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Nguyen Thi H, Tran Dang X, Hoang Thi Bich N, Vu Ngoc H, Ta Anh T, Pham Hong N. High Prevalence of Panton-Valentine Leukocidin Among Staphylococcus aureus Causing Acute Hematogenous Bone and Joint Infections From a Tertiary Children's Hospital in Vietnam. Pediatr Infect Dis J 2024; 43:715-719. [PMID: 38567978 DOI: 10.1097/inf.0000000000004305] [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: 07/19/2024]
Abstract
BACKGROUND We aimed to investigate the clinical features, antimicrobial susceptibility and pvl gene expression in Staphylococcus aureus causing acute hematogenous bone and joint infections (BJIs) in children in Vietnam. METHODS In this prospective study, the demographics, microbiology and clinical outcomes of pediatric patients with acute hematogenous BJIs were collected from September 2022 to September 2023. Antimicrobial susceptibility profiles were determined using VITEK2 Compact system. The pvl gene encoding the Panton-Valentine leukocidin (PVL) toxin was detected by using polymerase chain reaction. Mann-Whitney, χ 2 and Fisher test were used for statistical analysis. RESULTS In total, 78 patients (46 boys) with S. aureus acute hematogenous BJIs were recruited at the National Children's Hospital, Hanoi, Vietnam. Of all S. aureus isolates, 84.6% were methicillin-resistant S. aureus . All S. aureus isolates were susceptible to vancomycin, ciprofloxacin and levofloxacin; 97% of methicillin-resistant S. aureus isolates was resistant to clindamycin (minimum inhibitory concentration ≥8 μg/mL). The pvl gene was detected in 83.3% of isolates, including 57 methicillin-resistant S. aureus isolates. Patients in the pvl -positive group had significantly higher C-reactive protein levels than those in the pvl -negative group ( P = 0.04). In addition, all 8 children with septic shock were infected with pvl -positive S. aureus . CONCLUSIONS PVL is a prevalent virulence factor of S. aureus in Vietnam. Furthermore, high inflammatory parameters (C-reactive protein) may be present at the time of diagnosis in PVL positivity-related acute hematogenous BJIs. Further research is necessary to enhance our understanding of the varying correlations between virulence factors and outcomes of S. aureus BJIs.
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Affiliation(s)
- Ha Nguyen Thi
- From the Department of Pediatric, Ha Noi Medical University Hospital
| | | | | | - Hieu Vu Ngoc
- Department of Microbiology, Ha Noi Medical University
| | - Tuan Ta Anh
- From the Department of Pediatric, Ha Noi Medical University Hospital
- Pediatric Intensive care unit
| | - Nhung Pham Hong
- Department of Microbiology, Ha Noi Medical University
- Department of Microbiology, Bach Mai Hospital, Ha Noi, Vietnam
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Andriescu EC, Healy CM, Cohen A. A More Unusual Presentation of a Common Infectious Organism. Pediatr Rev 2024; 45:104-107. [PMID: 38296780 DOI: 10.1542/pir.2022-005523] [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: 02/02/2024]
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Gouveia C, Subtil A, Aguiar P, Canhão H, Norte S, Arcangelo J, Varandas L, Tavares D. Osteoarticular Infections: Younger Children With Septic Arthritis and Low Inflammatory Patterns Have a Better Prognosis in a European Cohort. Pediatr Infect Dis J 2023; 42:969-974. [PMID: 37625093 DOI: 10.1097/inf.0000000000004074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
BACKGROUND Osteoarticular infections (OAI) are associated with complications and sequelae in children, whose prediction are of great importance in improving outcomes. We aimed to design risk prediction models to identify early complications and sequelae in children with OAI. METHODS This observational study included children (>3 months-17 years old) with acute OAI admitted to a tertiary-care pediatric hospital between 2008 and 2018. Clinical treatment, complications and sequelae were recorded. We developed a multivariable logistic predictive model for an acute complicated course (ACC) and another for sequelae. RESULTS A total of 240 children were identified, 17.5% with ACC and 6.0% and 3.6% with sequelae at 6 and 12 months of follow-up, respectively. In the multivariable logistic predictive model for ACC, predictors were fever at admission [adjusted odds ratio (aOR): 2.98; 95% confidence interval (CI): 1.10-8.12], C-reactive protein ≥100 mg/L (aOR: 2.37; 95% CI: 1.05-5.35), osteomyelitis (aOR: 4.39; 95% CI: 2.04-9.46) and Staphylococcus aureus infection (aOR: 3.50; 95% CI: 1.39-8.77), with an area under the ROC curve of 0.831 (95% CI: 0.767-0.895). For sequelae at 6 months, predictors were age ≥4 years (aOR: 4.08; 95% CI: 1.00-16.53), C-reactive protein ≥110 mg/L (aOR: 4.59; 95% CI: 1.25-16.90), disseminated disease (aOR: 9.21; 95% CI: 1.82-46.73) and bone abscess (OR: 5.46; 95% CI: 1.23-24.21), with an area under the ROC curve of 0.887 (95% CI: 0.815-0.959). CONCLUSIONS In our model we could identify patients at low risk for complications and sequelae, probably requiring a less aggressive approach.
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Affiliation(s)
- Catarina Gouveia
- Faculdade de Ciências Médicas, Nova Medical School
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana Subtil
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- CEMAT, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal
| | - Pedro Aguiar
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | - Helena Canhão
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Susana Norte
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Joana Arcangelo
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
| | - Luís Varandas
- Faculdade de Ciências Médicas, Nova Medical School
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Delfin Tavares
- NOVA Medical School, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
- Orthopaedic Unit, Paediatric Department, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
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Predictive Factors to Guide Empiric Antimicrobial Therapy of Acute Hematogenous Osteomyelitis in Children. Pediatr Infect Dis J 2023; 42:449-455. [PMID: 36795576 DOI: 10.1097/inf.0000000000003875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
BACKGROUND Acute hematogenous osteomyelitis (AHO) is a serious infection in children. Pediatric Infectious Diseases Society guidelines recommend empiric methicillin-resistant Staphylococcus aureus (MRSA) therapy in regions where MRSA accounts for more than 10-20% of all staphylococcal osteomyelitis. We sought to examine factors present at the time of admission which may predict etiology and guide empiric treatment for pediatric AHO in a region with endemic MRSA. METHODS We reviewed admissions with International Classification of Diseases 9/10 codes for AHO from 2011 to 2020 in otherwise healthy children. Medical records were reviewed for clinical and laboratory parameters present on the day of admission. Logistic regression was used to determine clinical variables independently associated with (1) MRSA infection and (2) non-Staphylococcus aureus infection. RESULTS A total of 545 cases were included. An organism was identified in 77.1% of cases and S. aureus was the most common (66.2%); 18.9% of all AHO cases were MRSA. Organisms besides S. aureus were identified in 10.8% of cases. CRP >7 mg/dL, subperiosteal abscess, history of any prior skin or soft tissue infection (SSTI) and need for intensive care unit admission were independently associated with MRSA infection. Vancomycin was used as an empiric treatment in 57.6% of cases. If the above criteria were relied upon to predict MRSA AHO, empiric vancomycin use could have been reduced by 25%. CONCLUSIONS Critical illness, CRP >7 mg/dL at the time of presentation, subperiosteal abscess and history of SSTI are suggestive of MRSA AHO, and could be considered when planning empiric therapy. Further work is needed to validate these findings before wider implementation.
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Staphylococcus aureus Genomic Analysis and Outcomes in Patients with Bone and Joint Infections: A Systematic Review. Int J Mol Sci 2023; 24:ijms24043234. [PMID: 36834650 PMCID: PMC9967247 DOI: 10.3390/ijms24043234] [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: 01/12/2023] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/09/2023] Open
Abstract
Many studies have been published assessing the association between the presence of S. aureus genes and outcomes in patients with bone and joint infections (BJI), but it is not known if they have had similar findings. A systematic literature review was performed. All available data on studies in Pubmed between January 2000 to October 2022 reporting the genetic characteristics of S. aureus and the outcomes of BJIs were analyzed. BJI included prosthetic joint infection (PJI), osteomyelitis (OM), diabetic foot infection (DFI), and septic arthritis. Because of the heterogeneity of studies and outcomes, no meta-analysis was performed. With the search strategy, 34 articles were included: 15 articles on children and 19 articles on adults. In children, most BJI studied were OM (n = 13) and septic arthritis (n = 9). Panton Valentine leucocidin (PVL) genes were associated with higher biological inflammatory markers at presentation (n = 4 studies), more febrile days (n = 3), and more complicated/severe infection (n = 4). Other genes were reported anecdotally associated with poor outcomes. In adults, six studies reported outcomes in patients with PJI, 2 with DFI, 3 with OM, and 3 with various BJI. Several genes were associated with a variety of poor outcomes in adults, but studies found contradictory results. Whereas PVL genes were associated with poor outcomes in children, no specific genes were reported similarly in adults. Additional studies with homogenous BJI and larger sample sizes are needed.
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Kwon HK, Yu KE, Lee FY. Construction and evaluation of a clinically relevant model of septic arthritis. Lab Anim (NY) 2023; 52:11-26. [PMID: 36564668 DOI: 10.1038/s41684-022-01089-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/03/2022] [Indexed: 12/24/2022]
Abstract
Despite the creation of several experimental animal models for the study of septic arthritis, a protocol detailing the development of a reliable and easily reproducible animal model has not yet been reported. The experimental protocol described herein for the development of a clinically relevant mouse model of septic arthritis includes two main study stages: the first stage consisting of the preparation of the mice and of the methicillin-resistant Staphylococcus aureus (MRSA) cultures, followed by direct inoculation of MRSA into the knee joints of C57BL/6J mice (25-40 min); and a second study stage consisting of multiple sample collection and data analysis (1-3 days). This protocol may be carried out by researchers skilled in mouse care and trained to work with biosafety-level-2 agents such as MRSA. The model of septic arthritis described here has demonstrated clinical relevance in developing intra-articular inflammation and cartilage destruction akin to that of human patients. Moreover, we describe methods for serum, synovial fluid and knee joint tissue analysis that were used to confirm the development of septic arthritis in this model, and to test potential treatments. This protocol confers the advantages of enabling granular evaluation of the pathophysiology of MRSA infection and of the efficacy of therapeutic medications; it may also be employed to study a range of native joint diseases beyond inflammatory pathologies alone.
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Affiliation(s)
- Hyuk-Kwon Kwon
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
| | - Kristin E Yu
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Yale University, School of Medicine, New Haven, CT, USA.
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7
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Wang S, Wang M, Ning B, Zhang W. Clinical characteristics, pathogenesis, treatment and prognosis of osteomyelitis in children: a retrospective study from a single center. World J Emerg Med 2023; 14:312-316. [PMID: 37425083 PMCID: PMC10323502 DOI: 10.5847/wjem.j.1920-8642.2023.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/21/2023] [Indexed: 07/11/2023] Open
Affiliation(s)
- Shuang Wang
- Department of Pediatric Intensive Care Unit, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Ming Wang
- Department of Pediatric Intensive Care Unit, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Botao Ning
- Department of Pediatric Intensive Care Unit, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Wanglin Zhang
- Department of Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Aguilar-Gómez NE, Merida-Vieyra J, Isunza-Alonso OD, Morales-Pirela MG, Colín-Martínez O, Juárez-Benítez EJ, García de la Puente S, Aquino-Andrade A. Surveillance of osteoarticular infections caused by Staphylococcus aureus in a paediatric hospital in Mexico City. Front Cell Infect Microbiol 2022; 12:999268. [PMID: 36569208 PMCID: PMC9774039 DOI: 10.3389/fcimb.2022.999268] [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: 07/20/2022] [Accepted: 10/20/2022] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus is the main aetiologic agent of osteoarticular infections (OAIs) in paediatric patients. The aim of this prospective unicenter study was to describe the phenotypic and genotypic characteristics of S. aureus isolates obtained from OAIs in paediatric patients admitted to tertiary care hospital. Through a surveillance program called OsteoCode, a multidisciplinary team was created and we identified 27 patients with OAIs caused by S. aureus from 2019 to 2021. The susceptibility profile, virulence factors, biofilm formation, pulsed-field gel electrophoresis (PFGE), clonal complex (CC) and sequence type (ST) were determined. In addition, the clinical characteristics and evolution of the patients presented six months after the diagnosis of OAIs were described. Ninety-two percent of the isolates were methicillin-sensitive S. aureus (MSSA). In methicillin-resistant S. aureus (MRSA), SCCmec-II and SCCmec-V were detected. The pvl gene was only observed in MSSA (18.5%) and was associated with highest fever (p=0.015), multiple localization (p=0.017), and soft tissue sites of infection beyond the bone (pyomyositis, pulmonary abscess) (p=0.017). Biofilm formation was detected in 55.6% of isolates. The most common CC were CC5 and CC30 which represent the most common linages for bone and joint infections worldwide. The isolates were distributed in different STs, and ST672 was predominant. MRSA were associated with a longer duration of intravenous treatment and a prolonged hospital stay (p=0.023). Recurrent infection occurred in five children and orthopaedic complications in 33.3% of patients. This is the first study that reflects the epidemiology of S. aureus in OAIs in paediatric patients in Mexico; a clear predominance of MSSA distributed in different STs was observed. Our findings highlight that a multidisciplinary team is required for the diagnosis and treatment of OAIs.
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Affiliation(s)
| | - Jocelin Merida-Vieyra
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Oscar Colín-Martínez
- Department of Orthopaedic Surgery, Instituto Nacional de Pediatria, Mexico City, Mexico
| | | | | | - Alejandra Aquino-Andrade
- Molecular Microbiology Laboratory, Instituto Nacional de Pediatria, Mexico City, Mexico,*Correspondence: Alejandra Aquino-Andrade,
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9
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Kwon H, Yu KE, Cahill SV, Alder KD, Dussik CM, Kim S, Sharma L, Back J, Oh I, Lee FY. Concurrent targeting of glycolysis in bacteria and host cell inflammation in septic arthritis. EMBO Mol Med 2022; 14:e15284. [PMID: 36354099 PMCID: PMC9728052 DOI: 10.15252/emmm.202115284] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Intracellular infiltration of bacteria into host cells complicates medical and surgical treatment of bacterial joint infections. Unlike soft tissue infections, septic arthritis and infection-associated inflammation destroy cartilage that does not regenerate once damaged. Herein, we show that glycolytic pathways are shared by methicillin-resistant Staphylococcus aureus (MRSA) proliferation and host inflammatory machinery in septic arthritis. MRSA readily penetrates host cells and induces proinflammatory cascades that persist after conventional antibiotic treatment. The glycolysis-targeting drug dimethyl fumarate (DMF) showed both bacteriostatic and anti-inflammatory effects by hindering the proliferation of intracellular MRSA and dampening excessive intraarticular inflammation. Combinatorial treatment with DMF and vancomycin further reduced the proliferation and re-emergence of intracellular MRSA. Combinatorial adjuvant administration of DMF with antibiotics alleviated clinical symptoms of septic arthritis by suppressing bacterial burden and curbing inflammation to protect cartilage and bone. Our results provide mechanistic insight into the regulation of glycolysis in the context of infection and host inflammation toward development of a novel therapeutic paradigm to ameliorate joint bioburden and destruction in septic arthritis.
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Affiliation(s)
- Hyuk‐Kwon Kwon
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Kristin E Yu
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA
| | - Sean V Cahill
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryWashington University School of MedicineSt. LouisMOUSA
| | - Kareme D Alder
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA
| | - Christopher M Dussik
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopaedics and RehabilitationUniversity of RochesterRochesterNYUSA
| | - Sang‐Hun Kim
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Jungho Back
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
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10
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Fatal SARS-CoV-2-Associated Panton-Valentine Leukocidin-producing Staphylococcal Bacteremia: A Nationwide Multicenter Cohort Study. Pediatr Infect Dis J 2022; 41:e142-e145. [PMID: 35093994 DOI: 10.1097/inf.0000000000003476] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We reviewed all cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) bacteremia in Danish children between 2016 and 2021. We found 2 fatal cases with preceding viral prodrome due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Given the usual benign course of SARS-CoV-2 infection in children, awareness of possible superinfection with PVL-SA in a child with rapid deterioration is crucial to ensure adequate treatment, including antimicrobial drugs with antitoxin effect.
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12
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Trobisch A, Schweintzger NA, Kohlfürst DS, Sagmeister MG, Sperl M, Grisold AJ, Feierl G, Herberg JA, Carrol ED, Paulus SC, Emonts M, van der Flier M, de Groot R, Cebey-López M, Rivero-Calle I, Boeddha NP, Agapow PM, Secka F, Anderson ST, Behrends U, Wintergerst U, Reiter K, Martinon-Torres F, Levin M, Zenz W. Osteoarticular Infections in Pediatric Hospitals in Europe: A Prospective Cohort Study From the EUCLIDS Consortium. Front Pediatr 2022; 10:744182. [PMID: 35601438 PMCID: PMC9114665 DOI: 10.3389/fped.2022.744182] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric osteoarticular infections (POAIs) are serious diseases requiring early diagnosis and treatment. METHODS In this prospective multicenter cohort study, children with POAIs were selected from the European Union Childhood Life-threatening Infectious Diseases Study (EUCLIDS) database to analyze their demographic, clinical, and microbiological data. RESULTS A cohort of 380 patients with POAIs, 203 with osteomyelitis (OM), 158 with septic arthritis (SA), and 19 with both OM and SA, was analyzed. Thirty-five patients were admitted to the Pediatric Intensive Care Unit; out of these, six suffered from shock, one needed an amputation of the right foot and of four left toes, and two had skin transplantation. According to the Pediatric Overall Performance Score, 36 (10.5%) showed a mild overall disability, 3 (0.8%) a moderate, and 1 (0.2%) a severe overall disability at discharge. A causative organism was detected in 65% (247/380) of patients. Staphylococcus aureus (S. aureus) was identified in 57.1% (141/247) of microbiological confirmed cases, including 1 (0.7%) methicillin-resistant S. aureus (MRSA) and 6 (4.2%) Panton-Valentine leukocidin (PVL)-producing S. aureus, followed by Group A Streptococcus (18.2%) and Kingella kingae (8.9%). K. kingae and PVL production in S. aureus were less frequently reported than expected from the literature. CONCLUSION POAIs are associated with a substantial morbidity in European children, with S. aureus being the major detected pathogen. In one-third of patients, no causative organism is identified. Our observations show an urgent need for the development of a vaccine against S. aureus and for the development of new microbiologic diagnostic guidelines for POAIs in European pediatric hospitals.
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Affiliation(s)
- Andreas Trobisch
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria.,Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Group for Neonatal Infectious Diseases, Medical University of Graz, Graz, Austria
| | - Nina A Schweintzger
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Daniela S Kohlfürst
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Manfred G Sagmeister
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
| | - Matthias Sperl
- Department of Orthopedics and Traumatology, Pediatric Orthopedic Unit, Medical University of Graz, Graz, Austria
| | - Andrea J Grisold
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Gebhard Feierl
- Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Jethro A Herberg
- Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Enitan D Carrol
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Stephane C Paulus
- Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom
| | - Marieke Emonts
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.,National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre Based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom.,Pediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom
| | - Michiel van der Flier
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands.,Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, Netherlands
| | - Ronald de Groot
- Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands
| | - Miriam Cebey-López
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain
| | - Irene Rivero-Calle
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain
| | - Navin P Boeddha
- Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Paul-Michael Agapow
- Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Fatou Secka
- Medical Research Council Unit the Gambia, Banjul, Gambia
| | | | - Uta Behrends
- Department of Pediatrics and of Pediatric Surgery, Technische Universität München, Munich, Germany
| | - Uwe Wintergerst
- Department of Pediatrics, Hospital St. Josef, Braunau, Austria
| | - Karl Reiter
- Department of Pediatric Intensive Care, University Children's Hospital at Dr. von Haunersche Kinderklinik, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Federico Martinon-Torres
- Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.,Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain
| | - Michael Levin
- Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom
| | - Werner Zenz
- Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria
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De Marco G, Vazquez O, Gavira N, Ramadani A, Steiger C, Dayer R, Ceroni D. Surgery's role in contemporary osteoarticular infection management. Front Pediatr 2022; 10:1043251. [PMID: 36601031 PMCID: PMC9806351 DOI: 10.3389/fped.2022.1043251] [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: 09/13/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
The treatment paradigm for osteoarticular infections (OAIs) has changed drastically over the past 80 years, from the advent of penicillin to the use of broad-spectrum antibiotics. Before these drugs, surgery was the only available treatment for OAIs; today, antibiotic therapy is considered the primary response to them. As a result, surgical treatment of OAIs is thus far more rarely indicated, sometimes even considered outdated and obsolete. However, long experience has taught us that many OAI contexts can still benefit from surgical management, constituting an essential complement to medical treatment. The present article seeks to contextualize this discussion by providing a chronological review of the surgical treatments used in cases of OAI and describing the quality of evidence supporting their rehabilitation in well-established situations.
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Affiliation(s)
- Giacomo De Marco
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Oscar Vazquez
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Nathaly Gavira
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Ardian Ramadani
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Christina Steiger
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Romain Dayer
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
| | - Dimitri Ceroni
- Pediatric Orthopedics Unit, Pediatric Surgery Service, University Hospitals of Geneva, Genève, Switzerland
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14
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Woods CR, Bradley JS, Chatterjee A, Copley LA, Robinson J, Kronman MP, Arrieta A, Fowler SL, Harrison C, Carrillo-Marquez MA, Arnold SR, Eppes SC, Stadler LP, Allen CH, Mazur LJ, Creech CB, Shah SS, Zaoutis T, Feldman DS, Lavergne V. Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. J Pediatric Infect Dis Soc 2021; 10:801-844. [PMID: 34350458 DOI: 10.1093/jpids/piab027] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
This clinical practice guideline for the diagnosis and treatment of acute hematogenous osteomyelitis (AHO) in children was developed by a multidisciplinary panel representing Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with AHO, including specialists in pediatric infectious diseases, orthopedics, emergency care physicians, hospitalists, and any clinicians and healthcare providers caring for these patients. The panel's recommendations for the diagnosis and treatment of AHO are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of AHO in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.
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Affiliation(s)
- Charles R Woods
- Department of Pediatrics, University of Tennessee College of Medicine, Chattanooga, Tennessee, USA
| | - John S Bradley
- Division of Infectious Diseases, University of California San Diego School of Medicine, and Rady Children's Hospital, San Diego, California, USA
| | - Archana Chatterjee
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Lawson A Copley
- Departments of Orthopaedic Surgery and Pediatrics, University of Texas Southwestern, Dallas, Texas, USA
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Matthew P Kronman
- Division of Infectious Diseases, Seattle Children's Hospital, Seattle, Washington, USA
| | - Antonio Arrieta
- University of California Irvine School of Medicine and Children's Hospital of Orange County, Irvine, California, USA
| | - Sandra L Fowler
- Division of Infectious Diseases, Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Maria A Carrillo-Marquez
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Sandra R Arnold
- Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Stephen C Eppes
- Department of Pediatrics, ChristianaCare, Newark, Delaware, USA
| | - Laura P Stadler
- Department of Pediatrics, Division of Infectious Diseases, University of Kentucky, Lexington, Kentucky, USA
| | - Coburn H Allen
- Department of Pediatrics, University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Lynnette J Mazur
- Department of Pediatrics, University of Texas McGovern Medical School, Houston, Texas, USA
| | - C Buddy Creech
- Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Samir S Shah
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David S Feldman
- New York University Langone Medical Center, New York, New York, USA
| | - Valéry Lavergne
- Department of Medical Microbiology and Infection Control, Vancouver General Hospital, Vancouver, British Columbia, Canada.,University of Montreal Research Center, Montreal, Quebec, Canada
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15
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Jemaa MB, Trigui M, Zribi W, Elleuch E, Abid A, Koubaa M, Mnif B, Ellouze Z, Ayedi K, Hammemi A, Jemaa MB, Zribi M, Keskes H. [Acute osteomyelitis caused by community-acquired methicillin-resistant Staphylococcus aureus in children: about 15 cases]. Pan Afr Med J 2021; 39:84. [PMID: 34466186 PMCID: PMC8379408 DOI: 10.11604/pamj.2021.39.84.12560] [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: 04/19/2017] [Accepted: 07/06/2018] [Indexed: 11/11/2022] Open
Abstract
La prise en charge de l´ostéomyélite aiguë devient plus délicate depuis l´émergence du Staphylocoque aureus résistant à la méthicilline d´origine communautaire. Nous avons recueilli les cas d´ostéomyélite aiguë dues à ce germe sur une période de 21 ans (Janvier 1995-Décembre 2016) et nous avons essayé d´analyser les particularités de cette entité pathologique. Notre série comporte 15 enfants, d´âge moyen 9 ans. Le membre inférieur était atteint dans tous les cas. Une notion de traumatisme local a été signalée dans 8 cas et une porte d´entrée cutanée a été trouvée dans 4 cas. Le mode de début était aigu dans 12 cas avec un tableau de pseudo-paralysie du membre atteint. Une staphylococcie pulmonaire avec des signes septico-pyohémiques ont été notés dans un cas. L´hémoculture était positive dans 8 cas. La recherche par PCR de la leucocidine de Panton et Valentine était pratiquée dans 1 cas avec un résultat positif. Tous ces patients ont eu un débridement chirurgical et une antibiothérapie empirique secondairement adaptée. L´évolution était bonne dans 8 cas et mauvaise dans les autres cas avec passage à la chronicité dans 6 cas et un cas de décès. Une fracture pathologique a été signalée dans 3 cas. La survenue d´une ostéomyélite à Staphylocoque aureus résistant à la méthicilline d´origine communautaire est péjorative. Connaitre ces infections en se basant sur des arguments cliniques et paracliniques est un enjeu important pour une prise en charge thérapeutique spécifique et rapide.
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Affiliation(s)
- Mohamed Ben Jemaa
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Moez Trigui
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Wassim Zribi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Emna Elleuch
- Service des Maladies Infectieuses CHU Hédi Chaker de Sfax, Sfax, Tunisie
| | - Ameur Abid
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Makram Koubaa
- Service des Maladies Infectieuses CHU Hédi Chaker de Sfax, Sfax, Tunisie
| | - Basma Mnif
- Laboratoire de Microbiologie, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Zoubayer Ellouze
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Kamel Ayedi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Adnène Hammemi
- Laboratoire de Microbiologie, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Mounir Ben Jemaa
- Service des Maladies Infectieuses CHU Hédi Chaker de Sfax, Sfax, Tunisie
| | - Mohamed Zribi
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
| | - Hassib Keskes
- Service de Chirurgie Orthopédique et Traumatologique, CHU Habib Bourguiba de Sfax, Sfax, Tunisie
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16
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Osteomyelitis in Children from Rural Population of Uttar Pradesh. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2021. [DOI: 10.22207/jpam.15.3.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Occurrence of Staphylococcus aureus in children with osteomyelitis. This study was conducted at K. M. M. C. & Hospital, Mathura (UP). A total of 60 patients with osteomyelitis contributed to this study from October 2017 to October 2019. Patients with known immunodeficiency syndromes were excluded. Specimen collections were meticulously performed to avoid contamination which was accomplished by needle aspiration or surgical sampling. Staphylococcus aureus was recovered in more than half of the cases of osteomyelitis in both infants and children. Amikacin, Clindamycin and Cefazolin were effective in such cases. The distal end of the femur and upper-end tibia were the most common sites of infection where boys were more infected than girls. The haematogenous route was the main cause of the transmission of osteomyelitis in children. Principally Staphylococcus aureus causes the majority of cases of osteomyelitis in children followed by H. influenza, Group B Streptococcus, P. aeruginosa, E. coli and Serratia marcescens.
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17
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Yi J, Wood JB, Creech CB, Williams D, Jimenez-Truque N, Yildirim I, Sederdahl B, Daugherty M, Hussaini L, Munye M, Tomashek KM, Focht C, Watson N, Anderson EJ, Thomsen I. Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections. J Pediatr 2021; 234:236-244.e2. [PMID: 33771580 PMCID: PMC8238832 DOI: 10.1016/j.jpeds.2021.03.028] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/02/2021] [Accepted: 03/18/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To understand the epidemiology of acute hematogenous osteomyelitis and septic arthritis, including clinical and demographic features, microbiology, treatment approaches, treatment-associated complications, and outcomes. STUDY DESIGN Retrospective cohort study of 453 children with acute hematogenous osteomyelitis and/or septic arthritis from 2009 to 2015. RESULTS Among the 453 patients, 218 (48%) had acute hematogenous osteomyelitis, 132 (29%) had septic arthritis, and 103 (23%) had concurrent acute hematogenous osteomyelitis/septic arthritis. Treatment failure/recurrent infection occurred in 41 patients (9%). Patients with concurrent acute hematogenous osteomyelitis/septic arthritis had longer hospital stays, longer duration of antibiotic therapy, and were more likely to have prolonged bacteremia and require intensive care. Staphylococcus aureus was identified in 228 (51%) patients, of which 114 (50%) were methicillin-resistant S aureus. Compared with septic arthritis, acute hematogenous osteomyelitis and concurrent acute hematogenous osteomyelitis/septic arthritis were associated with higher odds of treatment failure (OR, 8.19; 95% CI, 2.02-33.21 [P = .003]; and OR, 14.43; 95% CI, 3.39-61.37 [P < .001], respectively). The need for more than 1 surgical procedure was also associated with higher odds of treatment failure (OR, 2.98; 95% CI, 1.18-7.52; P = .021). Early change to oral antibiotic therapy was not associated with treatment failure (OR, 0.64; 95% CI, 0.24-1.74; P = .386). Most (73%) medically attended treatment complications occurred while on parenteral therapy. CONCLUSIONS Musculoskeletal infections are challenging pediatric infections. S aureus remains the most common pathogen, with methicillin-resistant S aureus accounting for 25% of all cases. Concurrent acute hematogenous osteomyelitis/septic arthritis is associated with more severe disease and worse outcomes. Fewer treatment-related complications occurred while on oral therapy. Early transition to oral therapy was not associated with treatment failure.
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Affiliation(s)
- Jumi Yi
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia,University of California San Francisco
| | - James B. Wood
- Indiana University School of Medicine,Vanderbilt Vaccine Research Program, Department of Pediatrics and Division of Pediatric Infectious Diseases
| | - C. Buddy Creech
- Vanderbilt Vaccine Research Program, Department of Pediatrics and Division of Pediatric Infectious Diseases
| | - Derek Williams
- Vanderbilt Vaccine Research Program, Department of Pediatrics and Division of Pediatric Infectious Diseases,Division of Pediatric Hospital Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Natalia Jimenez-Truque
- Vanderbilt Vaccine Research Program, Department of Pediatrics and Division of Pediatric Infectious Diseases
| | - Inci Yildirim
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia,Yale School of Medicine, Department of Pediatrics and Section of Pediatric Infectious Diseases & Global Health, New Haven, Connecticut
| | - Bethany Sederdahl
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia
| | - Michael Daugherty
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia
| | - Laila Hussaini
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia
| | - Mohamed Munye
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia
| | - Kay M. Tomashek
- National Institutes of Health: Division of Microbiology and Infectious Diseases (DMID)
| | | | | | - Evan J. Anderson
- Emory University School of Medicine and Children’s Healthcare of Atlanta; Atlanta, Georgia
| | - Isaac Thomsen
- Vanderbilt Vaccine Research Program, Department of Pediatrics and Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN.
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18
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Wang J, Wang L. Novel therapeutic interventions towards improved management of septic arthritis. BMC Musculoskelet Disord 2021; 22:530. [PMID: 34107951 PMCID: PMC8191206 DOI: 10.1186/s12891-021-04383-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/18/2021] [Indexed: 01/19/2023] Open
Abstract
Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA). In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring. The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.
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Affiliation(s)
- Jian Wang
- Department of Nursing, The Third Hospital of Jinan, Shandong Province, Jinan, 250132, China.
| | - Liucai Wang
- Hand and Foot Surgery, Shandong Provincial Hospital, Jinan, 250000, China
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19
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Pimentel de Araujo F, Monaco M, Del Grosso M, Pirolo M, Visca P, Pantosti A. Staphylococcus aureus clones causing osteomyelitis: a literature review (2000-2020). J Glob Antimicrob Resist 2021; 26:29-36. [PMID: 33965630 DOI: 10.1016/j.jgar.2021.03.030] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Staphylococcus aureus is the most common causative organism of osteomyelitis (OM). Nevertheless, the molecular epidemiology of S. aureus causing OM remains ill-defined. This study aimed to address the global epidemiology of S. aureus clones from OM patients. METHODS Literature databases were searched for studies reporting the molecular typing of S. aureus involved in OM published between 1 January 2000 and 29 July 2020. Data from 32 articles that fulfilled the inclusion criteria were analysed for year of publication, country of patients, methicillin susceptibility and genotypic characteristics of S. aureus isolates. RESULTS Pandemic clones CC5, CC8, CC22, CC30 and CC45 were the most common in OM. The distribution of clones differed greatly among studies owing to the local epidemiology of S. aureus and the MSSA heterogeneity. PVL-positive MRSA clones belonging to ST80/CC80 and ST8/CC8/USA300 were the most common among paediatric patients in Europe and the USA; greater variability was observed in the adult population. In Europe, MRSA belonged to PVL-negative CC5, CC8 and CC22 indicating a nosocomial origin of infections; in Asia PVL-positive ST59/CC59 MRSA was the most frequent. PVL-positive clones were often detected in haematogenous OM in children and adults. Although MSSA were polyclonal, PVL-negative ST398/CC398 MSSA was the most prevalent clone in diabetic foot OM. CONCLUSION All major S. aureus clones circulating both in hospital and community settings appear to be capable of causing OM. Future studies reporting molecular typing and genomic data will provide more insights into the epidemiology and pathobiology of S. aureus clones causing OM.
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Affiliation(s)
- Fernanda Pimentel de Araujo
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy; Department of Science, Roma Tre University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Monica Monaco
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy.
| | - Maria Del Grosso
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
| | - Mattia Pirolo
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Paolo Visca
- Department of Science, Roma Tre University, Viale G. Marconi 446, 00146, Rome, Italy
| | - Annalisa Pantosti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161, Rome, Italy
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20
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Guzmán H, Meza P. INFECCIONES OSTEOARTICULARES EN NIÑOS. REVISTA MÉDICA CLÍNICA LAS CONDES 2021. [DOI: 10.1016/j.rmclc.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Abstract
Myositis is inflammation especially of the voluntary muscles, characterized by localized or diffuse pain, tenderness on movement or palpation, swelling, and/or weakness. The two main categories of myositis include non-infectious and infectious. Infective myositis may be due to a wide variety of pathogens, including bacteria, fungi, viruses, and parasites. A brief account of the various pathogens causing infective myositis is discussed.
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Affiliation(s)
- Gayathri Narayanappa
- Department of NeuropathologyNational Institute of Mental Health and NeurosciencesBangaloreIndia
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22
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A Comparison of the Epidemiology, Clinical Features, and Treatment of Acute Osteomyelitis in Hospitalized Children in Latvia and Norway. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57010036. [PMID: 33406590 PMCID: PMC7824191 DOI: 10.3390/medicina57010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/16/2020] [Accepted: 12/30/2020] [Indexed: 02/06/2023]
Abstract
Background and objectives: Paediatric acute osteomyelitis (AO) may result in major life-threatening and limb-threatening complications if not recognized and treated early. The management of AO may depend on local microbial prevalence and virulence factors. This study compares the approach to paediatric AO in hospitals in two countries—Latvia and Norway. Materials and Methods: The study includes patients with AO hospitalized in the paediatric department in the Norwegian hospital Sørlandet Sykehus Kristiansand (SSK), in the period between the 1st of January 2012 and the 31st of December 2019. The results from SSK are compared to the results of a published study of AO in patients hospitalized at the Children’s Clinical University Hospital (CCUH) in Riga, Latvia. Results: The most isolated pathogen from cultures in both hospitals was S. aureus (methicillin-sensitive). The lower extremity was the most affected body part (75% in CCUH, 95% in SSK), the main clinical symptom was pain (CCUH 92%, SSK 96.6%). Deep culture aspiration was most often taken intraoperatively in CCUH (76.6%) and percutaneously in SSK (44.8%). Oxacillin was the most applied antibiotic in CCUH (89.4%), and Cloxacillin in SSK (84.6%). Combined treatment with anti-Staphylococcal penicillins and Clindamycin was administered in 25.5% and 33.8% of CCUH and SSK patients, respectively. The median duration of the intravenous antibacterial treatment in CCUH and SSK was 15 and 10 days, respectively, and a switch to oral therapy was mainly made at discharge in both hospitals. The median total duration of antibiotic treatment was 25 days in CCUH and 35 days in SSK. 75% of CCUH and 10.3% of SSK patients were treated surgically. Complications were seen in 47% of patients in CCUH and in 38% in SSK. Conclusions: The transition to oral antibacterial treatment in both hospitals was delayed, which suggests a lack of criteria for discontinuation of intravenous therapy and could potentially contribute to longer hospitalization, higher cost of treatment and risk of complications. The use of more invasive techniques for deep culturing and significantly more common surgical interventions could possibly be linked to a higher complication rate in AO patients treated at the Latvian hospital.
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23
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McNeil JC. Acute Hematogenous Osteomyelitis in Children: Clinical Presentation and Management. Infect Drug Resist 2020; 13:4459-4473. [PMID: 33364793 PMCID: PMC7751737 DOI: 10.2147/idr.s257517] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/01/2020] [Indexed: 12/16/2022] Open
Abstract
Acute hematogenous osteomyelitis (AHO) is a common invasive infection encountered in the pediatric population. In addition to the acute illness, AHO has the potential to create long-term morbidity and functional limitations. While a number of pathogens may cause AHO, Staphylococcus aureus is the most common organism identified. Despite the frequency of this illness, little high-quality data exist to guide providers in the care of these patients. The literature is reviewed regarding the epidemiology, microbiology and management of AHO in children. A framework for empiric therapy is provided drawing from the available literature and published guidelines.
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Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA
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24
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Sahukhal GS, Tucci M, Benghuzzi H, Wilson G, Elasri MO. The role of the msaABCR operon in implant-associated chronic osteomyelitis in Staphylococcus aureus USA300 LAC. BMC Microbiol 2020; 20:324. [PMID: 33109085 PMCID: PMC7590495 DOI: 10.1186/s12866-020-01964-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 09/02/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The msaABCR operon regulates several staphylococcal phenotypes such as biofilm formation, capsule production, protease production, pigmentation, antibiotic resistance, and persister cells formation. The msaABCR operon is required for maintaining the cell wall integrity via affecting peptidoglycan cross-linking. The msaABCR operon also plays a role in oxidative stress defense mechanism, which is required to facilitate persistent and recurrent staphylococcal infections. Staphylococcus aureus is the most frequent cause of chronic implant-associated osteomyelitis (OM). The CA-MRSA USA300 strains are predominant in the United States and cause severe infections, including bone and joint infections. RESULTS The USA300 LAC strain caused significant bone damage, as evidenced by the presence of severe bone necrosis with multiple foci of sequestra and large numbers of multinucleated osteoclasts. Intraosseous survival and biofilm formation on the K-wires by USA300 LAC strains was pronounced. However, the msaABCR deletion mutant was attenuated. We observed minimal bone necrosis, with no evidence of intramedullary abscess and/or fibrosis, along reduced intraosseous bacterial population and significantly less biofilm formation on the K-wires by the msaABCR mutant. microCT analysis of infected bone showed significant bone loss and damage in the USA300 LAC and complemented strain, whereas the msaABCR mutant's effect was reduced. In addition, we observed increased osteoblasts response and new bone formation around the K-wires in the bone infected by the msaABCR mutant. Whole-cell proteomics analysis of msaABCR mutant cells showed significant downregulation of proteins, cell adhesion factors, and virulence factors that interact with osteoblasts and are associated with chronic OM caused by S. aureus. CONCLUSION This study showed that deletion of msaABCR operon in USA300 LAC strain lead to defective biofilm in K-wire implants, decreased intraosseous survival, and reduced cortical bone destruction. Thus, msaABCR plays a role in implant-associated chronic osteomyelitis by regulating extracellular proteases, cell adhesions factors and virulence factors. However additional studies are required to further define the contribution of msaABCR-regulated molecules in osteomyelitis pathogenesis.
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Affiliation(s)
- Gyan S Sahukhal
- Present Address: Center for Molecular and Cellular Biosciences, The University of Southern Mississippi, 118 College Drive # 5018, Hattiesburg, MS, 39406, USA.
| | - Michelle Tucci
- Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hamed Benghuzzi
- Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Gerri Wilson
- Department of Orthopaedics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamed O Elasri
- Present Address: Center for Molecular and Cellular Biosciences, The University of Southern Mississippi, 118 College Drive # 5018, Hattiesburg, MS, 39406, USA
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25
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Nadau E, Joseph C, Haraux E, Deroussen F, Gouron R, Klein C. Clinical features and outcomes in children with bone and joint infections of the ankle or foot. Arch Pediatr 2020; 27:464-468. [PMID: 33011034 DOI: 10.1016/j.arcped.2020.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/11/2020] [Accepted: 08/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The foot and ankle are uncommon sites of bone and joint infections (BJIs) in children. The objectives of the present study were to determine the clinical and bacteriologic features of BJIs and to assess any associated complications and orthopedic sequelae. METHODS We performed a retrospective, single-center study of children treated for foot or ankle BJIs between 2008 and 2018 in a French university medical center. A total of 23 children were included. The median age at diagnosis was 9.1 years. Osteomyelitis was noted in 14 cases; it involved the calcaneus in seven cases, the distal fibula in four cases, the first metatarsal in two cases, and the distal tibia in one case. Arthritis affected the ankle in six cases and the cuneiform-cuboidal joint in one case. In two cases, osteoarthritis of the ankle was associated with distal osteomyelitis of the tibia. Clinical, radiological, and bacteriological parameters, surgical procedures, complications, and sequelae were recorded and analyzed. RESULTS The median (range) time to diagnosis was 3.18 days (0-10), and trauma was reported in four cases. Fever was present on admission in 18 cases, and the serum C-reactive protein level was elevated in 22 cases. Standard X-rays showed osteolysis in one case and bone sequestration in another. Staphylococcusaureus was identified in 10 cases. Surgery was performed in 17 cases. A subperiosteal abscess that required surgical drainage complicated 10 cases of osteomyelitis. No recurrence was observed. At the last follow-up, the median (range) age was 11.9 years (1.5-19). Sequelae (spontaneous tibia-talus fusion, first metatarsal epiphysis fusion, and varus deformity of the hindfoot) were observed in three cases, all of which were initially complicated by an abscess. CONCLUSION Physicians should be aware that pediatric BJIs of the lower limb may involve the foot and ankle. S. aureus is frequently involved. In cases of osteomyelitis, complications are closely associated with subperiosteal abscesses justifying an early diagnosis. These BJIs must be treated rapidly, and the risk of sequelae justifies long-term follow-up.
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Affiliation(s)
- E Nadau
- Department of pediatric orthopedics, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France
| | - C Joseph
- Department of infectious disease, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France; AGIR group, microbiology research unit, EA4294, Jules-Verne university of Picardie, 80054 Amiens cedex 1, France
| | - E Haraux
- Department of pediatric orthopedics, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France
| | - F Deroussen
- Department of pediatric orthopedics, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France
| | - R Gouron
- Department of pediatric orthopedics, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France
| | - C Klein
- Department of pediatric orthopedics, Jules-Verne university of Picardie and Amiens Picardie university medical center, 80054 Amiens cedex 1, France.
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Huang J, Zhang T, Zou X, Wu S, Zhu J. Panton-valentine leucocidin carrying Staphylococcus aureus causing necrotizing pneumonia inactivates the JAK/STAT signaling pathway and increases the expression of inflammatory cytokines. INFECTION GENETICS AND EVOLUTION 2020; 86:104582. [PMID: 33017689 DOI: 10.1016/j.meegid.2020.104582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/13/2020] [Accepted: 10/01/2020] [Indexed: 11/17/2022]
Abstract
PURPOSE Methicillin-resistant Staphylococcus aureus (MRSA) carrying Panton-Valentine leukocidin, a pore-forming toxin, is a common cause of necrotizing pneumonia. However, the early pulmonary inflammatory response following PVL(+) MRSA infection is unknown. The purpose of this study was to use a murine model to determine the effect of PVL(+) MRSA on lung tissues and the expression of cytokines and JAK and STAT mRNA and protein. METHODS Mice were randomly divided into 3 groups and intra-nasally treated with PBS (control group), recombinant PVL (rPVL group), and PVL(+) MRSA (PVL group). At 24 and 48 h after inoculation, bronchoalveolar lavage fluid (BALF) was tested for cytokine levels, and lung tissues were tested for JAK and STAT mRNA and protein expression, and examined after hematoxylin and eosin staining. RESULTS Mice infected with the PVL(+) strain became ill, characterized by impaired mobility, hunched posture, ruffled fur, and labored breathing. Lung tissue exhibited tissue necrosis and hemorrhage. BALF levels of IL-8, TNF-α, IFN-γ, IL-12, sICAM-1, and sVCAM-1 were increased in the rPVL or PVL groups, while levels of IL-10 and IL-4 levels were similar among the groups. JAK1 and STAT1 mRNA expression and protein levels were increased in lung tissue from mice infected with PVL(+) MRSA and rPVL. CONCLUSIONS PVL is a significant S. aureus virulence factor, and upregulates the expression of proinflammatory cytokines but does not affect the expression of anti-inflammatory cytokines. The effect of PVL may be due to JAK/STAT pathway activation. Blockade of the JAK/STAT pathway may decrease the severity of PVL(+) MRSA pneumonia.
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Affiliation(s)
- Jing Huang
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China.
| | - Tiantuo Zhang
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
| | - Xiaoling Zou
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
| | - Shaozhu Wu
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
| | - Jiaxin Zhu
- Department of Pulmonary and Critical Care Medicine, the Third Affiliated Hospital of Sun Yat-Sen University, No. 600 Tianhe Road, Guangzhou, Guangdong, China
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27
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Miller LS, Fowler VG, Shukla SK, Rose WE, Proctor RA. Development of a vaccine against Staphylococcus aureus invasive infections: Evidence based on human immunity, genetics and bacterial evasion mechanisms. FEMS Microbiol Rev 2020; 44:123-153. [PMID: 31841134 PMCID: PMC7053580 DOI: 10.1093/femsre/fuz030] [Citation(s) in RCA: 144] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/13/2019] [Indexed: 12/12/2022] Open
Abstract
Invasive Staphylococcus aureus infections are a leading cause of morbidity and mortality in both hospital and community settings, especially with the widespread emergence of virulent and multi-drug resistant methicillin-resistant S. aureus strains. There is an urgent and unmet clinical need for non-antibiotic immune-based approaches to treat these infections as the increasing antibiotic resistance is creating a serious threat to public health. However, all vaccination attempts aimed at preventing S. aureus invasive infections have failed in human trials, especially all vaccines aimed at generating high titers of opsonic antibodies against S. aureus surface antigens to facilitate antibody-mediated bacterial clearance. In this review, we summarize the data from humans regarding the immune responses that protect against invasive S. aureus infections as well as host genetic factors and bacterial evasion mechanisms, which are important to consider for the future development of effective and successful vaccines and immunotherapies against invasive S. aureus infections in humans. The evidence presented form the basis for a hypothesis that staphylococcal toxins (including superantigens and pore-forming toxins) are important virulence factors, and targeting the neutralization of these toxins are more likely to provide a therapeutic benefit in contrast to prior vaccine attempts to generate antibodies to facilitate opsonophagocytosis.
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Affiliation(s)
- Lloyd S Miller
- Immunology, Janssen Research and Development, 1400 McKean Road, Spring House, PA, 19477, USA.,Department of Dermatology, Johns Hopkins University School of Medicine, 1550 Orleans Street, Cancer Research Building 2, Suite 209, Baltimore, MD, 21231, USA.,Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA.,Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD, 21287, USA.,Department of Materials Science and Engineering, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD, 21218, USA
| | - Vance G Fowler
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, 315 Trent Drive, Hanes House, Durham, NC, 27710, USA.,Duke Clinical Research Institute, Duke University Medical Center, 40 Duke Medicine Circle, Durham, NC, 27710, USA
| | - Sanjay K Shukla
- Center for Precision Medicine Research, Marshfield Clinic Research Institute, 1000 North Oak Avenue, Marshfield, WI, 54449, USA.,Computation and Informatics in Biology and Medicine, University of Wisconsin, 425 Henry Mall, Room 3445, Madison, WI, 53706, USA
| | - Warren E Rose
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,Pharmacy Practice Division, University of Wisconsin-Madison, 777 Highland Avenue, 4123 Rennebohm Hall, Madison, WI, 53705 USA
| | - Richard A Proctor
- Department of Medicine, University of Wisconsin-Madison School of Medicine and Public Health, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, USA.,Department of Medical Microbiology and Immunology, University of Wisconsin-Madison School of Medicine and Public Health, 1550 Linden Drive, Microbial Sciences Building, Room 1334, Madison, WI, 53705, USA
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28
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McNeil JC, Vallejo JG, Kok EY, Sommer LM, Hultén KG, Kaplan SL. Clinical and Microbiologic Variables Predictive of Orthopedic Complications Following Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children. Clin Infect Dis 2020; 69:1955-1961. [PMID: 30753346 DOI: 10.1093/cid/ciz109] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/31/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Staphylococcus aureus is the most common cause of acute hematogenous osteoarticular infections (AHOAIs) in children. The risk factors for the development of orthopedic complications (OC) after AHOAI are poorly understood. We sought to describe clinical and microbiologic variables present on the index admission that may predict OC in S. aureus AHOAI. METHODS Staphylococcus aureus AHOAI cases were identified from 2011-2017 at Texas Children's Hospital and reviewed for the development of OC. OC included chronic osteomyelitis, growth arrest, avascular necrosis, chronic dislocation, and pathologic fracture. All S. aureus isolates were characterized by pulsed-field gel electrophoresis and agr group. RESULTS A total of 286 cases were examined of which 27 patients (9.4%) developed OC. Patients who developed OC more often had infection with an agr group III organism (P = .04), bacteremia (P = .04), delayed source control (P < .001), ≥2 surgical procedures (P < .001), intensive care unit admission (P = .09), and fever >4 days after admission (P = .008). There was no association with OC and patient age, methicillin resistance, or choice/route of antibiotics. In multivariable analyses of OC, infection with agr group III S. aureus, prolonged fever, and delayed source control remained statistically significant. CONCLUSIONS OC develop following S. aureus AHOAI in 9.4% of cases. Although the development of OC is likely multifactorial, agr group III organisms, prolonged fever, and delayed source control are independently associated with OC. Moreover, early aggressive surgical source control may be beneficial in children with S. aureus AHOAI.
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Affiliation(s)
- J Chase McNeil
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Jesus G Vallejo
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Eric Y Kok
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Lauren M Sommer
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Kristina G Hultén
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Sheldon L Kaplan
- Department of Pediatrics, Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas
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Abstract
BACKGROUND We prospectively evaluated efficacy and safety of daptomycin versus active comparator in children with acute hematogenous osteomyelitis (AHO). METHODS Randomized, controlled, double-blind, global, multicenter, phase 3 trial. Patients 1-17 years of age with suspected/confirmed AHO requiring hospitalization and intravenous therapy were randomized 1:1 to intravenous daptomycin (once-daily, age-adjusted doses) or comparator (vancomycin, nafcillin or equivalent) ≥4 days, followed by oral therapy (14-42 days total). Primary endpoint: protocol-defined clinical improvement by Day 5 in the modified intention-to-treat (MITT) population (confirmed AHO, ≥1 dose of study treatment); differences between study arms were evaluated using a prespecified 15% noninferiority margin for daptomycin. RESULTS Seventy-three patients per arm received treatment. Pathogens were isolated from 62% of patients (83% methicillin-susceptible Staphylococcus aureus, 9% methicillin-resistant S. aureus [MRSA]). Clinical improvement by Day 5 was observed in 55/71 (78%) daptomycin- and 58/70 (83%) comparator-treated MITT patients (95% confidence interval [CI]: -19.4, 7.4). This difference was not statistically significant; however, daptomycin did not meet the prespecified 15% noninferiority margin, since the lower bound of the 95% CI extended below 15%. Overall, 82% of daptomycin and 87% of comparator patients achieved clinical cure at the test-of-cure visit (secondary endpoint). More comparator patients had treatment-emergent (63% vs. 46%) and treatment-related (18% vs. 7%) adverse events. CONCLUSIONS Differences between daptomycin and comparator for the primary endpoint were not statistically significant; however, prespecified noninferiority criteria for daptomycin were not met. With insufficient cases of confirmed MRSA, we could not evaluate daptomycin for MRSA AHO. Our nonvalidated protocol design yields valuable information for implementing future trials in AHO (ClinicalTrials.gov NCT01922011).
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30
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A comprehensive review of bacterial osteomyelitis with emphasis on Staphylococcus aureus. Microb Pathog 2020; 148:104431. [PMID: 32801004 DOI: 10.1016/j.micpath.2020.104431] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 02/04/2023]
Abstract
Osteomyelitis, a significant infection of bone tissue, gives rise to two main groups of infection: acute and chronic. These groups are further categorized in terms of the duration of infection. Usually, children and adults are more susceptible to acute and chronic infections, respectively. The aforementioned groups of osteomyelitis share almost 80% of the corresponding bacterial pathogens. Among all bacteria, Staphylococcus aureus (S. aureus) is a significant pathogen and is associated with a high range of osteomyelitis symptoms. S. aureus has many strategies for interacting with host cells including Small Colony Variant (SCV), biofilm formation, and toxin secretion. In addition, it induces an inflammatory response and causes host cell death by apoptosis and necrosis. However, any possible step to take in this respect is dependent on the conditions and host responses. In the absence of any immune responses and antibiotics, bacteria actively duplicate themselves; however, in the presence of phagocytic cell and harassing conditions, they turn into a SCV, remaining sustainable for a long time. SCV is characterized by notable advantages such as (a) intracellular life that mediates a dam against immune cells and (b) low ATP production that mediates resistance against antibiotics.
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31
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Jalali O, Best M, Wong A, Schaeffer B, Bauer B, Johnson L. Protocatechuic Acid as a Topical Antimicrobial for Surgical Skin Antisepsis: Preclinical Investigations. JB JS Open Access 2020; 5:JBJSOA-D-19-00079. [PMID: 32803102 PMCID: PMC7386545 DOI: 10.2106/jbjs.oa.19.00079] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background There is a need for novel skin antiseptic agents to combat the health-care burdens associated with surgical site infection (SSI) and bacterial resistance. The purpose of this proof-of-principle pilot study was to investigate the potential of the phenolic compound protocatechuic acid (PCA) as a topical antimicrobial for surgical skin antisepsis. Methods The Kirby-Bauer method of disc diffusion was used to investigate the in vitro antimicrobial activity and comparative effectiveness of PCA and 7 related compounds against SSI pathogens. To explore the in vivo efficacy of topical PCA for providing deep, penetrating skin antisepsis, living Cutibacterium acnes was intradermally injected into the skin of female BALB/c mice. Mice were assigned to treatment with daily applications of topical PCA at 3 doses (78, 39, and 19.5 mM) or no treatment (n = 2 mice per group). After 96 hours, infected skin samples were harvested to compare mean C. acnes counts by treatment. Results Compared with other polyphenols, PCA demonstrated the broadest spectrum of antimicrobial activity against tested SSI pathogens, including drug-resistant organisms. At 96 hours following infection, the mean C. acnes burden in untreated mice was 6.65 log colony-forming units (CFUs) per gram of skin. Compared with the untreated group, daily topical application of 78 mM of PCA was associated with a significantly lower C. acnes CFU burden in mice skin (mean, 5.51 log CFUs per gram of skin; p = 0.0295). Both lower dosages of topical PCA failed to show an effect. Conclusions PCA demonstrated laboratory efficacy against pathogens implicated in SSI, including drug-resistant organisms. In vivo, topical PCA demonstrated dose-dependent skin penetration and antimicrobial activity against mouse skin C. acnes loads. Human clinical studies exploring the antimicrobial efficacy of topical PCA for preoperative shoulder skin antisepsis are warranted. Clinical Relevance Topical PCA may have the potential to improve current shoulder SSI treatment and prevention protocols.
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Affiliation(s)
- Omid Jalali
- Keck School of Medicine of USC, Los Angeles, California
| | - Molly Best
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Alison Wong
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Brett Schaeffer
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Brendon Bauer
- Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
| | - Lanny Johnson
- Keck School of Medicine of USC, Los Angeles, California.,Loma Linda Department of Orthopedics (M.B.) and Loma Linda University School of Medicine (A.W., B.S., and B.B.), Loma Linda, California
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32
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Pediatric Community-Acquired Bone and Joint Staphylococcus Aureus Infections In Europe: Severe Infections are Associated to Panton-Valentine Leucocidin Presence. Pediatr Infect Dis J 2020; 39:e73-e76. [PMID: 32221170 DOI: 10.1097/inf.0000000000002640] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
To analyze host and pathogen factors related to disease severity of community-acquired bone and joint infections in children, a cohort of pediatric patients was prospectively recruited from 13 centers in 7 European countries. A total of 85 children were included, 11 (13%) had a severe infection. Panton-Valentine leukocidin-positive isolates were 17%, and 6% of the isolates were methicillin-resistant Staphylococcus aureus. Multivariate analysis identified Panton-Valentine leukocidin presence (adjusted odds ratio, 12.6; P = 0.01) as the only factor independently associated with severe outcome, regardless of methicillin resistance.
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Kalita M, Parker MFL, Luu JM, Stewart MN, Blecha JE, VanBrocklin HF, Evans M, Flavell RR, Rosenberg OS, Ohliger MA, Wilson DM. Arabinofuranose-derived positron-emission tomography radiotracers for detection of pathogenic microorganisms. J Labelled Comp Radiopharm 2020; 63:231-239. [PMID: 32222086 PMCID: PMC7364301 DOI: 10.1002/jlcr.3835] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/06/2020] [Accepted: 02/26/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Detection of bacteria-specific metabolism via positron emission tomography (PET) is an emerging strategy to image human pathogens, with dramatic implications for clinical practice. In silico and in vitro screening tools have recently been applied to this problem, with several monosaccharides including l-arabinose showing rapid accumulation in Escherichia coli and other organisms. Our goal for this study was to evaluate several synthetically viable arabinofuranose-derived 18 F analogs for their incorporation into pathogenic bacteria. PROCEDURES We synthesized four radiolabeled arabinofuranose-derived sugars: 2-deoxy-2-[18 F]fluoro-arabinofuranoses (d-2-18 F-AF and l-2-18 F-AF) and 5-deoxy-5-[18 F]fluoro-arabinofuranoses (d-5-18 F-AF and l-5-18 F-AF). The arabinofuranoses were synthesized from 18 F- via triflated, peracetylated precursors analogous to the most common radiosynthesis of 2-deoxy-2-[18 F]fluoro-d-glucose ([18 F]FDG). These radiotracers were screened for their uptake into E. coli and Staphylococcus aureus. Subsequently, the sensitivity of d-2-18 F-AF and l-2-18 F-AF to key human pathogens was investigated in vitro. RESULTS All 18 F radiotracer targets were synthesized in high radiochemical purity. In the screening study, d-2-18 F-AF and l-2-18 F-AF showed greater accumulation in E. coli than in S. aureus. When evaluated in a panel of pathologic microorganisms, both d-2-18 F-AF and l-2-18 F-AF demonstrated sensitivity to most gram-positive and gram-negative bacteria. CONCLUSIONS Arabinofuranose-derived 18 F PET radiotracers can be synthesized with high radiochemical purity. Our study showed absence of bacterial accumulation for 5-substitued analogs, a finding that may have mechanistic implications for related tracers. Both d-2-18 F-AF and l-2-18 F-AF showed sensitivity to most gram-negative and gram-positive organisms. Future in vivo studies will evaluate the diagnostic accuracy of these radiotracers in animal models of infection.
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Affiliation(s)
- Mausam Kalita
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Matthew F. L. Parker
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Justin M. Luu
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Megan N. Stewart
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Joseph E. Blecha
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Henry F. VanBrocklin
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Michael Evans
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Robert R. Flavell
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Oren S. Rosenberg
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94158, USA
| | - Michael A. Ohliger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
- Department of Radiology, Zuckerberg San Francisco General Hospital, San Francisco, CA 94110, USA
| | - David M. Wilson
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA 94158, USA
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Weiss L, Lansell A, Figueroa J, Suchdev PS, Kirpalani A. Declining Prevalence of Methicillin-Resistant Staphylococcus aureus Septic Arthritis and Osteomyelitis in Children: Implications for Treatment. Antibiotics (Basel) 2020; 9:E101. [PMID: 32121093 PMCID: PMC7148457 DOI: 10.3390/antibiotics9030101] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/01/2023] Open
Abstract
This study sought to assess clinical characteristics and differences in outcomes between children with Methicillin-resistant Staphylococcus aureus (MRSA) and Methicillin-sensitive Staphylococcus aureus (MSSA) osteomyelitis or septic arthritis and whether initial antibiotic regimen affects patient outcomes. We analyzed records of children ages 15 days to 18 years admitted between 2009 and 2016 to two tertiary children's hospitals who were diagnosed with an osteoarticular infection and had a microorganism identified. A total of 584 patients met inclusion criteria, of which 365 (62.5%) had a microbiological diagnosis. MSSA was the most common pathogen identified (45.5%), followed by MRSA (31.2%). Compared to MSSA, patients with MRSA had a higher initial C-reactive protein and longer hospitalization. Patients whose initial antibiotic regimens included vancomycin had a longer hospitalization than those initiated on clindamycin without vancomycin, even after removing sicker patients admitted to the pediatric intensive care unit. While MRSA was associated with increased severity of osteoarticular infections compared to MSSA, the incidence of MRSA has been declining at our institution. Patients with longer lengths of stay were more likely to be on vancomycin. Clindamycin should be considered in the initial antibiotic regimen for osteomyelitis and septic arthritis with ongoing surveillance of local microbiology and outcomes.
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Affiliation(s)
- Lindsay Weiss
- Division of Hospital Medicine, Joe DiMaggio Children’s Hospital, Hollywood, FL 33021, USA;
| | - Amanda Lansell
- Pediatric Hospital Medicine, Rainbow Babies & Children’s Hospital, Cleveland, OH 44106, USA;
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (J.F.); (P.S.S.)
| | - Parminder S. Suchdev
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (J.F.); (P.S.S.)
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Anjali Kirpalani
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA 30322, USA; (J.F.); (P.S.S.)
- Division of Hospital Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA
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35
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Fusco NM, Nichols K. Common bacterial infections and their treatment in hospitalized pediatric patients. Am J Health Syst Pharm 2020; 76:1521-1531. [PMID: 31532502 DOI: 10.1093/ajhp/zxz164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Common bacterial infections in pediatric patients that the hospital pharmacist may encounter are reviewed, and guidance on the safe and effective use of antibiotics to treat those infections is provided. SUMMARY Pharmacists play a key role in evaluating and creating antibiotic treatment plans for patients with infections. Bacterial infections are a common reason for hospital admission in pediatric patients, and pharmacists working in hospitals may be consulted to provide treatment and monitoring recommendations. It is important for pharmacists to be aware of similarities and differences in adult and pediatric populations with regard to presenting signs and symptoms of bacterial infections, common causative pathogens, and antibiotic selection, dosing, and monitoring. This article reviews current approaches to treatment of common bacterial infections in pediatric patients and also provides general suggestions for antibiotic use. CONCLUSION Pharmacists have an opportunity to positively impact the care of pediatric patients with bacterial infections. Especially at facilities where pediatric patients are not regularly treated, pharmacists can potentially improve care through provision of recommendations for optimal antibiotic selection, dosing, and monitoring.
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Affiliation(s)
- Nicholas M Fusco
- Department of Pharmacy Practice, University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY
| | - Kristen Nichols
- Butler University College of Pharmacy and Health Sciences, Indianapolis, IN
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Characterisation of community-acquired Staphylococcus aureus causing skin and soft tissue infections in a children's hospital in Shanghai, China. Epidemiol Infect 2019; 147:e323. [PMID: 31831085 PMCID: PMC7006014 DOI: 10.1017/s0950268819002127] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Community-acquired Staphylococcus aureus is a major pathogen responsible for skin and soft tissue infections (SSTIs). This study aimed to investigate the prevalence and molecular characteristics of community-acquired S. aureus isolates recovered from paediatric patients with SSTIs in Shanghai, China. Between January 2015 and January 2018, 91 community-acquired S. aureus isolates were characterised by antibiotic susceptibility, multilocus sequence typing (ST), staphylococcal protein A gene (spa) type and virulence genes. Methicillin-resistant S. aureus (MRSA) strains were also characterised by staphylococcal cassette chromosome mec (SCCmec) type. Forty-one (45.1%) S. aureus isolates were MRSA. ST59 (33.0%, 30/91) was the most common sequence type, and t437 (18.7%, 17/91) was the most common spa type. SCCmec IV and V accounted for 61.0% and 34.1% of all MRSA isolates, respectively. Each isolate carried at least six virulence genes. The positive rates of Panton-Valentine leukocidin genes among all S. aureus, MRSA and methicillin-susceptible S. aureus isolates were 30.8% (28/91), 39.0% (16/41) and 24% (12/50), respectively. The prevalence of community-associated MRSA was surprisingly high among children with community-acquired SSTIs in Shanghai. ST59-t437 was the most prevalent community-acquired S. aureus clone causing SSTIs.
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Hoppe PA, Holzhauer S, Lala B, Bührer C, Gratopp A, Hanitsch LG, Humme D, Kieslich M, Kallinich T, Lau S, Leistner R, Niebank M, Pokrywka A, Ringe H, Schaper AS, Schröder JT, Schwarz C, Staab D, Stegemann MS, Thee S, Varnholt V, von Bernuth H, Weber-Carstens S, Wendt A, Krüger R. Severe infections of Panton-Valentine leukocidin positive Staphylococcus aureus in children. Medicine (Baltimore) 2019; 98:e17185. [PMID: 31567961 PMCID: PMC6756729 DOI: 10.1097/md.0000000000017185] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Infections caused by Panton-Valentine leukocidin-positive Staphylococcus aureus (PVL-SA) mostly present as recurrent skin abscesses and furunculosis. However, life-threatening infections (eg, necrotizing pneumonia, necrotizing fasciitis, and osteomyelitis) caused by PVL-SA have also been reported.We assessed the clinical phenotype, frequency, clinical implications (surgery, length of treatment in hospitals/intensive care units, and antibiotic treatments), and potential preventability of severe PVL-SA infections in children.Total, 75 children treated for PVL-SA infections in our in- and outpatient units from 2012 to 2017 were included in this retrospective study.Ten out of 75 children contracted severe infections (PVL-methicillin resistant S aureus n = 4) including necrotizing pneumonia (n = 4), necrotizing fasciitis (n = 2), pyomyositis (n = 2; including 1 patient who also had pneumonia), mastoiditis with cerebellitis (n = 1), preorbital cellulitis (n = 1), and recurrent deep furunculosis in an immunosuppressed patient (n = 1). Specific complications of PVL-SA infections were venous thrombosis (n = 2), sepsis (n = 5), respiratory failure (n = 5), and acute respiratory distress syndrome (n = 3). The median duration of hospital stay was 14 days (range 5-52 days). In 6 out of 10 patients a history suggestive for PVL-SA colonization in the patient or close family members before hospital admission was identified.PVL-SA causes severe to life-threatening infections requiring lengthy treatments in hospital in a substantial percentage of symptomatic PVL-SA colonized children. More than 50% of severe infections might be prevented by prompt testing for PVL-SA in individuals with a history of abscesses or furunculosis, followed by decolonization measures.
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Affiliation(s)
- Pia-Alice Hoppe
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | | | | | | | - Daniel Humme
- Department of Dermatology, Venerology and Allergy
| | | | | | - Susanne Lau
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | | | - Hannelore Ringe
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | | | - Carsten Schwarz
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Doris Staab
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | | | - Stephanie Thee
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Verena Varnholt
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Horst von Bernuth
- Department of Pediatric Pneumology, Immunology and Intensive Care
- Department of Immunology, Labor Berlin Charité-Vivantes GmbH
- Berlin-Brandenburg Center for Regenerative Therapies
| | - Steffen Weber-Carstens
- Department of Anesthesiology and Operative Intensive Care Medicine Campus Mitte and Campus-Virchow Klinikum, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Anke Wendt
- Department of Pediatric Pneumology, Immunology and Intensive Care
| | - Renate Krüger
- Department of Pediatric Pneumology, Immunology and Intensive Care
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Ogata H, Nagasawa K, Takeuchi N, Hagiwara S, Sawada D, Umimura T, Konno Y, Yamaide F, Takatani R, Takatani T, Nakano T, Hishiki H, Ishiwada N, Shimojo N. Psoitis and multiple venous thromboses caused by Panton Valentine Leukocidin-positive methicillin-sensitive Staphylococcus aureus in a 12-year-old girl: A case report. J Infect Chemother 2019; 25:630-634. [PMID: 30902556 DOI: 10.1016/j.jiac.2019.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/16/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022]
Abstract
Panton Valentine Leukocidin (PVL) is one of the many toxins produced by Staphylococcus aureus. In Japan, PVL-positive S. aureus strains are mainly methicillin-resistant S. aureus (MRSA). Data regarding PVL-positive methicillin-sensitive S. aureus (MSSA) are scarce. In this report, we describe a case of severe infection by PVL-positive MSSA. A 12-year-old healthy girl was admitted with high fever and pain in the lower back. Computed tomography revealed a diagnosis of psoitis and multiple venous thromboses. Blood cultures obtained after admission revealed infection with MSSA. Her fever continued despite adequate antibiotic therapy. On the fifth hospitalization day, she developed bladder dysfunction, and an abscess was noted near the third lumbar vertebra. She underwent an emergency operation and recovered. Bacterial analyses revealed that the causative MSSA was a PVL-producing single variant of ST8 (related to USA300clone), of sequence type 2149. PVL is known to cause platelet activation. This case demonstrates the need for detailed analyses of the causative strain of bacteria in cases of S. aureus infection with deep vein thrombosis, even in cases of known MSSA infection.
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Affiliation(s)
- Hitoshi Ogata
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Koo Nagasawa
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan.
| | | | - Sho Hagiwara
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Daisuke Sawada
- Department of Pediatrics, Kimitsu Central Hospital, Japan
| | - Tomotaka Umimura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Japan
| | - Yuki Konno
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Fumiya Yamaide
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Rieko Takatani
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Tomozumi Takatani
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Taiji Nakano
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | - Haruka Hishiki
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
| | | | - Naoki Shimojo
- Department of Pediatrics, Graduate School of Medicine, Chiba University, Japan
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Association of infections and venous thromboembolism in hospitalized children with nephrotic syndrome. Pediatr Nephrol 2019; 34:261-267. [PMID: 30194664 PMCID: PMC6628263 DOI: 10.1007/s00467-018-4072-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 08/07/2018] [Accepted: 08/24/2018] [Indexed: 01/07/2023]
Abstract
BACKGROUND Nephrotic syndrome (NS) results in hypercoagulability and increased risk of infection. Furthermore, infection increases the risk of venous thromboembolism (VTE). Our objective was to determine the prevalence of infection, VTE, and the associated outcomes among a cohort of hospitalized children with NS. METHODS All children with NS admitted to 17 pediatric hospitals across North America from 2010 to 2012 were included. Prevalence of infection and VTE was determined. Wilcoxon rank-sum and logistic regression were performed. RESULTS Seven-hundred thirty hospitalizations occurred among 370 children with NS. One-hundred forty-eight children (40%) had ≥ 1 infection (211 episodes) and 11 (3%) had VTE. Those with VTE had infection more frequently (p = 0.046) and were younger at NS diagnosis (3.0 vs. 4.0 years; p = 0.008). The most common infectious pathogen identified was Streptococcus pneumoniae. The median hospital length of stay for those with infection [10 vs 5 days (p < 0.0001)] or VTE [22 vs 6 days (p < 0.0001)] was longer than those without either complication. Of those with infection, 13% had an intensive care unit (ICU) stay compared with 3.3% of those without infection. Median ICU stay was 4 days in those with VTE compared to 0 days in those without (p < 0.001). By logistic regression, only the number of ICU days was associated with VTE (OR 1.074, 95% CI 1.013-1.138). CONCLUSIONS Hospitalized children with NS have high rates of infection. Presence of VTE was associated with infection. Both were associated with longer hospitalizations and ICU stays.
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Validation and Modification of a Severity of Illness Score for Children With Acute Hematogenous Osteomyelitis. J Pediatr Orthop 2019; 39:90-97. [PMID: 27741035 DOI: 10.1097/bpo.0000000000000879] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Children with osteomyelitis demonstrate a wide spectrum of illness. Objective measurement of severity is important to guide resource allocation and treatment decisions, particularly for children with advanced illness. The purpose of this study is to validate and improve a previously published severity of illness scoring system for children with acute hematogenous osteomyelitis (AHO). METHODS Children with AHO were prospectively studied during evaluation and treatment by a multidisciplinary team who provided care according to evidence-based guidelines to reduce variation. A severity of illness score was calculated for each child and correlated with surrogate measures of severity. Univariate analysis was used to assess the significance of each parameter within the scoring model along with new parameters, which were evaluated to improve the model. The scoring system was then modified by the addition of band count to replace respiratory rate. The modified score was calculated and applied to the prospective cohort followed by correlation with the surrogate measures of severity. RESULTS One hundred forty-eight children with AHO were consecutively studied. The original severity of illness score correlated well with length of stay and other established measures of severity. Band percent of the white blood cell differential ≥1.5% was found to be significantly associated with severity and chosen to replace respiratory rate in the model. The modified calculated severity scores correlated well with the chosen surrogate measures and significantly differentiated children with osteomyelitis on the basis of causative organism, length of stay, intensive care, surgeries, bacteremia, and disseminated or multifocal disease. CONCLUSIONS The findings of this study validate the previously published severity of illness scoring tool in large cohort of children who were prospectively evaluated. The replacement of respiratory rate with band count improved the scoring system.
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Abstract
Background: The epidemiology of acute hematogenous osteomyelitis (AHO) in children has changed. Methods: We reviewed the current literature regarding the epidemiology, microbiology, pathogenesis, clinical presentation, diagnosis, and antimicrobial management of AHO in children. Results: Staphylococcus aureus is the most common microorganism causing pediatric AHO, followed by group A Streptococcus (GAS). AHO due to community-associated methicillin-resistant Staphylococcus aureus (MRSA) can cause severe and complicated disease. Pathogen isolation by culture is key for targeted antibiotic therapy. Polymerase chain reaction assay in tissue sample or joint fluid may enhance the yield of Kingella kingae. C-reactive protein is useful in diagnosis and monitoring the course of AHO. Magnetic resonance imaging is the preferred diagnostic imaging study for AHO. Clindamycin or vancomycin (for serious disease) is recommended for empiric therapy of suspected AHO due to MRSA depending on the geographic prevalence. Penicillinase-stable penicillins or first-generation cephalosporins are preferred antibiotics to treat methicillin-sensitive S aureus (MSSA) infection. Beta-lactam agents are the drugs of choice for treating AHO due to K kingae, GAS, or Streptococcus pneumoniae. For uncomplicated AHO due to MSSA, a short parenteral antibiotic course followed by oral therapy for a minimum total duration of 3-4 weeks is adequate. Complicated AHO due to MRSA may warrant prolonged therapy with surgical intervention. Conclusion: Given the evolution of pathogens, the variability in clinical presentations and course ranging from simple to complex disease, and response to treatment, the management of AHO continues to evolve and warrants an individualized, multidisciplinary approach.
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Affiliation(s)
| | - Avinash K. Shetty
- Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC
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DeRonde KJ, Girotto JE, Nicolau DP. Management of Pediatric Acute Hematogenous Osteomyelitis, Part II: A Focus on Methicillin-Resistant Staphylococcus aureus, Current and Emerging Therapies. Pharmacotherapy 2018; 38:1021-1037. [PMID: 29989190 DOI: 10.1002/phar.2164] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has become the most prevalent cause of acute hematogenous osteomyelitis (AHO) in pediatric patients. This increase in MRSA is due to the rise in community-acquired MRSA. Therefore, it is important that clinicians are aware of the various and upcoming therapies that cover this bacterium. A literature search of the Medline database was performed from creation through January 2018. Articles chosen for the review emphasize well-established MRSA treatment options for pediatric AHO, newer therapies on the horizon, and important pharmacokinetics and pharmacodynamic concepts for treatment. Traditional therapies, including vancomycin and clindamycin, remain effective for the treatment of pediatric AHO. When these agents cannot be used, evidence in AHO has been growing for daptomycin, linezolid, and ceftaroline. Further initial pediatric data with the long-acting lipoglycopeptides show promise and in the future may provide a role in AHO treatment in children.
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Affiliation(s)
- Kailynn J DeRonde
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut.,Department of Pharmacy, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Jennifer E Girotto
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut.,Department of Pharmacy, Connecticut Children's Medical Center, Hartford, Connecticut.,Division of Infectious Diseases and Immunology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut.,Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut
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Comparison of Methicillin-resistant Versus Susceptible Staphylococcus aureus Pediatric Osteomyelitis. J Pediatr Orthop 2018; 38:e285-e291. [PMID: 29462119 DOI: 10.1097/bpo.0000000000001152] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The incidence of methicillin-resistant Staphylococcus aureus (MRSA) pediatric osteomyelitis has risen and been associated with a more severe clinical course than methicillin-susceptible Staphylococcus aureus (MSSA) infections. National databases have been underutilized to describe these trends. We compared demographics, clinical course, and outcomes for patients with MRSA versus MSSA osteomyelitis. METHODS We queried the 2009 and 2012 Healthcare Cost and Utilization Project Kids Inpatient Database for discharge records with diagnosis codes for osteomyelitis and S. aureus. We explored demographics predicting MRSA and evaluated MRSA versus MSSA as predictors of clinical outcomes including surgery, sepsis, thrombophlebitis, length of stay, and total charges. RESULTS A total of 4214 discharge records were included. Of those, 2602 (61.7%) had MSSA and 1612 (38.3%) had MRSA infections. Patients at Southern and Midwestern hospitals were more likely to have MRSA than those at Northeastern hospitals. Medicaid patients' odds of MRSA were higher than those with private insurance, and black patients were more likely to have MRSA compared with white patients. MRSA patients were more likely to undergo multiple surgeries compared with MSSA patients and were more likely to have complications including severe sepsis, thrombophlebitis, and pulmonary embolism. Patients with MRSA had longer lengths of stay than those with MSSA and higher total charges after controlling for length of stay. CONCLUSION Review of a national database demonstrates MRSA is more prevalent in the South and Midwest regions and among black patients. MRSA patients have more surgeries, complications, and longer lengths of stay. LEVEL OF EVIDENCE Level III.
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DeRonde KJ, Girotto JE, Nicolau DP. Management of Pediatric Acute Hematogenous Osteomyelitis, Part I: Antimicrobial Stewardship Approach and Review of Therapies for Methicillin-Susceptible Staphylococcus aureus, Streptococcus pyogenes, and Kingella kingae. Pharmacotherapy 2018; 38:947-966. [PMID: 29920709 DOI: 10.1002/phar.2160] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute hematogenous osteomyelitis (AHO), often occurring in young children, is the most frequently diagnosed type of osteomyelitis in pediatric patients. Optimizing antibiotics is essential as delays to receipt of appropriate therapy can lead to chronic osteomyelitis, as well as impairments in bone growth and development. Antimicrobial stewardship programs (ASPs) are in a key position to help improve the care of patients with AHO as they contain a pharmacist with expertise in antibiotic drug selection, optimization of dosing, and microbiologic test review. A literature search of the MEDLINE database was conducted from initiation through January 2018. Articles selected for the review focus on pathogen identification, pharmacokinetics and pharmacodynamics, efficacy and safety in children, transition from intravenous to oral therapy, duration of treatment, and antimicrobial stewardship interventions. This review will highlight the potential roles ASPs can have in improving the management of AHO in pediatric patients. These roles include the creation of clinical pathways, improving testing algorithms, antibiotic choice and dosing, intravenous to oral transitions, duration of treatment, and therapy monitoring. Overall, patients are most effectively treated by focusing treatments on age, presentation, local sensitivities, and directed therapy with pathogen identification.
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Affiliation(s)
- Kailynn J DeRonde
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut.,Department of Pharmacy, Connecticut Children's Medical Center, Hartford, Connecticut
| | - Jennifer E Girotto
- Department of Pharmacy Practice, School of Pharmacy, University of Connecticut, Storrs, Connecticut.,Department of Pharmacy, Connecticut Children's Medical Center, Hartford, Connecticut.,Division of Infectious Diseases and Immunology, Connecticut Children's Medical Center, Hartford, Connecticut
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut.,Division of Infectious Diseases, Hartford Hospital, Hartford, Connecticut
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Association of Vancomycin MIC and Molecular Characteristics with Clinical Outcomes in Methicillin-Susceptible Staphylococcus aureus Acute Hematogenous Osteoarticular Infections in Children. Antimicrob Agents Chemother 2018. [PMID: 29530845 DOI: 10.1128/aac.00084-18] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Strains of methicillin-resistant Staphylococcus aureus (MRSA), particularly those belonging to the USA300 pulsotype, have been well described to cause severe osteoarticular infections (OAIs). A vancomycin MIC of ≥1.5 μg/ml has been demonstrated to contribute to disease severity in adults with MRSA and even methicillin-susceptible S. aureus (MSSA) bacteremia. Little data exist describing the outcomes of MSSA OAIs in terms of molecular characteristics and vancomycin MIC. All patients/isolates were chosen from a surveillance study at Texas Children's Hospital (TCH). S. aureus OAI isolates were identified from 2011 to 2016 and subjected to vancomycin Etests, pulsed-field gel electrophoresis (PFGE), and PCR to determine Panton-Valentine leucocidin (PVL) production and agr group. Two hundred fifty-two cases of S. aureus OAI were identified; 183 cases were MSSA (72.6%). During the study period, a decrease in the proportion of cases secondary to MRSA was observed, declining from 37.8% to 15.9% (P = 0.02). Of the MSSA isolates, 26.2% and 23.5% were USA300 and PVL positive, respectively. An increase in the proportion of MSSA isolates with a vancomycin MIC of ≥1.5 μg/ml occurred in the study period (P = 0.004). In MSSA, an elevated vancomycin MIC was associated with multiple surgical procedures and venous thromboses, even when adjusting for empirical β-lactam use. An increase in vancomycin MIC was noted among isolates belonging to agr group 4 during the study period. Methicillin resistance is declining among S. aureus OAI isolates at TCH. Simultaneously, vancomycin Etest MICs are increasing among MSSA isolates. Vancomycin MICs of ≥2 μg/ml are associated with adverse clinical outcomes in MSSA irrespective of antibiotic choice, suggesting that this may be a surrogate for organism virulence.
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Bernstein DT, Haruno LS, Daram S, Dawson JR, Zhang W, Rosenfeld SB. Patient Factors Associated With Methicillin-Resistant Staphylococcus aureus Septic Arthritis in Children. Orthopedics 2018; 41:e277-e282. [PMID: 29451940 DOI: 10.3928/01477447-20180213-04] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Accepted: 12/15/2017] [Indexed: 02/03/2023]
Abstract
Staphylococcus aureus is the most common causative organism in pediatric septic arthritis, with methicillin-resistant Staphylococcus aureus (MRSA) being responsible for a significant portion of these infections. Early identification and initiation of proper treatment may improve outcomes by minimizing potential morbidity. The purpose of this study was to identify variables obtained on initial patient presentation associated with MRSA septic arthritis. Sixteen factors were retrospectively evaluated in 109 consecutive pediatric patients diagnosed with culture-confirmed septic arthritis. Graphical and logistical regression analyses were employed to determine factors independently predictive of MRSA septic arthritis. Twenty-seven (25%) patients had MRSA and 82 (75%) had non-MRSA septic arthritis. C-reactive protein of 13.7 mg/L or greater, duration of symptoms of 4 days or more, heart rate of 126 beats per minute or greater, and absolute neutrophil count of 8.72×103 cells/µL or greater were associated with MRSA septic arthritis. Ultimately, 98% of patients with 1 or no risk factors had non-MRSA and 96% of patients with MRSA septic arthritis had 2 or more positive risk factors. Elevated C-reactive protein, duration of symptoms, heart rate, and absolute neutrophil count are predictive of MRSA infection in the setting of pediatric septic arthritis and can be obtained on initial evaluation. In patients for whom there is concern for MRSA infection, this may guide more expedient treatment, such as early initiation of contact precautions and appropriate antibiotic therapy before culture results become available. [Orthopedics. 2018; 41(2):e277-e282.].
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Li B, Webster TJ. Bacteria antibiotic resistance: New challenges and opportunities for implant-associated orthopedic infections. J Orthop Res 2018; 36:22-32. [PMID: 28722231 PMCID: PMC5775060 DOI: 10.1002/jor.23656] [Citation(s) in RCA: 330] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/21/2017] [Indexed: 02/04/2023]
Abstract
There has been a dramatic increase in the emergence of antibiotic-resistant bacterial strains, which has made antibiotic choices for infection control increasingly limited and more expensive. In the U.S. alone, antibiotic-resistant bacteria cause at least 2 million infections and 23,000 deaths a year resulting in a $55-70 billion per year economic impact. Antibiotics are critical to the success of surgical procedures including orthopedic prosthetic surgeries, and antibiotic resistance is occurring in nearly all bacteria that infect people, including the most common bacteria that cause orthopedic infections, such as Staphylococcus aureus (S. aureus). Most clinical cases of orthopedic surgeries have shown that patients infected with antibiotic-resistant bacteria, such as methicillin-resistant S. aureus (MRSA), are associated with increased morbidity and mortality. This paper reviews the severity of antibiotic resistance at the global scale, the consequences of antibiotic resistance, and the pathways bacteria used to develop antibiotic resistance. It highlights the opportunities and challenges in limiting antibiotic resistance through approaches like the development of novel, non-drug approaches to reduce bacteria functions related to orthopedic implant-associated infections. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:22-32, 2018.
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Affiliation(s)
- Bingyun Li
- Department of Orthopaedics, School of Medicine, West Virginia University, Morgantown, WV 26506, USA,Mary Babb Randolph Cancer Center, Morgantown, WV 26506, USA,Correspondence to: Bingyun Li, PhD, Department of Orthopaedics, School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506-9196, USA, Tel: 1-304-293-1075, Fax: 1-304-293-7070, , URL: http://medicine.hsc.wvu.edu/ortho-bli/. Thomas J. Webster, PhD, Department of Chemical Engineering, 313 Snell Engineering Center, 360 Huntington Avenue, Northeastern University, Boston, MA 02115, USA, Tel: 1- 617-373-2989, , URL: http://www.che.neu.edu/people/webster-thomas
| | - Thomas J. Webster
- Department of Chemical Engineering, Northeastern University, Boston, MA 02115, USA,Center of Excellence for Advanced Materials Research, King Abdulaziz University, Jeddah, Saudi Arabia,Correspondence to: Bingyun Li, PhD, Department of Orthopaedics, School of Medicine, West Virginia University, 1 Medical Center Drive, Morgantown, WV 26506-9196, USA, Tel: 1-304-293-1075, Fax: 1-304-293-7070, , URL: http://medicine.hsc.wvu.edu/ortho-bli/. Thomas J. Webster, PhD, Department of Chemical Engineering, 313 Snell Engineering Center, 360 Huntington Avenue, Northeastern University, Boston, MA 02115, USA, Tel: 1- 617-373-2989, , URL: http://www.che.neu.edu/people/webster-thomas
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Abstract
PURPOSE To describe the clinical presentation, management, and outcomes of surgically treated septic arthritis of the shoulder in a pediatric population. METHODS A retrospective chart review over 5 years of children with operatively managed septic arthritis of the shoulder was completed. Demographics, clinical presentation, symptoms duration, antibiotic regimen and duration, number of surgical procedures, and evaluation of laboratory value improvements were collected. Pretreatment and final radiographs were assessed. Causative organisms were reviewed. Patients were stratified in age groups to determine clinical variability based upon patient age. RESULTS A total of 22 children, ages 15 days to 14 years (average 37.3 mo), were treated for septic arthritis of the shoulder from 2006 to 2010 at a single pediatric institution. All patients were managed with open anterior arthrotomy at an average of 1.95 days after initial orthopaedic consultation (range, 0 to 15 d). Multiple presenting signs were noted; the most common was decreased use (59%). Average admission laboratory values include C-reactive protein 10.6 (range, 0.3 to 41.6), erythrocyte sedimentation rate 62.8 (range, 11 to 107), and white blood cell count 14.9 (range, 5.9 to 31.7). Initial radiographs were read as normal in 12 patients, concern for osteomyelitis in 5, cortical irregularity in 4, effusion in 3, and neoplasm in a single child. Nineteen patients had a preoperative magnetic resonance imaging and 15 demonstrated an effusion, 15 had evidence of humeral osteomyelitis, 5 had a subperisoteal abscess, and 4 had soft tissue abscesses. Eight patients remained culture negative. The most commonly identified organism was methcillin-resistant Staphylococcus aureus (MRSA) (22.7%). The patients under 12 months of age revealed more diverse organisms at culture and were less likely to have MRSA. All patients averaged 1.55 (range, 1 to 5) surgical procedures and had an average hospital stay of 13.5 days. Intravenous antibiotics averaged 16.3 days followed by an average of 34 days of oral treatment. MRSA patients were significantly more likely to require multiple operations to eradicate the infection (P<0.02) and had a longer duration of intravenous antibiotic use (P<0.003). MRSA patients were more likely to have abnormal radiographs at final follow-up (P<0.03). CONCLUSIONS Septic arthritis of the shoulder in children is commonly associated with adjacent osteomyelitis. Pediatric septic arthritis of the shoulder due to MRSA bacteria can have a more virulent course than other bacterial causes, but is a less commonly identified organism in the youngest patients. SIGNIFICANCE To our knowledge, this is one of the largest series published concerning the treatment, course, and outcomes of pediatric septic arthritis of the shoulder. LEVEL OF EVIDENCE Level III-therapeutic.
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Pérez-López LM, Vara-Patudo I, Torner-Rubies F, Moreno-Romo D, Cabo LDSD, Fortuny C, Knörr G. Pediatric Psoas Abscess, Early Diagnosis of a Challenging Condition. J Acute Med 2017; 7:158-166. [PMID: 32995190 PMCID: PMC7517886 DOI: 10.6705/j.jacme.2017.0704.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 02/02/2017] [Accepted: 04/21/2017] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Psoas abscess is a rare entity at the pediatric stage of life. The clinical presentation of psoas abscess is insidious and not specifi c, and this usually causes diagnostic delay. Early diagnosis is relevant to prevent devastating consequences of this condition. AIMS This study aimed to describe the natural history of psoas abscess, present our experience in a children's hospital, determine warning signs and symptoms that may lead to early diagnosis, and describe differential diagnoses. We also discuss the devastating consequences of misdiagnosing psoas abscess. METHODS This retrospective study was performed at Sant Joan de Déu Children's Hospital (Barcelona, Spain) from 2008 to 2016. All patients younger than 18 years old (n = 12) with psoas abscess who were diagnosed by imaging tests were included. RESULTS The initial clinical presentation of the patients was variable. Painful hip mobility at extension (7 cases), limping (5 cases), and fever (4 cases) were the most frequent presentations. Laboratory parameters were abnormal in nine patients. The main responsible bacteria was Staphylococcus aureus (9 cases). The mean hospital stay was 28 days (range, 10-71 days). Percutaneous drainage under ultrasound control was applied in two patients. Surgical debridement was performed in seven patients, and repeated procedures were required in three of them. CONCLUSIONS Because of the erratic presentation of psoas abscess, its suspected diagnosis is essential for an early diagnosis, which will minimize the risk of diagnostic delay. One or more signs and symptoms at the same time might be considered as initiation of psoas abscess. Physicians should be aware of risk factors, such as previous traumatism and a known disturbed immunological system or temporal circumstances, which might lead to psoas abscess. Laboratory parameters may provide more confi dence in diagnosis, and early imaging tests provide a defi nitive diagnosis.
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Affiliation(s)
- Laura M Pérez-López
- University of Barcelona Pediatric Orthopaedic Surgery Department, Sant Joan de Déu Children's Hospital Barcelona Spain
| | - Isabel Vara-Patudo
- Niño Jesús Children's Hospital Pediatric Orthopaedic Surgery Department Complutense University of Madrid Madrid
| | - Ferran Torner-Rubies
- University of Barcelona Pediatric Orthopaedic Surgery Department, Sant Joan de Déu Children's Hospital Barcelona Spain
| | - David Moreno-Romo
- University of Barcelona Pediatric Orthopaedic Surgery Department, Sant Joan de Déu Children's Hospital Barcelona Spain
| | - Lydia de Sena-de Cabo
- University of Barcelona Pediatric Orthopaedic Surgery Department, Sant Joan de Déu Children's Hospital Barcelona Spain
| | - Clàudia Fortuny
- Sant Joan de Déu Children's Hospital. University of Barcelona Pediatric Infectious Diseases, Pediatric Department Barcelona Spain
| | - Gorka Knörr
- University of Barcelona Pediatric Orthopaedic Surgery Department, Sant Joan de Déu Children's Hospital Barcelona Spain
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