient.
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Affiliation(s)
- Reza Zandi
- Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shahin Talebi
- Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shirin Sheibani
- Student Research Committee, School of Medicine, Mazandaran University of Medical Science, Sari, Iran
| | - Akbar Ehsani
- Department of Orthopedic Surgery, Taleghani Hospital Research Development Committee, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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11
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Elbow Septic Arthritis caused by Klebsiella pneumoniae in a Newborn - Case Report and Literature Review. REV ROMANA MED LAB 2022. [DOI: 10.2478/rrlm-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
Septic arthritis is a rare condition in children, especially in neonates. Early recognition and proper treatment are required to avoid serious complications. We present the case of a male newborn diagnosed with septic arthritis of the right elbow who was treated with repeated joint aspiration and i.v. antibiotics (Amikacin and Meropenem). Blood culture and joint cultures were positive for Klebsiella pneumoniae. The final outcome was good, with no apparent local or systemic complications. General considerations regarding this rare condition, etiology and treatment options are also included in the paper.
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Jiang W, Xu H, Wang X, Xie J, Huang Q, Zhou Z, Pei F. Poor performance of monocyte-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, and fibrinogen when screening for occult infection among patients with sequelae of suppurative hip arthritis before total hip arthroplasty. INTERNATIONAL ORTHOPAEDICS 2022; 46:1929-1935. [PMID: 35718825 DOI: 10.1007/s00264-022-05474-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/05/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Total hip arthroplasty (THA) is considered the best treatment for sequelae of suppurative hip arthritis, but such patients are more likely to have occult infection and therefore to suffer post-operative periprosthetic joint infection. Our study examined (1) the occult infection rate among patients with sequelae of suppurative hip arthritis, and whether (2) neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), or fibrinogen levels can be used to screen such patients for occult infection before THA. METHODS We retrospectively enrolled 428 patients who underwent primary THA at our hospital between 2010 and 2021, of whom 31 had occult infection and 397 did not. The maximum sensitivity and specificity were determined for the three indicators using receiver operating characteristic curves, and positive and negative predictive values were calculated. RESULTS Patients with occult infection showed significantly higher erythrocyte sedimentation rate (ESR) and higher levels of C-reactive protein (CRP) and fibrinogen than those without occult infection. The various potential indicators gave the following areas under the receiver operating characteristic curves: ESR, 0.586; CRP, 0.599; interleukin-6, 0.651; NLR, 0.506; MLR, 0.600; and fibrinogen, 0.589. Sensitivity and specificity were as follows: ESR, 30.8% and 92.5%; CRP, 50.0% and 70.2%; interleukin-6, 57.7% and 67.5%; NLR, 46.7% and 62.9%; MLR, 60.0% and 61.7%; and fibrinogen, 43.3% and 81.7%. CONCLUSION The rate of occult infection was 7.24% among our patients. ESR, NLR, MLR, and levels of CRP, interleukin-6, and fibrinogen may be unreliable for screening such patients for occult infection before THA according to sensitivity and specificity.
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Affiliation(s)
- Wenyu Jiang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
| | - Hong Xu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
| | - Xing Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
| | - Jinwei Xie
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
| | - Qiang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China.
| | - Zongke Zhou
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
| | - Fuxing Pei
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, SiChuan University, No.37, Guoxue Road, Wuhou district, Chengdu, 610041, Sichuan, People's Republic of China
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Uthraraj NS, Sahukar S, Hiriyur Prakash MP, Sriraam LM, Virani S, Guruprasad G, Relwani J. Septic Arthritis of Neonates: Descriptive Study of a Neonatal Intensive Care Unit Nosocomial Outbreak. Cureus 2022; 14:e24543. [PMID: 35664399 PMCID: PMC9142763 DOI: 10.7759/cureus.24543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2022] [Indexed: 11/05/2022] Open
Abstract
Purpose This is a retrospective descriptive study of a nosocomial outbreak of septic arthritis in a neonatal intensive care unit with a Pseudomonas species as the predominant organism. There have been no previous reports of the same. The risk factors for this disease were analysed. The different diagnostic modalities that we used are described and the short-term outcomes are reported after antibiotic therapy and surgery. Methods Fourteen patients and 16 joints were included in the study over a three-month period. The risk factors were analysed from the records and included prematurity, birth weight, sex and joint predilection. The causative organisms were also analysed from microbiological profiling. The outcomes after surgery and adjunctive antibiotic therapy were analysed in terms of clinical and laboratory parameters. Results Pseudomonasaeruginosa was found to be the predominant organism in this series. The hip joint was predominantly involved and the majority of the patients were found to be premature. All the neonates affected were found to have low birth weight. Conclusion Prematurity and low birth weight were found to have an association with risk for septic arthritis. In our setting of a nosocomial outbreak, a Pseudomonas species was more common than other organisms. A treatment regimen of arthrotomy surgery and adjunctive antibiotic therapy was found to be effective in all our patients.
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Awwad E, Tolley M, Antoniou G, Williams N. Clinical presentations of Kingella kingae musculoskeletal infections in South Australian children. J Paediatr Child Health 2021; 57:1196-1200. [PMID: 33655677 DOI: 10.1111/jpc.15422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/11/2021] [Accepted: 02/14/2021] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to alert clinicians to the spectrum of presentations of Kingella kingae musculoskeletal infections. METHODS Between August 2010 and March 2018, 55 children presented with positive K. kingae polymerase chain reaction on joint fluid, bone or deep soft tissue collections involving the limbs and subsequently underwent retrospective medical record, radiological and laboratory review. Demographics and clinical information are presented. RESULTS Median age at presentation was 15.9 months (range 4.3 months-10.7 years) and 64% were male. Septic arthritis was the most common diagnosis (95%), median duration of symptoms was 4 days, 65% had a preceding infection (e.g. upper respiratory or gastrointestinal) and 22% re-presented to emergency departments after prior discharge. The lower limb was involved in 84%, with the knee being most affected (55%). If the lower limb was involved, 82% of previously weight-bearing children had a limp or were unable to weight bear. On presentation, median temperature was 36.7°C and inflammatory markers were mildly elevated. No blood cultures grew K. kingae. Five synovial fluid cultures were positive for K. kingae. Plain radiography showed effusion, soft tissue swelling or a lesion in 53% of patients. All 41 ultrasounds showed effusion, soft tissue swelling or synovial thickening. One patient with delayed diagnosis later presented with avascular necrosis of the femoral head. CONCLUSION Kingella kingae is difficult to diagnose due to non-specific symptoms, absence of fevers and often unremarkable blood tests. Despite generally having good long-term outcomes, our case of avascular necrosis suggests accurate diagnosis and treatment are important.
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Affiliation(s)
- Elias Awwad
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
| | - Morgan Tolley
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Georgia Antoniou
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Nicole Williams
- Department of Orthopaedic Surgery and Paediatric Trauma Service, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, Adelaide, South Australia, Australia
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Sweeney E, Rodenberg R, MacDonald J. Overuse Knee Pain in the Pediatric and Adolescent Athlete. Curr Sports Med Rep 2021; 19:479-485. [PMID: 33156034 DOI: 10.1249/jsr.0000000000000773] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Overuse knee pain is common in young athletes. There are many potential overuse injuries which present with insidious onset of pain that can challenge sports medicine providers, including Osgood-Schlatter's disease, patellofemoral syndrome, osteochondritis dissecans, and stress fractures. The differential diagnosis of insidious onset knee pain also includes malignancies, infections, and rheumatologic issues. A thorough history and physical examination can guide the treating provider in making a diagnosis and appropriate treatment plan. Although not always necessary, imaging is often helpful in overuse knee pain, and laboratory workup may be necessary. Conservative treatment is often the first recommendation in the management of overuse knee pain in young athletes, and this may include activity modification, ice, anti-inflammatory medications, bracing, and physical therapy. This review summarizes common overuse knee injuries seen in pediatric and adolescent athletes.
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Qian Z, Mamtimin A, Zhang X, Xu B, Mu W, Cao L. Mid-Term Outcomes of Cementless Total Hip Arthroplasty in Adult Patients with Childhood Hip Infection. Med Sci Monit 2021; 27:e930760. [PMID: 33712550 PMCID: PMC7968116 DOI: 10.12659/msm.930760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Patients with hip joint infections in childhood often have many aftereffects of different degrees, regardless of the kind of treatment or natural course. Total hip arthroplasty is currently the most effective treatment for sequelae of childhood hip septic or tuberculous infection. This is a mid-term follow-up study of treatment results of patients who had undergone total hip arthroplasty (THA) with cementless prostheses. MATERIAL AND METHODS We retrospectively analyzed and followed 45 patients (45 hips) who underwent THA with cementless prostheses between 2010 and 2017. There were 45 patients, including 17 men and 28 women. The average age of the patients was 46 years (range, 18-67 years). All hip infections occurred in early childhood or adolescence, and the mean interval between initial infection and THA was 38.2 years (range, 15-60 years). The mean follow-up was 6.1 years (range, 2.7-9.5 years). RESULTS Two patients underwent revision surgery because of loosening of the prosthesis, and 1 patient underwent revision surgery because of a new infection with no relationship with childhood infection during the follow-up. The average Harris hip scores significantly increased from 43.1 to 86.4 (P<0.01), and the average visual analog scale significantly increased from 4.6 to 1.7 (P<0.01). The hip dysfunction and osteoarthritis outcome scores were also significantly changed (P<0.01) at the final follow-up. There were 2 cases of transient sciatic nerve palsy and intraoperative periprosthetic fractures in 3 cases. During follow-up, single revision was performed after 6 years of primary arthroplasty because of aseptic loosening in 2 cases and prosthesis infection in 1 case, which was not related to childhood pathogens. CONCLUSIONS THA for patients with sequelae of hip joint infection has a satisfactory effect that can effectively relieve joint pain and improve hip function. The recurrence rate of infection after either pyogenic infection or tuberculous is very low. The mid-term outcomes of THA in this setting were satisfactory, with high prosthesis survivorship and hip function scores.
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Di Pietro GM, Borzani IM, Aleo S, Bosis S, Marchisio P, Tagliabue C. Pediatric Septic Arthritis of the Knee Due to a Multi-Sensitive Streptococcus pyogenes Strain Responsive to Clindamycin-A Case Report. CHILDREN-BASEL 2021; 8:children8030189. [PMID: 33802408 PMCID: PMC8001213 DOI: 10.3390/children8030189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 12/24/2022]
Abstract
Septic arthritis is an inflammatory process usually generated by a bacterial infection. The knee is one of the most frequently involved joints. The etiology varies depending on age, and hematogenous spread remains the primary cause in children. Herein, we report a case of a previously healthy three-year-old female who was referred to our institution for acute swelling of her right knee. After a clinical and radiological diagnosis of septic arthritis, an empirical treatment with a combination of cefotaxime and clindamycin was initiated. The isolation of a multi-sensitive Streptococcus pyogenes strain from the joint’s effusion prompted the discontinuation of clindamycin and the usage of cefotaxime alone. One week later, an ultrasound was executed due to worsening in the patient’s clinical conditions, and an organized corpuscular intra-articular effusion with diffuse synovial thickening was revealed. Cefotaxime was therefore replaced with clindamycin, which improved the symptoms. Despite the antibiotic sensitivity test having revealed a microorganism with sensitivity to both cephalosporin and clindamycin, clinical resistance to cefotaxime was encountered and a shift in the antimicrobial treatment was necessary to ensure a full recovery. This case study confirms that an antibiotic regimen based solely on a susceptibility test may be ineffective for such cases.
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Affiliation(s)
- Giada Maria Di Pietro
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Correspondence:
| | - Irene Maria Borzani
- Radiology Unit, Pediatric Division, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Sebastiano Aleo
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
| | - Samantha Bosis
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
| | - Paola Marchisio
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
| | - Claudia Tagliabue
- Paediatric Highly Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.A.); (S.B.); (C.T.)
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Laliotis N, Chrysanthou C, Konstandinidis P, Giannakopoulou L. Diagnostic approach and arthroscopic treatment of septic arthritis of the knee, in an infant. Clin Case Rep 2020; 8:3389-3393. [PMID: 33363939 PMCID: PMC7752424 DOI: 10.1002/ccr3.3382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 11/12/2022] Open
Abstract
A 9-month-old baby presented with sudden inability to stand and unable to move his leg. Clinical examination showed edema and knee effusion. Blood tests and MRI confirmed septic knee arthritis without bone involvement. He was treated with arthroscopic lavage. He had a complete recovery and normal growth.
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Abstract
BACKGROUND Musculoskeletal infection is a major cause of morbidity in the pediatric population. Despite the canonical teaching that an irritable joint and signs of infection likely represent an infected joint space, recent evidence in the pediatric hip has demonstrated that alternative diagnoses are equally or more likely and that combinations of pathologies are common. The knee is the second most commonly infected joint in children, yet there remains a paucity of available data regarding the epidemiology and workup of the infected pediatric knee. The authors hypothesize that there is heterogeneity of pathologies, including combinations of pathologies, that presents as a potentially infected knee in a child. The authors aim to show the utility of magnetic resonance imaging and epidemiologic and laboratory markers in the workup of these patients. METHODS A retrospective review of all consults made to the pediatric orthopaedic surgery team at a single tertiary care center from September 2009 through December 2015 regarding a concern for potential knee infection was performed. Excluded from the study were patients with penetrating trauma, postoperative infection, open fracture, no C-reactive protein (CRP) within 24 hours of admission, sickle cell disease, an immunocompromised state, or chronic osteomyelitis. RESULTS A total of 120 patients were analyzed in this study. There was marked variability in pathologies. Patients with isolated osteomyelitis or osteomyelitis+septic arthritis were older, had an increased admission CRP, were more likely to be infected with Staphylococcus aureus, required an increased duration of antibiotics, and had an increased incidence of musculoskeletal complications than patients with isolated septic arthritis. CONCLUSIONS When considering a child with an irritable knee, a heterogeneity of potential underlying pathologies and combinations of pathologies are possible. Importantly, the age of the patient and CRP can guide a clinician when considering further workup. Older patients with a higher admission CRP value warrant an immediate magnetic resonance imaging, as they are likely to have osteomyelitis, which was associated with worse outcomes when compared with patients with isolated septic arthritis. LEVEL OF EVIDENCE Level III-retrospective research study.
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Cohen E, Katz T, Rahamim E, Bulkowstein S, Weisel Y, Leibovitz R, Fruchtman Y, Leibovitz E. Septic arthritis in children: Updated epidemiologic, microbiologic, clinical and therapeutic correlations. Pediatr Neonatol 2020; 61:325-330. [PMID: 32184066 DOI: 10.1016/j.pedneo.2020.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 02/15/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Septic arthritis (SA) is an infection characterized by significant epidemiologic and microbiologic differences between developed and developing regions and between age groups. OBJECTIVES To determine the epidemiologic, clinical, microbiologic and therapeutic aspects of pediatric SA in Southern Israel. METHODS A retrospective case-series study based on the records of children <16 years of age admitted with SA at Soroka Medical Center, Beer-Sheva, during 2006-2013. RESULTS 189 patients were enrolled. There were 119 (63%) Bedouin and 70 (37%) Jewish children. The knee (39.7%), hip (28%) and ankle (13.8%) were the most commonly involved joints. Blood and/or synovial fluid cultures were positive in 48 (25.4%) patients. Overall SA incidence among children <16 years and <5 years was 11.7 and 25.4/100,000, respectively, without changes throughout the study period. SA incidence among Bedouin children was higher than among Jewish children (15.4 vs. 8.3/100,000 cases). Staphylococcus aureus was the most commonly isolated pathogen (18, 19.5% of all patients), followed by Kingella kingae (10, 5.3%)-(37.5% and 20.8% among culture-positive patients, respectively). The number of children with culture-positive SA that required surgery was higher than those with culture-positive SA treated conservatively (P < 0.001). Hospitalization was longer in children treated surgically than in those treated conservatively (P < 0.001). CONCLUSION This study is the largest single-center series on pediatric SA published in the last five years and provided an updated picture on incidence and the microbiologic, clinical and therapeutic aspects of pediatric SA in Southern Israel. The study supports a regional presentation pattern of SA and may guide its therapeutic management.
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Affiliation(s)
- Eugen Cohen
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Tiberiu Katz
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Eldad Rahamim
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Shlomi Bulkowstein
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Yaron Weisel
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Ron Leibovitz
- Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Yariv Fruchtman
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel.
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Shahid M, Holton C, O’Riordan S, Kraft JK. Sonography of musculoskeletal infection in children. ULTRASOUND (LEEDS, ENGLAND) 2020; 28:103-117. [PMID: 32528546 PMCID: PMC7254949 DOI: 10.1177/1742271x20901736] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 11/29/2019] [Indexed: 11/16/2022]
Abstract
Musculoskeletal infection, especially in young children, often presents with non-specific clinical signs and symptoms necessitating early imaging to identify the source of infection. While MRI is the investigation of choice to demonstrate bone infection, it is expensive and often requires a general anaesthetic in the young child. Ultrasound can be a useful tool in the initial assessment due to its easy availability and portable equipment. It does not involve ionising radiation and is used to guide aspiration and drainage procedures. This review explains sonographic features of septic arthritis, osteomyelitis, pyomyositis and soft tissue infection in children and highlights advantages and limitations of sonography when assessing the child with suspected musculoskeletal infection.
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Affiliation(s)
- Monique Shahid
- Clarendon Wing Radiology Department, Leeds Children’s Hospital, Leeds, UK
| | - Colin Holton
- Department of Paediatric Orthopaedics, Leeds Children’s Hospital, Leeds, UK
| | - Sean O’Riordan
- Department of Paediatric Medicine, Leeds Children’s Hospital, Leeds, UK
| | - Jeannette K Kraft
- Clarendon Wing Radiology Department, Leeds Children’s Hospital, Leeds, UK
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Differential MRI findings of transient synovitis of the hip in children when septic arthritis is suspected according to symptom duration. J Pediatr Orthop B 2020; 29:297-303. [PMID: 31503109 DOI: 10.1097/bpb.0000000000000671] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
We investigated the differential MRI findings in children with transient synovitis of the hip in whom septic arthritis was suspected. Under the hypothesis that disease progression can alter representative MRI findings, we stratified these findings in accordance with symptom duration as this can correlate with disease progression. We analyzed 65 children who underwent MRI for acute hip pain and who were suspected of having a septic condition (i.e. presented with fever or increased inflammatory markers) when the imaging was performed. Symptom duration was defined as the interval from the first presentation of hip pain to the MRI scan. We divided the patients into two subgroups according to symptom duration: patients with short symptom duration (≤2 days, short-term subgroup, n = 30) and those with long symptom duration (≥3 days, long-term subgroup, n = 35). Twenty-eight (43.1%) of the study subjects were diagnosed with septic arthritis. Whereas only a high-grade joint effusion was a significant MRI finding differentiating septic arthritis from transient synovitis in the whole cohort, the presence of contralateral joint effusion in the short-term subgroup (P = 0.024) and the absence of a change/enhancement of the signal intensity of soft tissue in the long-term subgroup (P < 0.001) were significant predictors of transient synovitis. The significances of differential MRI findings for septic arthritis and transient synovitis seem to change according to symptom duration. We suggest that symptom duration, which may correlate with disease progression, should also be considered when interpreting MRIs of children under suspicion of septic arthritis.
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Yagdiran A, Zarghooni K, Semler JO, Eysel P. Hip Pain in Children. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 117:72-82. [PMID: 32070474 DOI: 10.3238/arztebl.2020.0072] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 05/28/2019] [Accepted: 10/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atraumatic hip pain in children is one of the most common symptoms with which pediatricians, orthopedists, and general practitioners are confronted, with an incidence of 148 cases per 100 000 persons per year. METHODS This article is based on publications up to April 2019 that were retrieved by a selective search in the PubMed data- base, including case reports and reviews. RESULTS Infants with fever often have purulent coxitis, which can be diagnosed by blood tests and ultrasonography. Toddlers and older children may suffer from painful restriction of motion of the hip joint, associated with limping (antalgic gait) or even the in- ability to walk. The main elements of the differential diagnosis in children aged 2-10 are coxitis fugax and idiopathic necrosis of the femoral head (Perthes disease). In children aged 10 and up, and in adolescents, slipped capital femoral epiphysis (SCFE) is typical. Bone tumors and rheumatic diseases must always be considered as well. The initial diagnostic steps on presentation of a child with restricted hip movement should be plain x-rays and joint ultrasonography for the detection of an effusion. Suspicion of a tumor is the main indication for tomographic imaging (computed tomography or magnetic resonance imaging). CONCLUSION The underlying cause of hip pain in children should be diagnosed early to avoid adverse sequelae.
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Affiliation(s)
- Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University Hospital Cologne; Department of Pediatrics, University Hospital Cologne
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Gupta G, Chaudhary M, Khunt A, shah V, Shah MM. An unreported case of Streptococcus cristatus septic arthritis of wrist in a neonate. J Clin Orthop Trauma 2020; 11:328-331. [PMID: 32099306 PMCID: PMC7026528 DOI: 10.1016/j.jcot.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 02/02/2019] [Accepted: 02/04/2019] [Indexed: 11/27/2022] Open
Abstract
Septic Arthritis of the wrist is rare in the paediatric population due to its extraarticular metaphysis. We report here a case of wrist septic arthritis in a neonate caused by an uncommon causative organism, Streptococcus cristatus. A 15 days old male child was referred with the complaint of swelling and decreased movement of the left wrist for 5 days. Local examination revealed warm, tender, erythematous and fluctuant swelling over the dorso-ulnar aspect of the left wrist. Ultrasonography of the affected region was suggestive of focal fluid collection in the wrist and periosteal elevation of the distal ulna. Aspiration followed by arthrotomy of the wrist joint was performed and multiple holes were made in the distal ulnar metaphysis using 0.8mm k-wire. The pus culture was positive for Streptococcus cristatus, sensitive to vancomycin, which was given for a total of 4 weeks. At one year follow up the child had a full, painless range of motion with no functional deficit. Final follow up x rays of the left wrist were normal. Streptococcus cristatus strains are described as Gram-positive, catalase-negative cocci, approximately 1 μm in diameter growing in chains and were originally isolated from the human throat and oral cavities. Its association with bone and joint infections has not been described in the literature. To our knowledge, this is the first case of isolated septic arthritis of wrist in a 15 days old child caused by Streptococcus cristatus. To conclude, wrist septic arthritis in a neonate is a rare entity. With the advanced diagnostics, species-level identification of rare organism like Streptococcus cristatus is possible along with antibiotic sensitivity for appropriate therapy. Early surgical decompression and intravenous culture-directed antibiotics are the mainstays of management.
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Affiliation(s)
- Gaurav Gupta
- Clinical Fellow (Paediatric Orthopaedics) at OrthoKids Clinic, Drive-in Road, Ahmedabad, India
| | - Manu Chaudhary
- Infectious Diseases Consultant (American Board Certified), Pediatrics and Infectious Diseases Centre, Ahmedabad, Gujarat, India & Apollo Hospital International Limited, Ahmedabad, Gujarat, India
| | - Aliraza Khunt
- Sehat Hospital, 2nd Floor, Royal Nawab Avenue, Above Moti Bakery, Juhapura, Ahmedabad, India
| | - Viral shah
- Unipath Specialty Laboratory Limited, Microbiology Department, 2nd Floor, Doctor House, Near Parimal Under Bridge, Paldi, Ahmedabad, India
| | - Maulin M. Shah
- OrthoKids Clinic, Drive-in Road, Ahmedabad, Ahmedabad, 380052, India,Corresponding author.
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Obana KK, Murgai RR, Schur M, Broom AM, Hsu A, Kay RM, Pace JL. Synovial fluid cell counts and its role in the diagnosis of paediatric septic arthritis. J Child Orthop 2019; 13:417-422. [PMID: 31489049 PMCID: PMC6701437 DOI: 10.1302/1863-2548.13.190022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Clinical presentation of paediatric septic arthritis (SA) can be similar to other joint pathologies. Despite potential for infection in all major joints, most diagnostic criteria are based on values from the hip. This study identifies the best joint aspirate values in diagnosing SA in all joints. METHODS In all, 166 patients who underwent 172 joint aspirations at the authors' institution between 01 September 2004 and 01 September 2014 were retrospectively identified. Recorded measures included age, sex, duration of symptoms, fever history, weight-bearing status, aspiration results, serum results and antibiotic administration. Patients were placed in the following four categories: 'culture confirmed SA' (C-SA), 'suspected SA' (S-SA), 'Other' and 'Other-rheumatologic' (Other-R), a subcategory of 'Other'. RESULTS Most common sites of aspiration were the knee (55%) and hip (29%). Diagnostic grouping was as follows: C-SA = 44, S-SA = 45, Other = 83 (Other-R = 21). Fever and non-weight-bearing prior to admission were useful predictors of SA, though in C-SA patients, 21% did not have a fever and 23% could weight bear at the time of admission. Aspirate white blood cell (WBC) count was significantly greater in both C-SA (92 000 cells/hpf) and S-SA (54 000) than in Other (10 000) and Other-R (18 000) patients. The percentage of polymorphonuclear (%PMN) was also significantly greater in C-SA (81.1%) and S-SA (80.9%) than in Other (57.9%) and Other-R (63.3%). CONCLUSION Joint aspirate values, especially %PMN, are valuable in diagnosing SA. Additionally, antibiotics pre-aspiration did not affect %PMN, facilitating subsequent diagnosis of infection. Lastly, while aspirate WBC count was a valuable indicator of SA, this finding is not as definitive as previous research suggests. LEVEL OF EVIDENCE IV Case Series.
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Affiliation(s)
- K. K. Obana
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA
| | - R. R. Murgai
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - M. Schur
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - A. M. Broom
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - A. Hsu
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - R. M. Kay
- Children’s Orthopaedic Center, Children’s Hospital Los Angeles, Los Angeles, California, USA,Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - J. L. Pace
- Elite Sports Medicine, Connecticut Children’s Medical Center, Farmington, Connecticut, USA,Correspondence should be sent to R. M. Kay, Children’s Orthopaedic Center, Children’s Hospital Los Angeles, 4650 Sunset Blvd. MS# 69, Los Angeles, CA 90027, USA.
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Abstract
Septic arthritis is an emergent condition caused by bacterial infection of a joint space. The most common etiology is hematogenous spread from bacteremia, but it can also occur from direct inoculation from bites, injection injuries, cellulitis, abscesses, or local trauma. Septic arthritis occurs most frequently in the lower extremities, with the hips and knees serving as the most common locations. The most sensitive findings include pain with motion of the joint, limited range of motion, tenderness of the joint, new joint swelling, and new effusion. Laboratory testing and imaging can support the diagnosis, but the criterion standard is diagnostic arthrocentesis. Treatment involves intravenous antibiotics and joint decompression.
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Ben-Zvi L, Sebag D, Izhaki G, Katz E, Bernfeld B. Diagnosis and Management of Infectious Arthritis in Children. Curr Infect Dis Rep 2019; 21:23. [PMID: 31144135 DOI: 10.1007/s11908-019-0678-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Septic arthritis is limb and life-threatening condition which necessitates rapid diagnosis and treatment. It is important for a medical practitioner to be familiar with this condition. This review summarizes the epidemiology, risk factors, diagnosis and differential diagnosis, complications, as well as treatment and the following-up of this condition. RECENT FINDINGS Different causative organisms require unique diagnostic and treatment approaches. Establishing the diagnosis often requires multiple diagnostic modalities, some of which are new and innovative. Differential diagnosis requires excluding non-infectious inflammatory causes, such as reactive arthritis, juvenile rheumatoid arthritis, transient synovitis, and pericapsular pyomyositis. There is no consensus regarding the nature or duration of pharmacological or surgical treatment. Treatment includes administration of appropriate antimicrobial therapy and including the use of steroids and drainage. The most common complications are osteonecrosis of the femoral head and chronic osteomyelitis. Complications of septic arthritis are mostly due to a missed diagnosis. Further studies are required to better evaluate the diagnostic and therapeutic choice.
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Affiliation(s)
- Lior Ben-Zvi
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel.
| | - Diklah Sebag
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Guy Izhaki
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Eldad Katz
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
| | - Benjamin Bernfeld
- Department of Orthopedic Surgery, Lady Davis Carmel Medical Center, 7 Michal Street, 34362, Haifa, Israel
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Tretiakov M, Cautela FS, Walker SE, Dekis JC, Beyer GA, Newman JM, Shah NV, Borrelli J, Shah ST, Gonzales AS, Cushman JM, Reilly JP, Schwartz JM, Scott CB, Hesham K. Septic arthritis of the hip and knee treated surgically in pediatric patients: Analysis of the Kids' Inpatient Database. J Orthop 2019; 16:97-100. [PMID: 30655655 PMCID: PMC6329196 DOI: 10.1016/j.jor.2018.12.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/05/2018] [Accepted: 12/23/2018] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE This study evaluated incidence over time, any association between race and demographics, and hospital-related parameters in pediatric patients with septic hip or knee arthritis. METHODS The Kids' Inpatient Database was used to identify all children with a diagnosis of septic hip or knee arthritis who underwent incision and drainage (1997-2012). RESULTS Between 1997 and 2012, overall incidence of septic arthritis of the knee (0.20-0.33 per 100,000) and hip (0.12-0.18 per 100,000) increased. CONCLUSION Incidence of pediatric septic joint arthritis, an emergent orthopaedic condition, has increased over time. Patient demographics may vary with respect to both age and race.
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Affiliation(s)
- Mikhail Tretiakov
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Frank S. Cautela
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sarah E. Walker
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Joanne C. Dekis
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - George A. Beyer
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jared M. Newman
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Neil V. Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jenna Borrelli
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Sharan T. Shah
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Anter S. Gonzales
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Jennifer M. Cushman
- New Jersey Society of Physical Medicine & Rehabilitation, South Orange, NJ, USA
| | - John P. Reilly
- Department of Orthopaedic Surgery, Staten Island University Hospital, Northwell Health, Staten Island, NY, USA
| | - Jeffrey M. Schwartz
- Department of Orthopaedic Surgery, Kings County Hospital Center, Brooklyn, NY, USA
| | - Claude B. Scott
- Department of Orthopaedic Surgery, Kings County Hospital Center, Brooklyn, NY, USA
| | - Khalid Hesham
- Department of Orthopaedic Surgery and Rehabilitation Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA
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Qin YF, Li ZJ, Li H. Corticosteroids as adjunctive therapy with antibiotics in the treatment of children with septic arthritis: a meta-analysis. Drug Des Devel Ther 2018; 12:2277-2284. [PMID: 30087552 PMCID: PMC6061407 DOI: 10.2147/dddt.s163560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose We performed a meta-analysis to systematically assess the effect of adjunctive administration of dexamethasone with antibiotic therapy in the clinical course of septic arthritis (SA) in children. Method Potential academic articles were identified from the Cochrane Library, Medline, PubMed, Embase, ScienceDirect, and other databases. The time range we retrieved from was from the inception of electronic databases to January 2018. The reference lists of identified studies were manually checked to identify other potentially eligible trials. The STATA version 11.0 (Stata Corporation, College Station, TX, USA) was used to analyze the pooled data. Results Three randomized controlled trials, and one retrospective cohort study were included in the meta-analysis. There were significant differences in the days of hospitalization (mean difference [MD] = -4.226, 95% CI: -4.785 to -3.667, P=0.001), the days of intravenous antibiotics treatment (MD = -3.593, 95% CI: -4.825 to -2.361, P=0.001), the days of oral antibiotics treatment (MD = -1.658, 95% CI: -2.539 to -0.777, P=0.001), and the days to normalization of C-reactive protein (MD = -3.075, 95% CI: -3.362 to -2.788, P=0.001). Conclusion The present meta-analysis base points strongly toward a beneficial effect for corticosteroids in SA. Corticosteroids as adjunctive therapy with antibiotics in the treatment of children with SA could shorten the number of days of hospitalization, the days of intravenous antibiotics treatment, the days of oral antibiotics treatment, and the days to normalization of C-reactive protein. We recommend corticosteroids as adjunctive therapy with antibiotics in the treatment of children with SA.
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Affiliation(s)
- Ya-Fei Qin
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China,
| | - Zhi-Jun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China,
| | - Hui Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin 300052, China,
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Abstract
BACKGROUND Acute septic arthritis of the knee in children may be treated by arthroscopic or open methods; however, pediatric data comparing these methods is limited regarding both short- and long-term outcomes. This study aimed to compare outcomes after arthroscopic versus open surgery for acute pediatric septic knee arthritis. METHODS Pediatric patients with acute knee septic arthritis treated at our institution from 1996 to 2016 were retrospectively assessed. The clinical presentations, operations, microorganisms, laboratory results, knee radiologic findings and antibiotics administered were compared. Patients' long-term outcomes were assessed at mean 6.9 (range 1.1-20.3) years. RESULTS Twenty-four patients met the inclusion criteria. Eleven patients received arthroscopic irrigation and 13 had open irrigation. Five patients in the open group (38.5%) required a second irrigation compared with none in the arthroscopic group [95% confidence interval (CI): 12%-65%; P = 0.041]. Time to range the knee occurred earlier in the arthroscopic group (5.0 days; arthroscopic vs. 10.6 days; open, difference 5.6 days: 95% CI: 0.84-10.3, P = 0.023), as well as weight-bearing (2.7 days; arthroscopic vs. 10.3 days; open, difference 7.6 days: 95% CI: 2.3-12.9, P = 0.008). Eighty-three percent of patients attended follow-up. No infections recurred. No significant differences were found in Knee injury and Osteoarthritis Outcome Scores for children, Lysholm scores, range-of-motion, leg length, gait and radiologic findings. CONCLUSIONS For acute pediatric septic knee arthritis, arthroscopic irrigation is associated with less repeat surgical irrigations and allows earlier knee ranging and weight-bearing compared with open irrigation. At long-term follow-up, no significant difference was found between groups.
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Li Y, Zhou Q, Liu Y, Chen W, Li J, Yuan Z, Yong B, Xu H. Delayed treatment of septic arthritis in the neonate: A review of 52 cases. Medicine (Baltimore) 2016; 95:e5682. [PMID: 28002339 PMCID: PMC5181823 DOI: 10.1097/md.0000000000005682] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
There is still controversy on the management of septic arthritis in neonates. This study aims to investigate the treatment of septic arthritis in neonates.We reviewed 52 neonates (37 males and 15 females) with septic arthritis in our hospital during 2004 to 2015. The mean age at onset of infection was 17.5 ± 7.6 days, mean age at admission was 32.6 ± 10.7 days. A total of 56 joints were involved (22 knees, 18 shoulders, 13 hips, and 3 other joints). Thiryt-six patients underwent surgical drainage, 14 patients were treated nonoperatively, 2 families refused treatment. Forty-four patients (48 joints) were followed for 4.5 ± 1.2 years. Based on treatment, these 48 joints were divided into an operative group and a nonoperative group. Clinical presentations, imaging examination results, treatments, and outcomes were analyzed.Among the patients who were followed-up, the time from onset to treatment in the operatively managed group (12.7 ± 8.1 days) was significantly shorter than that in the conservatively managed group (20.0 ± 8.2 days). There were no significant differences between both groups on the age at onset, age at admission, imaging score, length of hospital stay, WBC counts, and intravenous medication time. Thirty-five sites (72.9%) recovered completely. There was no significant difference on recovery rate between operative and nonoperative group. Only 33.3% of the hips recovered, this was significantly lower than that of knee/ankle (85.0%) and shoulder/elbow (78.9%). Sequels were found in 13 joints. Logistic regression indicated that sex, imaging score, and hip joint involvement were predictors of sequel. One point of imaging score increased the risk of sequels by a factor of 2.960, and hip joint involvement increased the risk of sequels by a factor of 12.712. Females were more likely to have sequels than males.Surgical drainage is recommended for early diagnosed neonatal septic arthritis and hip infections. A conservative approach may be more efficient for patients whose diagnosis and treatment had been delayed for more than 2 weeks. Antibiotics should be administered intravenously for 2 weeks and then orally for another 2 weeks. First-generation cephalosporin and clindamycin are recommended empirical antibiotics before causative agent and its resistance pattern are known.
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Gogi N, Khan SA. Editorial: Pediatric Orthopedics at the Doorstep of the Pediatrician. Indian J Pediatr 2016; 83:814-6. [PMID: 27392617 DOI: 10.1007/s12098-016-2194-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/27/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Nitish Gogi
- Department of Orthopedics, The Calderdale & Huddersfield Foundation Trust Hospital, Huddersfield, UK
| | - Shah Alam Khan
- Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
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Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis. Int J Mol Sci 2016; 17:ijms17060855. [PMID: 27258258 PMCID: PMC4926389 DOI: 10.3390/ijms17060855] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022] Open
Abstract
Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.
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