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Gajagowni S, Padhye A. Neonatal Osteomyelitis. Neoreviews 2024; 25:e265-e273. [PMID: 38688888 DOI: 10.1542/neo.25-5-e265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Osteomyelitis is a serious and potentially life-threatening condition affecting the skeletal system of newborns. The condition is relatively rare in neonates but occurs at higher rates in high-risk pregnancies, in preterm infants, and with the use of invasive devices. As a result of the anatomy and immature immune system of newborns, neonates differ in presentation, diagnosis, and management of osteomyelitis compared to patients of other age groups. An understanding of these differences will assist clinicians in the prompt diagnosis and management of this neonatal infection and lead to improved long-term outcomes.
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Affiliation(s)
| | - Amruta Padhye
- Department of Pediatrics, University of Missouri School of Medicine, Columbia, MO
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2
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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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Liu Y, Zhao K, Liu Y, Sun YH, Li MX, Yu M, Zhu LQ, Wang XD. Bone and joint infection complicated with sepsis in neonates and infants under three months of age. J Pediatr (Rio J) 2024; 100:156-162. [PMID: 37837994 PMCID: PMC10943287 DOI: 10.1016/j.jped.2023.09.003] [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: 06/04/2023] [Revised: 09/06/2023] [Accepted: 09/06/2023] [Indexed: 10/16/2023] Open
Abstract
OBJECTIVE Studies focusing on bone and joint infections (BJIs) in young infants are rare. Some cases of BJI are accompanied by sepsis. This study aimed to identify the clinical and bacteriological features of sepsis in neonates and young infants with BJIs. METHODS Neonates and infants younger than 3 months diagnosed with BJI in the present institution from 2014 to 2021 were retrospectively reviewed. Patient characteristics, clinical data, and outcomes were documented and compared between those with and without sepsis. RESULTS Twenty-five patients with a mean age of 34.8 days were included. Nine BJI cases had concomitant sepsis (group A), and 16 had BJI without sepsis (group B). Within group A, staphylococcus aureus was the major pathogenic germ (5 cases, of which 4 were of the methicillin-resistant staphylococcus aureus (MRSA) type). There was no statistical difference in male-to-female ratio, age, history of hospitalization, anemia, birth asphyxia, peripheral leukocyte counts, C-reactive protein on admission, and sequelae between groups. Univariate analyses indicated a significant difference in the incidence of septic arthritis (SA) combined with osteomyelitis (OM) (88.9% vs 37.5%), congenital deformities (44.4% vs 0%), and mean duration of symptoms (2.83 days vs 9.21 days) in comparisons between groups A and B. CONCLUSION Staphylococcus aureus is the main pathogenic bacteria in BJI cases complicated with sepsis in neonates and young infants. Among infants younger than 3 months diagnosed with BJI, those with concurrent SA and OM, MRSA infection, or congenital deformities are more likely to develop sepsis.
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Affiliation(s)
- Yao Liu
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Kai Zhao
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Ya Liu
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Yu-Han Sun
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Meng-Xia Li
- Children's Hospital of Soochow University, Pediatrics Research Institute, Suzhou, Jiangsu Province, China
| | - Min Yu
- Children's Hospital of Soochow University, Department of Neonatology, Suzhou, Jiangsu Province, China
| | - Lun-Qing Zhu
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China
| | - Xiao-Dong Wang
- Children's Hospital of Soochow University, Department of Orthopaedics, Suzhou, Jiangsu Province, China.
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4
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Mitsiakos G, Gialamprinou D, Tsakalidis C, Babatseva E, Lithoxopoulou M, Diamanti E. Osteomyelitis and Thrombosis in a Newborn with Group A Streptococcus Infection. Prague Med Rep 2023; 124:293-300. [PMID: 37736952 DOI: 10.14712/23362936.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023] Open
Abstract
Neonatal osteomyelitis (OM), although exceptionally rare, has been linked to detrimental sequel, as diagnosis in the early stages is challenging and any delay in treatment can lead to disturbance in skeletal growth. In pediatric OM the most commonly grown bacteria is Staphylococcus aureus followed by group A Streptococcus (GAS). Notwithstanding, sepsis-induced coagulopathy is a well-known entity in children and adults, still sepsis-associated thrombosis is sparsely observed. we present a case of a newborn with GAS associated OM and thrombosis. A term neonate on the 11th day of life was referred to our NICU due to right (R) lower limb edema, cyanosis and core temperature up to 39 °C. Late onset sepsis was suspected and started on vancomycin and amikacin. A colour Doppler scan showed thrombosis of the R common femoral vein. The neonate started on iv unfractionated heparin. Ampicillin was added given positive for GAS blood culture. An MRI on the 5th day of admission, showed evidence of thrombosis resolution. On the 14th day of admission, a bone Tc99 scan showed evidence of OM of R femur. Antibiotic treatment switched to amoxicillin per os. The management was restricted to anticoagulant therapy with low molecular weight heparin for 3 months and antibiotic therapy for 6 months without surgery intervention and the patient recovered and discharged at 42 days of age. Early diagnosis and treatment of neonatal osteomyelitis can prevent bone destruction. Sepsis-associated thrombosis is barely observed during osteomyelitis, yet it should be considered as an emerged case requiring prompt treatment.
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Affiliation(s)
- Georgios Mitsiakos
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Dimitra Gialamprinou
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Christos Tsakalidis
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Evgenia Babatseva
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Maria Lithoxopoulou
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Elisavet Diamanti
- 2nd Neonatal Department and Neonatal Intensive Care Unit, Aristotle University of Thessaloniki, "Papageorgiou" General Hospital of Thessaloniki, Thessaloniki, Greece
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Branco J, Duarte M, Norte S, Arcangelo J, Alves P, Brito M, Tavares D, Gouveia C. Osteoarticular infections in infants under 3 months of age. Pediatr Int 2022; 64:e15212. [PMID: 35938592 DOI: 10.1111/ped.15212] [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: 11/11/2021] [Revised: 02/18/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute osteoarticular infections (OAI) in infants under 3 months of age (≤3M) are rare and remain a diagnostic challenge. Orthopedic complications and functional sequelae have been less well described in this age group. Our aims were to evaluate trends in aetiology, management, and outcomes of OAI ≤ 3M, and to compare these younger children who have OAI with older children. METHODS A longitudinal observational study was conducted of OAI cases admitted to tertiary care pediatric hospital from 2008 to 2018. OAI ≤ 3M was compared with children above 3 months. Clinical, microbiological, imaging, and outcome data were analyzed. RESULTS We identified 24 (9.1%) of the 263 OAI in children under 3 months. Analyzing OAI ≤ 3M there was a twofold increase since 2014; 54% were males with a median age of 28 days (IQR: 13.5-60.0), 10 (41.7%) were premature and nine (37.5%) had healthcare-associated infections. Microbiological causes were identified in 87.5%, mostly Staphylococcus aureus (57.1%) and Group B Streptococcus (23.8%), and 25% were multidrug-resistant (5 methicillin-resistant S. aureus and 1 Enterobacter cloacae). Bacteremia (100% vs 36.8%, P = 0.037), multidrug resistant bacteria (75% vs 16, P = 0.04), and healthcare-associated infections (100% vs 26.3%, P = 0.014) were associated with sequelae. Comparing OAI ≤ 3M with older children, OAI ≤ 3M were treated with longer antibiotic courses, had more complications and sequelae (17.4% vs 3.2%, P = 0.002). CONCLUSIONS S. aureus is still the most common cause of OAI ≤ 3M, and 25% of causative bacteria were multidrug-resistant bacteria. Complications and sequelae were more frequent in OAI ≤ 3M when compared with older children.
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Affiliation(s)
- Joana Branco
- Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Mariana Duarte
- Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Susana Norte
- Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Joana Arcangelo
- Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Pedro Alves
- Centro Tecnológico e Biomédico, Radiodiagnóstico, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Maria Brito
- Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Delfin Tavares
- Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Catarina Gouveia
- Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal.,Nova Medical School, Faculdade de Ciências Médicas, Lisbon, Portugal
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Musso P, Parigi S, Bossi G, Marseglia GL, Galli L, Chiappini E. Epidemiology and Management of Acute Hematogenous Osteomyelitis, Neonatal Osteomyelitis and Spondylodiscitis in a Third Level Paediatric Center. CHILDREN-BASEL 2021; 8:children8080616. [PMID: 34438507 PMCID: PMC8391380 DOI: 10.3390/children8080616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 01/12/2023]
Abstract
Acute hematogenous osteomyelitis (AHOM) is a rare pathology in pediatric population. The aim of this study is to analyse the epidemiological data and the management, compared to European Society for Paediatric Infectious Disease (ESPID, European Society for Pediatric Infectious Diseases) guidelines 2017 of 216 children with AHOM, divided in three cohorts (neonatal-onset osteomyelitis, those with vertebral involvement and other types of osteomyelitis). We conducted a retrospective single center study, evaluating data from all the children (aged 0–18 years) consecutively admitted to the Meyer Children’s Hospital, during a period of ten years (1 January 2010–31 December 2019). Isolation of pathogen was possible in 65 patients and S. aureus was the most frequently involved (43/65 children). Magnetic Resonance Imaging (MRI, magnetic resonance imaging) was performed in 201/216 cases and was compatible with osteomyelitis in 185/201 of these children (92.03%). In the neonatal-onset osteomyelitis group the percentage of diagnostic ultrasound for osteomyelitis was 36.36% significantly higher than the other groups. The median duration of total antibiotic therapy was 37.5 days. In total, 186/199 children recovered without complications. The present study delineates three heterogeneous cohorts of patients. S. aureus is confirmed as the first pathogen for isolation in all three groups analysed. MRI represent a gold standard for diagnosis. Longer duration of antibiotics treatment was performed in neonatal and spondylodiscitis group, compared to the other types of osteomyelitis.
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Affiliation(s)
- Paola Musso
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (G.B.); (G.L.M.)
- Correspondence:
| | - Sara Parigi
- Department of Health Sciences, University of Florence, 50100 Florence, Italy; (S.P.); (L.G.); (E.C.)
| | - Grazia Bossi
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (G.B.); (G.L.M.)
| | - Gian Luigi Marseglia
- Pediatric Clinic, Department of Pediatrics, Fondazione IRCCS Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy; (G.B.); (G.L.M.)
| | - Luisa Galli
- Department of Health Sciences, University of Florence, 50100 Florence, Italy; (S.P.); (L.G.); (E.C.)
| | - Elena Chiappini
- Department of Health Sciences, University of Florence, 50100 Florence, Italy; (S.P.); (L.G.); (E.C.)
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7
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Ajewole O, Baker L, Hackett G, Aprile J. Previously Healthy 3-week-old Infant with Limited Right Arm Mobility. Pediatr Rev 2021; 42:212-214. [PMID: 33795469 DOI: 10.1542/pir.2020-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | - Lena Baker
- Penn State Health Children's Hospital, Hershey, PA
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8
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Rai A, Chakladar D, Bhowmik S, Mondal T, Nandy A, Maji B, Hazra A, Mondal R. Neonatal septic arthritis: Indian perspective. Eur J Rheumatol 2020; 7:S72-S77. [PMID: 35929862 PMCID: PMC7004267 DOI: 10.5152/eurjrheum.2019.19052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 08/06/2019] [Indexed: 08/12/2023] Open
Abstract
OBJECTIVE To delineate the pattern of joint involvement in neonatal septic arthritis, assess the prognosis, and determine significant predictors of unfavorable outcome. METHODS Subjects were recruited through purposive sampling after obtaining parental consent. A detailed history and examination findings with perinatal data were recorded. Ultrasound and magnetic resonance imaging data of affected joints and blood culture and aspirated joint fluid culture data were recorded along with management received. Cases were followed-up every 3 months from discharge up to minimum 12 months. An unfavorable outcome indicated by permanent joint deformity or restricted range of movement of the affected joint, limb length discrepancy, and persistent joint deformity upon radio imaging at the end of the follow-up period were also included. RESULTS The hip joint involvement (59.2%) was the commonest with predominance of the monoarticular pattern of affliction (74.4%). An overall outcome was favorable in 70.3% subjects with prompt diagnosis and management. A delay in seeking treatment was found to be an indicator of unfavorable outcome. In addition, disease detection by ultrasound at presentation predicted unfavorable outcome. CONCLUSION Neonatal septic arthritis is a rare disease with predominant hip or knee involvement. Outcome is favorable with early detection and institution of appropriate management. A delay in treatment worsens prognosis.
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Affiliation(s)
- Akash Rai
- Department of Pediatrics, North Bengal Medical College, Darjeeling, India
| | | | | | - Tanushree Mondal
- Department of Community Medicine, Medical College, Kolkata, India
| | - Arnab Nandy
- Department of Pediatrics, North Bengal Medical College, Darjeeling, India
| | - Biplab Maji
- Department of Pediatrics, Medical College, Kolkata, India
| | - Avijit Hazra
- Department of Pharmacology, IPGMER, Kolkata, India
| | - Rakesh Mondal
- Department of Pediatrics, North Bengal Medical College, Darjeeling, India
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9
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Mediamolle N, Mallet C, Aupiais C, Doit C, Ntika S, Vialle R, Grimprel E, Pejin Z, Bonacorsi S, Lorrot M. Bone and joint infections in infants under three months of age. Acta Paediatr 2019; 108:933-939. [PMID: 30188592 DOI: 10.1111/apa.14569] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/20/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023]
Abstract
AIM Studies on bone and joint infections (BJI) in infants under three months are rare. We described the clinical and paraclinical features and outcomes of infants hospitalised with BJI under three months of age. METHODS The French National Hospital Discharge Database provided data on BJIs in infants under three months of age from January 2004 to 2015 in three Parisian Paediatric teaching hospitals. RESULTS We included 71 infants under three months of age with BJI, the median age was 25 days, and the interquartile range (IQR) was 17-43 days. The most common infection sites were the hip (32%) and knee (32%). Symptoms included pain (94%), limited mobility (87%) and/or fever (52%). There were 11 (15.5%) cases of nosocomial BJI. A pathogen was identified in 51 infants (71.8%), including Streptococcus agalactiae (45%), Staphylococcus aureus (22%) and Escherichia coli (18%). The initial median C-reactive protein test rate was 31 mg/L (IQR 17-68). Of the 34 infants followed for more than one year, four developed severe orthopaedic conditions such as epiphysiodesis, limb length discrepancy, bone necrosis and/or impaired limb function. CONCLUSION Streptococcus agalactiae was the most common cause of BJI in infants under three months. Orthopaedic sequelae were rare, but severe, and required long-term follow-up.
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Affiliation(s)
- Nicolas Mediamolle
- Paediatric Department‐Division of infectious disease Armand Trousseau Hospital, AP‐HP Paris France
| | - Cindy Mallet
- Department of Pediatric Orthopedic Surgery Robert Debré Hospital AP‐HP Paris France
| | - Camille Aupiais
- Department of Pediatric Emergency Care Inserm U1123 and CIC‐EC 1426, Inserm, U1138, Equipe 22 Robert Debré Hospital AP‐HP Université Paris Diderot Sorbonne Paris‐Cité Paris France
| | - Catherine Doit
- Department of Microbiology Associated‐National Reference Center for Escherichia Coli UMR 1137, INSERM Robert Debré Hospital APHP Paris France
| | - Serge Ntika
- Pediatric Department Centre hospitalier de Blois Blois France
| | - Raphael Vialle
- Department of Pediatric Orthopedic Surgery Armand Trousseau Hospital APHP Paris France
| | - Emmanuel Grimprel
- Paediatric Department‐Division of infectious disease Armand Trousseau Hospital, AP‐HP Paris France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique Société Française de Pédiatrie Paris France
| | - Zagorka Pejin
- Pediatric Orthopedic Surgery Necker‐Enfants‐Malades Hospital AP‐HP Paris France
| | - Stephane Bonacorsi
- Department of Microbiology Associated‐National Reference Center for Escherichia Coli UMR 1137, INSERM Robert Debré Hospital APHP Paris France
| | - Mathie Lorrot
- Paediatric Department‐Division of infectious disease Armand Trousseau Hospital, AP‐HP Paris France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique Société Française de Pédiatrie Paris France
- Inserm UMR 1123 ECEVE Sorbonne Paris Cité France
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10
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Boulnois I, Gouron R, Pluquet E, Peltier F, Plancq MC, Deroussen F, Klein C. Late recurrence of an osteoarticular infection caused by Klebsiella pneumoniae in a child. Arch Pediatr 2018; 25:497-499. [PMID: 30361083 DOI: 10.1016/j.arcped.2018.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 06/14/2018] [Accepted: 09/23/2018] [Indexed: 10/28/2022]
Abstract
Klebsiella pneumoniae is an opportunistic pathogen in neonates. A 23-day-old newborn developed septic arthritis of the right hip due to an ESBL-producing strain. A recurrence on the knee was observed at 4 years of age. A molecular investigation confirmed the clonal link of the strains responsible for the two infections and allowed us to identify virulence factors.
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Affiliation(s)
- I Boulnois
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - R Gouron
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - E Pluquet
- Department of Bacteriology, Amiens University Hospital and Jules Verne University of Picardy, Microbiology Research Unit EA4294, Jules Verne University of Picardie, 80054 Amiens, France
| | - F Peltier
- Department of Bacteriology, Amiens University Hospital and Jules Verne University of Picardy, Microbiology Research Unit EA4294, Jules Verne University of Picardie, 80054 Amiens, France
| | - M-C Plancq
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - F Deroussen
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France
| | - C Klein
- Department of Pediatric Orthopaedic Surgery, Amiens University Hospital and Jules Verne University of Picardy, 80054 Amiens, France.
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11
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Wickramasinghe S, Navarreto-Lugo M, Ju M, Samia ACS. Applications and challenges of using 3D printed implants for the treatment of birth defects. Birth Defects Res 2018; 110:1065-1081. [PMID: 29851302 DOI: 10.1002/bdr2.1352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/25/2018] [Indexed: 11/06/2022]
Abstract
Pediatric implants are a special subclass of a vast number of clinically used medical implants, uniquely designed to address the needs of young patients who are at the onset of their developmental growth stage. Given the vulnerability of the implant receiver, it is crucial that the implants manufactured for small children with birth-associated defects be given careful considerations and great attention to design detail to avoid postoperative complications. In this review, we focus on the most common types of medical implants manufactured for the treatment of birth defects originating from both genetic and environmental causes. Particular emphasis is devoted toward identifying the implant material of choice and manufacturing approaches for the fabrication of pediatric prostheses. Along this line, the emerging role of 3D printing to enable customized implants for infants with congenital disorders is presented, as well as the possible complications associated with prosthetic-related infections that is prevalent in using artificial implants for the treatment of birth malformations.
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Affiliation(s)
| | | | - Minseon Ju
- Department of Chemistry, Case Western Reserve University, Cleveland, Ohio
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12
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Brachial Plexus Palsy in Young Infants Harboring Osteomyelitis of the Humerus: Case Report and Review of the Literature. Pediatr Infect Dis J 2017; 36:1219-1222. [PMID: 28033242 DOI: 10.1097/inf.0000000000001520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present an infant with brachial plexus palsy who had osteomyelitis of the humerus and summarize previously reported cases. Although Staphylococcus aureus is the most common pathogen in osteomyelitis in infants, group B Streptococcus is responsible for 40% of humeral osteomyelitis. Early diagnosis is critical to prevent long-term sequalae but is hampered by infants frequently being well and afebrile at presentation.
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13
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Group A Streptococcal Suppurative Arthritis and Osteomyelitis of the Shoulder With Brachial Plexus Palsy in a Newborn. Pediatr Infect Dis J 2016; 35:1151-3. [PMID: 27622687 DOI: 10.1097/inf.0000000000001255] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Osteoarticular infections in the newborn period are rare. A serious complication is paralysis of the affected extremity resulting from either pain or direct involvement of the nerve. We report a newborn with combined osteomyelitis and suppurative arthritis caused by Streptococcus pyogenes presenting with right brachial plexus palsy.
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Merlini L, Anooshiravani M, Ceroni D. Concomitant septic arthritis and osteomyelitis of the hip in young children; a new pathophysiological hypothesis suggested by MRI enhancement pattern. BMC Med Imaging 2015; 15:17. [PMID: 25986395 PMCID: PMC4438534 DOI: 10.1186/s12880-015-0057-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 05/08/2015] [Indexed: 11/11/2022] Open
Abstract
Background In children, septic arthritis (SA) of the hip is either primary or concomitant with acute haematogenous osteomyelitis (AHO). However, seldom, patients with isolated SA at presentation, may later show osteomyelitis in the metaphysis. The aim of this study was to elaborate a physiopathological hypothesis based on the peculiar MRI findings to explain the onset of AHO after SA. Methods Cases of acute infection of the hip admitted between January 2010 and December 2013 were retrospectively reviewed to assess radiographic and MRI features, as well as bacteriological findings. Only children with isolated SA were included in this study, whereas cases of concomitant SA and AHO at presentation were excluded. Results Ten patients met the inclusion criteria. Six (1–11 months) demonstrated, on the initial MRI, decreased perfusion on gadolinium enhanced fat-suppressed T1-weighted sequence of the femoral epiphysis and developed one month later metaphyseal AHO. Four (5–14 years) did not show decreased perfusion and did not develop AHO on follow-up. The type of germ involved influenced neither the type of enhancement pattern nor the outcome. Conclusions Age under one year and decreased perfusion of the affected femoral epiphysis increases the risk of secondary AHO. Our study is the first report in human medicine supporting the physiopathological hypothesis described by Alderson et al. in an animal model: primary infection can originally affect the joint, then penetrate the epiphyseal cartilage, and finally spread into the metaphyseal region through transphyseal vessels present only in the first 12/18 months of life.
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Affiliation(s)
- Laura Merlini
- Unit of Pediatric Radiology Geneva University Hospital HUG, 6 Willy-Donzé, Geneva, 1205, Switzerland.
| | - Mehrak Anooshiravani
- Unit of Pediatric Radiology Geneva University Hospital HUG, 6 Willy-Donzé, Geneva, 1205, Switzerland.
| | - Dimitri Ceroni
- Unit of Pediatric Orthopedics, University Hospital, Geneva, Switzerland.
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Nguon S, Novy P, Kokoska L. Potentiation of the in vitro antistaphylococcal effect of oxacillin and tetracycline by the anti-inflammatory drug diacetyl rhein. Chemotherapy 2014; 59:447-52. [PMID: 25138175 DOI: 10.1159/000363730] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/20/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The anti-inflammatory drug diacetyl rhein has been found to possess promising antistaphylococcal effects against various drug-resistant strains in our previous study. In the present work, we explored the in vitro combinatory interactions of diacetyl rhein with oxacillin and tetracycline against 13 standard strains and clinical isolates of Staphylococcus aureus, including those resistant to erythromycin, methicillin and tetracycline. METHODS Minimum inhibitory concentrations were determined by broth microdilution assay, and the effects of combinations were evaluated according to the sum of fractional inhibitory concentrations (ΣFICs). RESULTS Synergistic or additive effects were observed against all S. aureus strains (ΣFIC 0.258-1), whereas diacetyl rhein-oxacillin appeared to be the most effective combination, synergistically inhibiting the growth of 4 strains tested. CONCLUSION To our best knowledge, this is the first report on a synergistic antibacterial effect of diacetyl rhein. Our results suggest this promising compound for further evaluation of its synergistic anti-infective potential as an agent with a combined anti-inflammatory and synergistic antibacterial action.
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Affiliation(s)
- Samnang Nguon
- Department of Food Science and Technology, Faculty of Agro-Industry, Royal University of Agriculture, Phnom Penh, Cambodia
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