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Bobak L, Dorney I, Lavu MS, Mistovich RJ, Kaelber DC. Increased risk of osteomyelitis and septic arthritis in osteogenesis imperfecta. J Pediatr Orthop B 2024; 33:290-296. [PMID: 37669133 PMCID: PMC10894311 DOI: 10.1097/bpb.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
We investigated the prevalence of osteomyelitis and septic arthritis in individuals with osteogenesis imperfecta (OI) as compared to the general population. We performed a retrospective cohort study utilizing the TriNetX Analytics platform, a federated, aggregated electronic health record (EHR) research network containing national, deidentified EHR data. We queried patients with OI, based on encounter diagnoses. Patients in this group with any occurrence of osteomyelitis or septic arthritis were recorded. A control cohort was established to compare the prevalence in patients without OI. Of 8444 individuals with OI, 433 (5.13%) had encounter diagnoses for osteomyelitis and 61 (0.72%) had encounter diagnoses for septic arthritis. In comparison, of 79 176 436 patients without OI, 352 009 (0.44%) had encounter diagnoses for osteomyelitis, while 106 647 (0.13%) had encounter diagnoses for septic arthritis. The relative risk for osteomyelitis in OI patients was 11.53 (95% CI: 10.52-12.64), while the relative risk for septic arthritis was 5.36 (95% CI: 4.18-6.89). The relative risk for osteomyelitis in pediatric OI patients was 30.55 (95% CI: 24.35-38.28). To our knowledge, this is the first study investigating musculoskeletal infections in patients with OI, as well as the first to report the overall prevalence in the general population. Clinicians may benefit from a high index of suspicion for musculoskeletal infections in OI patients with corresponding symptoms. Further study is warranted to investigate if modifications to conventional diagnostic pathways and criteria are valuable in this population. Level of evidence: Retrospective Cohort Study - Level II.
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Affiliation(s)
- Lukas Bobak
- Case Western Reserve University School of Medicine
| | - Ian Dorney
- Case Western Reserve University School of Medicine
| | | | - R Justin Mistovich
- Case Western Reserve University School of Medicine
- Department of Orthopaedic Surgery, The MetroHealth System
- Division of Pediatric Orthopaedic Surgery, University Hospitals Rainbow Babies and Children's Hospital
| | - David C Kaelber
- Case Western Reserve University School of Medicine
- Departments of Internal Medicine
- Pediatrics
- Population and Quantitative Health Sciences, Case Western Reserve University
- The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, USA
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2
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Hunter S, Crawford H, Ao BT, Grant C. Methods to Reduce Cost of Treatment in Childhood Bone and Joint Infection: A Systematic Review. JBJS Rev 2024; 12:01874474-202405000-00007. [PMID: 38814570 DOI: 10.2106/jbjs.rvw.24.00043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Childhood bone and joint infection (BJI) is a potentially severe disease with consequences for growth and development. Critically unwell children may require prolonged hospitalization and multiple surgeries. Acknowledging rising healthcare costs and the financial impact of illness on caregivers, increased efforts are required to optimize treatment. This systematic review aims to characterize existing costs of hospital care and summarize strategies, which reduce treatment expense. METHODS A systematic review of the literature was performed from January 1, 1980, to January 31, 2024. Data were extracted on hospitalization costs for pediatric BJI by decade and global region. Results have been converted to cost per day in US dollars with purchase parity for 2023. Studies reporting innovations in clinical care to reduce length of stay (LOS) and simplify treatment were identified. Studies trialing shorter antibiotic treatment were only included if they specifically reported changes in LOS. RESULTS Twenty-three studies met inclusion criteria; of these, a daily hospitalization cost could be derived from 7 publications. Overall hospitalization cost and inpatient charges rose steeply from the 1990s to the 2020s. By contrast, average LOS seems to have decreased. Cost per day was higher in the United States than in Europe and higher for cases with confirmed methicillin-resistant Staphylococcus aureus. Sixteen studies report innovations to optimize care. For studies where reduced LOS was achieved, early magnetic resonance imaging with immediate transfer to theater when necessary and discharge on oral antibiotics were consistent features. CONCLUSION Rising costs of hospital care and economic consequences for families can be mitigated by simplifying treatment for childhood BJI. Hospitals that adopt protocols for early advanced imaging and oral antibiotic switch may provide satisfactory clinical outcomes at lower cost. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Sarah Hunter
- University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Orthopaedic Department, Starship Hospital, Auckland, New Zealand
| | - Haemish Crawford
- University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Orthopaedic Department, Starship Hospital, Auckland, New Zealand
| | - Braden Te Ao
- University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- School of Population Health and Health Economics, University of Auckland, Auckland, New Zealand
| | - Cameron Grant
- University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
- Department of Child and Youth Health, Starship Hospital, Auckland, New Zealand
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3
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Sun K, Zhang C, Mao Z, Wang C, Zhu H, Sun H, Wang K, Cheng W. Clinical characteristics of neonatal and infant osteomyelitis and septic arthritis: a multicenter retrospective study. J Pediatr (Rio J) 2024:S0021-7557(24)00032-9. [PMID: 38642591 DOI: 10.1016/j.jped.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/12/2024] [Accepted: 03/12/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE Signs and symptoms of osteomyelitis or septic arthritis in neonates and infants are often nonspecific and early-stage bone infections in infants may often go unnoticed. The objective of this study was to analyze the clinical characteristics of newborns and infants with osteomyelitis and septic arthritis to improve understanding of the disorder and to assist clinicians with diagnosis. METHODS A retrospective multicenter study was conducted on neonates (0-28 days old, n = 94) and infants (1-12 months old, n = 415) with osteoarticular infections. Data consisting of clinical characteristics, complications, laboratory outcomes, and the pathogenic microorganisms causing osteomyelitis were tabulated. The statistics were further broken down into two regions and the significant differences between neonates and infants were evaluated and compared to the literature. RESULTS Compared to infants, neonates had significantly lower incidences of fever (p < 0.0001), higher incidences of localized swelling (p = 0.0021), higher rate of infection at the humerus (p = 0.0016), higher percentage of Escherichia coli (p < 0.0001) and Klebsiella pneumoniae (p = 0.0039) infections, lower percentage of Staphylococcus aureus infections (p < 0.0001) and were more likely to develop septic arthritis (p < 0.0001). CONCLUSION Distinct differences were found between neonatal and infants with osteoarticular infections. Future studies should focus on improving diagnosis and subsequent treatment regimens for younger age groups.
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Affiliation(s)
- Keming Sun
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China
| | - Chunxu Zhang
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China
| | - Ziwen Mao
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China; Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Zhengzhou, Henan, China
| | - Chen Wang
- Hebei Children's Hospital, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, China
| | - Hua Zhu
- Hebei Children's Hospital, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, China
| | - Huiqing Sun
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Neonatology, Zhengzhou, Henan, China
| | - Kang Wang
- Hebei Children's Hospital, Department of Orthopaedic Surgery, Shijiazhuang, Hebei, China
| | - Weyland Cheng
- Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Department of Orthopaedic Surgery, Zhengzhou, Henan, China; Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, Henan Provincial Key Laboratory of Children's Genetics and Metabolic Diseases, Zhengzhou, Henan, China.
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4
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Malik J, Swanson RJ, Okimoto R, Khaled S. Disturbance of Growth in Pediatric Patients Due to Osteomyelitis Caused by Growth Plate Infection. Cureus 2023; 15:e50631. [PMID: 38226077 PMCID: PMC10789496 DOI: 10.7759/cureus.50631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Osteomyelitis, a severe bone infection, poses a multifaceted challenge to healthcare professionals. While its pathophysiology and treatment have been extensively studied, the impact of osteomyelitis on skeletal growth, particularly in pediatric patients, is an area that warrants attention. This abstract highlights the significance of understanding and managing growth disturbances in osteomyelitis, providing key findings and recommendations for clinicians. Understanding growth disturbance in osteomyelitis is essential because it can lead to lifelong consequences for pediatric patients. The infection may affect the growth plate, leading to limb length discrepancies, angular deformities, and functional impairments. These complications not only diminish the quality of life but also pose a substantial economic burden on the healthcare system. Therefore, early recognition and intervention are crucial. Key findings indicate that the risk of growth disturbances in osteomyelitis is particularly high in pediatric patients due to the vulnerability of the growth plate. Timely diagnosis, appropriate management, and targeted interventions can mitigate the long-term sequelae of growth disturbances. These include utilizing advanced imaging techniques to assess the extent of growth plate involvement, optimizing antibiotic therapy, and employing surgical techniques like epiphysiodesis, guided growth, or corrective osteotomies. Additionally, fostering a multidisciplinary approach that involves orthopedic surgeons, infectious disease specialists, and pediatric endocrinologists is vital to achieving successful outcomes. Recommendations for managing growth disturbance in osteomyelitis encompass early detection, meticulous monitoring, and a tailored treatment plan. Healthcare providers should remain vigilant for signs of growth plate involvement in osteomyelitis patients, especially in the pediatric population. A thorough evaluation, including advanced imaging and clinical assessment, is essential for accurate diagnosis. Close collaboration between specialists to address the infection and its skeletal consequences is crucial. Furthermore, patient and family education plays a pivotal role in fostering compliance with the treatment regimen. In conclusion, understanding and managing growth disturbances in osteomyelitis is paramount, particularly in pediatric patients. The implications of growth plate involvement are significant, and timely intervention is essential to prevent lifelong consequences. By implementing a comprehensive approach that combines accurate diagnosis, multidisciplinary collaboration, and patient education, healthcare professionals can enhance the quality of life and well-being of those affected by this challenging condition.
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Affiliation(s)
- Jamal Malik
- Department of Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - R James Swanson
- Department of Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Richard Okimoto
- Department of Research, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Syed Khaled
- Gastroenterology, North Kansas City Hospital, Kansas City, USA
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Ryan CB, Romere CM, Shah R, Souder CD, Ellington M. Rate of concomitant cellulitis and osteoarticular infections in a pediatric population. J Pediatr Orthop B 2023; 32:476-480. [PMID: 36445357 DOI: 10.1097/bpb.0000000000001037] [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: 11/30/2022]
Abstract
Concern for infection is a common presentation in pediatric emergency departments. Clinical signs of cellulitis in pediatric patients often lead to a workup for osteoarticular infection despite a lack of evidence to suggest that the two entities commonly co-exist. With this in mind, we asked: (1) What is the rate of concomitant cellulitis and osteoarticular infections in the pediatric population? (2) What factors are associated with concomitant cellulitis and osteoarticular infections? This is a retrospective study of 482 pediatric patients who underwent MRI to evaluate for either cellulitis or an osteoarticular infection at a single tertiary care children's hospital. Data were analyzed to assess the prevalence of osteomyelitis concomitant with cellulitis in our sample population. Concomitant cellulitis and osteoarticular infection were present in 11% of all cases (53/482). Of the concomitant infections, 92% percent (49/53) were present in distal locations (Group 1) and 8% (4/53) were present in proximal locations (Group 2). Bivariate analysis showed that concomitant infections on the distal extremities were significantly more common than concomitant infections on the proximal extremities ( P < 0.001). We found that concomitant cellulitis and osteoarticular infection were (1) uncommon and (2) significantly less common when clinical signs of cellulitis were present in the proximal extremities (proximal to ankle or wrist). This suggests that advanced imaging is most appropriate for patients who present with cellulitis on the distal extremities and can be used more judiciously in patients presenting with cellulitis on the proximal extremities. Level of Evidence - Level III.
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Affiliation(s)
- Claire Berdelle Ryan
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Chase Matthew Romere
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Romil Shah
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
| | - Christopher D Souder
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
- Department of Orthopedic Surgery, Central Texas Pediatric Orthopedics, Austin, Texas, USA
| | - Matthew Ellington
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin
- Department of Orthopedic Surgery, Central Texas Pediatric Orthopedics, Austin, Texas, USA
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6
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Tassi MF, le Meur N, Stéfic K, Grammatico-Guillon L. Performance of French medico-administrative databases in epidemiology of infectious diseases: a scoping review. Front Public Health 2023; 11:1161550. [PMID: 37250067 PMCID: PMC10213695 DOI: 10.3389/fpubh.2023.1161550] [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: 02/08/2023] [Accepted: 04/17/2023] [Indexed: 05/31/2023] Open
Abstract
The development of medico-administrative databases over the last few decades has led to an evolution and to a significant production of epidemiological studies on infectious diseases based on retrospective medical data and consumption of care. This new form of epidemiological research faces numerous methodological challenges, among which the assessment of the validity of targeting algorithm. We conducted a scoping review of studies that undertook an estimation of the completeness and validity of French medico-administrative databases for infectious disease epidemiological research. Nineteen validation studies and nine capture-recapture studies were identified. These studies covered 20 infectious diseases and were mostly based on the evaluation of hospital claimed data. The evaluation of their methodological qualities highlighted the difficulties associated with these types of research, particularly those linked to the assessment of their underlying hypotheses. We recall several recommendations relating to the problems addressed, which should contribute to the quality of future evaluation studies based on medico-administrative data and consequently to the quality of the epidemiological indicators produced from these information systems.
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Affiliation(s)
| | - Nolwenn le Meur
- Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, Rennes, France
| | - Karl Stéfic
- INSERM U1259, Université de Tours, Tours, France
- Laboratoire de virologie et CNR VIH-Laboratoire associé, CHRU de Tours, Tours, France
| | - Leslie Grammatico-Guillon
- INSERM U1259, Université de Tours, Tours, France
- Service d'Information Médicale d'Epidémiologie et d'Economie de la Santé, CHRU de Tours, Tours, France
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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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8
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Ossurarson F, Thors V, Haraldsson A. Simplified antibiotic treatment for paediatric osteoarticular infections achieved good outcomes. Acta Paediatr 2022; 111:2188-2194. [PMID: 35924594 DOI: 10.1111/apa.16510] [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: 04/06/2022] [Revised: 06/23/2022] [Accepted: 08/03/2022] [Indexed: 11/28/2022]
Abstract
AIM Early diagnosis of osteoarticular infections (OAI) in children and effective treatment prevents complications. The objective of this study was to evaluate effectiveness and safety of shortened intravenous antibiotic treatment of OAI. Incidence, diagnostics, and pathogens of paediatric OAI were assessed. METHODS This retrospective study included all paediatric OAI admissions to The Children's Hospital Iceland in 2006-2020. The treatment was evaluated by dividing the study cohort into two groups. The simplified treatment group received intravenous antibiotics for less than seven days. The longer intravenous group received intravenous antibiotics for a minimum of seven days. RESULTS In total, 205 cases of OAI were included: 106 osteomyelitis, 83 septic arthritis and 16 with both. Age standardized incidence was 17 per 100,000 children and decreased over the study period (p = 0.004). A pathogen was identified in 37% (75/205) of cases of which 65% (49/75) were Staphylococcus aureus and 12% (9/75) Kingella kingae. Simplified treatment was not associated with increased risk of complications. CONCLUSION This study supports claims that simplified treatment for OAI is safe and effective. Further simplification of treatment might be viable. For uncertain reasons the incidence of OAI was decreasing in Iceland, predominantly in young children.
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Affiliation(s)
| | - Valtyr Thors
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland.,Children´s Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
| | - Asgeir Haraldsson
- University of Iceland, Faculty of Medicine, Reykjavik, Iceland.,Children´s Hospital Iceland, Landspitali University Hospital, Reykjavik, Iceland
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9
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Moutaouakkil K, Abdellaoui H, Arhoune B, Atarraf K, El Fakir S, Yahyaoui G, Mahmoud M, Afifi MA, Oumokhtar B. Paediatric osteoarticular infections caused by staphylococcus aureus producing panton-valentine leucocidin in morocco: Risk factors and clinical features. Afr J Paediatr Surg 2022; 19:78-82. [PMID: 35017376 PMCID: PMC8809469 DOI: 10.4103/ajps.ajps_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to estimate the prevalence of Staphylococcus aureus producing Panton-Valentine leucocidin (PVL) isolated from children diagnosed with osteoarticular infections (OAIs), and to examine risk factors and clinical features. METHODS This prospective study was conducted from January 2017 to December 2018. All hospitalised children diagnosed with S. aureus OAI are included. Blood cultures, articular fluids, synovial tissues and/or bone fragments were collected for bacteriological culture. Antimicrobial susceptibility tests were determined by disk diffusion method. Genes encoding methicillin resistance (mecA) and PVL virulence factors (luk-S-PV and luk-F-PV) were detected by multiplex polymerase chain reaction. The demographic, clinical, laboratory, radiographic and clinical features were reviewed prospectively from medical records. RESULTS A total of 37 children with S. aureus OAIs were included, 46% of them have PVL-positive infection and 70.6% were male. The mean age was 8.12 years (±4.57), and almost were from rural settings (76.5%). Children with Staphylococcus aureus producing Panton-Valentine leucocidin (SA-PVL) were significantly associated with type of infection (P = 0.005), location of infection (P = 0.037) and abnormal X-ray (P = 0.029). All strains SA-PVL+ are sensitive to methicillin, but one strain SA-PVL negative was methicillin-resistant S. aureus, confirmed by gene mecA positive. CONCLUSION The prevalence of S. aureus infections producing PVL toxin was high in OAIs amongst Moroccan children, mainly due to methicillin-susceptible S. aureus. Type and location of infections and abnormal X-ray were significantly associated with SA-PVL. Routine diagnostic testing of PVL-SA, continuous epidemiological surveillance and multidisciplinary management of OAI is essential to prevent serious complications.
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Affiliation(s)
- Kaoutar Moutaouakkil
- Microbiology and Molecular Biology Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Hicham Abdellaoui
- Pediatric Orthopedic Traumatology Department, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Btissam Arhoune
- Microbiology and Molecular Biology Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Karima Atarraf
- Pediatric Orthopedic Traumatology Department, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Samira El Fakir
- Laboratory of Epidemiology, Clinical Research and Community Health- Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Ghita Yahyaoui
- Central Laboratory of Medical Analysis, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Mustapha Mahmoud
- Central Laboratory of Medical Analysis, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Moulay Abderrahmane Afifi
- Pediatric Orthopedic Traumatology Department, Hassan II University Teaching Hospital, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
| | - Bouchra Oumokhtar
- Microbiology and Molecular Biology Laboratory, Faculty of Medicine and Pharmacy, Sidi Mohammed Ben Abdellah University, Fez, Morocco
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10
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Global epidemiology of childhood bone and joint infection: a systematic review. Infection 2022; 50:329-341. [DOI: 10.1007/s15010-021-01741-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/07/2021] [Indexed: 11/26/2022]
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Butt FE, Lee EY, Chaturvedi A. Pediatric Musculoskeletal Infections: Imaging Guidelines and Recommendations. Radiol Clin North Am 2021; 60:165-177. [PMID: 34836563 DOI: 10.1016/j.rcl.2021.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Pediatric musculoskeletal infections often pose a diagnostic challenge due to their frequently vague and nonspecific clinical presentation. Imaging evaluation is a crucial component to diagnostic workup of these entities. Changed epidemiology of these infections over the past 2 decades has resulted in increases in both disease incidence and severity in the pediatric population. Prompt and accurate diagnosis is essential in order to reduce the risk of morbid sequelae, and to optimize patient management. In this article, the unique pathophysiology of musculoskeletal infections and characteristic imaging findings in children compared with adults are reviewed.
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Affiliation(s)
- Frederick E Butt
- Department of Radiology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, USA.
| | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Apeksha Chaturvedi
- Department of Imaging Sciences, University of Rochester Medical Center, School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, USA
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12
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The Epidemiology of Osteomyelitis in Children. CHILDREN 2021; 8:children8111000. [PMID: 34828711 PMCID: PMC8621985 DOI: 10.3390/children8111000] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
Abstract
Pediatric osteomyelitis remains challenging to treat. Detailed epidemiological data are required to estimate future developments. Therefore, we aimed to analyze how the incidence has changed over the last decade depending on age, gender, osteomyelitis subtype, and anatomical localization. Cases were quantified for patients aged 20 years or younger, using yearly reported ICD-10 diagnosis codes from German medical institutions for the time period 2009 to 2019. Incidence rates of osteomyelitis increased by 11.7% from 8.2 cases per 100,000 children in 2009 to 9.2 cases per 100,000 children in 2019. The age-specific incidence rate revealed the highest occurrence of osteomyelitis in patients aged 10–15 years (15.3/100,000 children), which increased by 23% over the observation period, followed by the age group 5–10 years (9.7/100,000 children). In 2019, out of all diagnoses, 39.2% were classified as acute, 38.4% as chronic, and 22.4% were unspecified, whereby chronic cases increased by 38.7%. The lower extremity was mainly affected, with 58.9% of osteomyelitis diagnoses in 2019. In conclusion, pediatric osteomyelitis is a serious issue, even in a developed and industrialized country such as Germany. Considering the recent incidence increase, the permanent need for appropriate treatment should let pediatricians and orthopedic surgeons deal with diagnosis and treatment protocols.
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Sepehrizadeh T, Jong I, DeVeer M, Malhotra A. PET/MRI in paediatric disease. Eur J Radiol 2021; 144:109987. [PMID: 34649143 DOI: 10.1016/j.ejrad.2021.109987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022]
Abstract
Nuclear medicine and molecular imaging have a small but growing role in the management of paediatric and neonatal diseases. During the past decade, combined PET/MRI has emerged as a clinically important hybrid imaging modality in paediatric medicine due to diagnostic advantages and reduced radiation exposure compared to alternative techniques. The applications for nuclear medicine, radiopharmaceuticals and combined PET/MRI in paediatric diagnosis is broadly similar to adults, however there are some key differences. There are a variety of clinical applications for PET/MRI imaging in children including, but not limited to, oncology, neurology, cardiovascular, infection and chronic inflammatory diseases, and in renal-urological disorders. In this article, we review the applications of PET/MRI in paediatric and neonatal imaging, its current role, advantages and disadvantages over other hybrid imaging techniques such as PET/CT, and its future applications. Overall, PET/MRI is a powerful imaging technology in diagnostic medicine and paediatric diseases. Higher soft tissue contrasts and lower radiation dose of the MRI makes it the superior technology compared to other conventional techniques such as PET/CT or scintigraphy. However, this relatively new hybrid imaging has also some limitations. MRI based attenuation correction remains a challenge and although methodologies have improved significantly in the last decades, most remain under development.
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Affiliation(s)
| | - Ian Jong
- Department of diagnostic imaging, Monash Health, Melbourne, Australia
| | - Michael DeVeer
- Monash Biomedical Imaging, Monash University, Melbourne, Australia
| | - Atul Malhotra
- Monash Newborn, Monash Children's Hospital, Melbourne, Australia; Department of Paediatrics, Monash University, Melbourne, Australia
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Van Belkum A, Gros MF, Ferry T, Lustig S, Laurent F, Durand G, Jay C, Rochas O, Ginocchio CC. Novel strategies to diagnose prosthetic or native bone and joint infections. Expert Rev Anti Infect Ther 2021; 20:391-405. [PMID: 34384319 DOI: 10.1080/14787210.2021.1967745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Bone and Joint Infections (BJI) are medically important, costly and occur in native and prosthetic joints. Arthroplasties will increase significantly in absolute numbers over time as well as the incidence of Prosthetic Joint Infections (PJI). Diagnosis of BJI and PJI is sub-optimal. The available diagnostic tests have variable effectiveness, are often below standard in sensitivity and/or specificity, and carry significant contamination risks during the collection of clinical samples. Improvement of diagnostics is urgently needed. AREAS COVERED We provide a narrative review on current and future diagnostic microbiology technologies. Pathogen identification, antibiotic resistance detection, and assessment of the epidemiology of infections via bacterial typing are considered useful for improved patient management. We confirm the continuing importance of culture methods and successful introduction of molecular, mass spectrometry-mediated and next-generation genome sequencing technologies. The diagnostic algorithms for BJI must be better defined, especially in the context of diversity of both disease phenotypes and clinical specimens rendered available. EXPERT OPINION Whether interventions in BJI or PJI are surgical or chemo-therapeutic (antibiotics and bacteriophages included), prior sensitive and specific pathogen detection remains a therapy-substantiating necessity. Innovative tests for earlier and more sensitive and specific detection of bacterial pathogens in BJI are urgently needed.
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Affiliation(s)
- Alex Van Belkum
- bioMérieux, Open Innovation and Partnerships, 3 Route De Port Michaud, La Balme Les Grottes, France
| | | | - Tristan Ferry
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Centre Interrégional De Référence Pour La Prise En Charge Des Infections Ostéo-articulaires Complexes (Crioac Lyon), Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | - Sebastien Lustig
- Maladies Infectieuses, Université Claude Bernard Lyon 1, Villeurbanne, France.,Service De Chirurgie Orthopédique, Hôpital De La Croix-Rousse, Lyon, France
| | - Frédéric Laurent
- Service Des Maladies Infectieuses Et Tropicales, Hospices Civils De Lyon, Hôpital De La Croix-Rousse, Lyon, France.,Ciri - Centre International De Recherche En Infectiologie, Inserm, U1111, Université́ Claude Bernard Lyon 1CNRS, UMR5308, Ecole Normale Supérieure De Lyon, Univ Lyon, Lyon, France
| | | | - Corinne Jay
- bioMérieux, BioFire Development Emea, Grenoble, France
| | - Olivier Rochas
- Corporate Business Development, bioMérieux, Marcy-l'Étoile, France
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15
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Guillon A, Laurent E, Duclos A, Godillon L, Dequin PF, Agrinier N, Kimmoun A, Grammatico-Guillon L. Case fatality inequalities of critically ill COVID-19 patients according to patient-, hospital- and region-related factors: a French nationwide study. Ann Intensive Care 2021; 11:127. [PMID: 34410543 PMCID: PMC8375279 DOI: 10.1186/s13613-021-00915-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background The COVID-19 sanitary crisis inflicted different challenges regarding the reorganization of the human and logistic resources, particularly in intensive care unit (ICU). Interdependence between regional pandemic burden and individual outcome remains unknown. The study aimed to assess the association between ICU bed occupancy and case fatality rate of critically ill COVID-19 patients. Methods A cross-sectional study was performed in France, using the national hospital discharge database from March to May, 2020. All patients admitted to ICU for COVID-19 were included. Case fatality was described according to: (i) patient’s characteristics (age, sex, comorbid conditions, ICU interventions); (ii) hospital’s characteristics (baseline ICU experience assessed by the number of ICU stays in 2019, number of ICU physicians per bed), and (iii) the regional outbreak-related profiles (workload indicator based on ICU bed occupancy). The determinants of lethal outcome were identified using a logistic regression model. Results 14,513 COVID-19 patients were admitted to ICU; 4256 died (29.3%), with important regional inequalities in case fatality (from 17.6 to 33.5%). Older age, multimorbidity and clinical severity were associated with higher mortality, as well as a lower baseline ICU experience of the health structure. Regions with more than 10 days with ≥ 75% of ICU occupancy by COVID-19 patients experienced an excess of mortality (up to adjusted OR = 2.2 [1.9–2.6] for region with the highest occupancy rate of ICU beds). Conclusions The regions with the highest burden of care in ICU were associated with up to 2.2-fold increase of death rate. Supplementary Information The online version contains supplementary material available at 10.1186/s13613-021-00915-4.
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Affiliation(s)
- Antoine Guillon
- Intensive Care Unit, Tours University Hospital, Research Center for Respiratory Diseases, INSERM U1100, University of Tours, Tours, France
| | - Emeline Laurent
- Epidemiology Unit EpiDcliC, Service of Public Health, Tours University Hospital, 2 Bd Tonnellé, 37044, Tours Cedex 9, France.,Research Unit EA1075 (Education Ethique et Santé), University of Tours, Tours, France
| | - Antoine Duclos
- Research on Healthcare Performance Lab (RESHAPE) INSERM U1290, University of Claude Bernard Lyon 1, Lyon, France.,Health Data Department, Hospices Civils de Lyon, Lyon, France
| | - Lucile Godillon
- Epidemiology Unit EpiDcliC, Service of Public Health, Tours University Hospital, 2 Bd Tonnellé, 37044, Tours Cedex 9, France
| | - Pierre-François Dequin
- Intensive Care Unit, Tours University Hospital, Research Center for Respiratory Diseases, INSERM U1100, University of Tours, Tours, France
| | - Nelly Agrinier
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, 54000, Nancy, France
| | - Antoine Kimmoun
- Teaching Hospital of Nancy, Intensive Care Unit, University of Lorraine, Nancy, France
| | - Leslie Grammatico-Guillon
- Epidemiology Unit EpiDcliC, Service of Public Health, Tours University Hospital, 2 Bd Tonnellé, 37044, Tours Cedex 9, France. .,MAVIVH, INSERM U1259; University of Tours, Tours, France.
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16
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Mamo MD, Daba FB, Beshir M, Fanta K. Treatment and Clinical Outcomes of Osteoarticular Infections Among Pediatrics Admitted to Jimma University Medical Center, Ethiopia: A Prospective Observational Study. Infect Drug Resist 2021; 14:2933-2941. [PMID: 34349528 PMCID: PMC8326276 DOI: 10.2147/idr.s323490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Despite the high burden of osteoarticular infections in sub-Saharan Africa, there is a paucity of data regarding the osteoarticular infections management approach and clinical outcomes in the region. Hence, this study aimed to evaluate a management protocol, clinical outcomes, and its determinants among pediatric patients with osteoarticular infections. METHODS A pediatric patient admitted to Jimma University Medical Center (JUMC), Ethiopia, with a diagnosis of osteoarticular infections was enrolled prospectively from April 30 to October 30, 2019. Clinical characteristics, management modality, and in-hospital complications were recorded from admission to discharge. Data were analyzed by using SPSS v.23 and the p-value <0.05 was considered statistically significant. RESULTS Among a total of 150 pediatric patients enrolled in this study, osteomyelitis was diagnosed in 111 (74%), while the rest 39 (26%) had septic arthritis. The majority 105 (70%) of the study participants were male with a mean age of 8.79 ± 4.2 years. The culture was performed for only 3.6% of the patients. Almost all (98.7%) of the patients received intravenous (IV) antibiotics, and ceftriaxone was the most common IV antibiotic used as a monotherapy 66 (44.6%) or in combination with metronidazole 47 (31.8%) or gentamicin (12.8%). Almost half (45.3%) of the patients had poor treatment outcomes. Factors associated with poor treatment outcome were comorbidity [AOR=3.3, 95% CI (1.08-10.16)] and use of combination antibiotics [AOR=2.9, 95% CI (1.16-7.3)]. Rural residence [AOR=0.39, 95% CI (0.168-0.92)] and surgical interventions [AOR=0.29, 95% CI (0.006-0.144)] were associated with good treatment outcomes. CONCLUSION Almost half of pediatric patients with osteoarticular infections had poor treatment outcome. Health providers should increase the accessibility of microbiological tests and diagnostic imaging, which can guide treatment decisions and improve outcomes of patients with osteoarticular infections.
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Affiliation(s)
- Mekonnen Damessa Mamo
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Mohammed Beshir
- Department of Pediatrics, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
| | - Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
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El-Sobky T, Mahmoud S. Acute osteoarticular infections in children are frequently forgotten multidiscipline emergencies: beyond the technical skills. EFORT Open Rev 2021; 6:584-592. [PMID: 34377550 PMCID: PMC8335954 DOI: 10.1302/2058-5241.6.200155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Acute osteoarticular infections (AOI) should be treated as top emergencies. The first few days following the inception of infection are ultra-critical to long-term prognosis.A comprehensive road map for management of childhood AOI is still lacking despite recent advances in microbiology and imaging (magnetic resonance imaging). The many faces of childhood AOI warrant a multidiscipline approach to management.Laboratory and imaging findings of are still debatable and should not overshadow or delay a management plan based on the experienced physician's clinical judgment.Ample evidence-based practice supports the use of a few days of intravenous antibiotic administration followed by oral therapy until correlative clinical and basic laboratory (acute phase reactants) results improve.The growing body of evidence on 'high-risk' children/neonates of AOI warrants continual clinical extra-vigilance in identifying these patient subsets.Open drainage and debridement remain the mainstay of treatment of septic hips, whereas for other joints the use of alternative surgical techniques should be individualized or on case-by-case basis.Because the consequences of misdiagnosis of AOI are usually grave and permanent, proactive treatment/overtreatment is justified in the event of unconfirmed but suspicious diagnosis. Cite this article: EFORT Open Rev 2021;6:584-592. DOI: 10.1302/2058-5241.6.200155.
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Affiliation(s)
- Tamer El-Sobky
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shady Mahmoud
- Division of Paediatric Orthopaedics, Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Salmon-Rousseau A, Auvray C, Besset Q, Briandet C, Desplantes C, Chavanet P. Costal osteomyelitis due to Bartonella henselae in a 10-year-old girl. J Bone Jt Infect 2021; 6:171-178. [PMID: 34109101 PMCID: PMC8182667 DOI: 10.5194/jbji-6-171-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 05/03/2021] [Indexed: 11/13/2022] Open
Abstract
Bartonella henselae
is the bacterial agent responsible for cat scratch
disease. This infection is frequently the cause of localized lymphadenitis in
children. It is also sometimes responsible for endocarditis, encephalitis, hepatic
peliosis and in rare cases osteomyelitis. We describe the second known case of unifocal thoracic
osteomyelitis in a
10-year-old child.
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Affiliation(s)
| | - Christelle Auvray
- Laboratory of Virology, François Mitterrand University Hospital, Dijon, France
| | - Quentin Besset
- Infectious Diseases Department, Dijon University Hospital, Dijon, France
| | - Claire Briandet
- Department of Pediatric Onco-Hematology, Dijon University Hospital, Dijon, France
| | - Claire Desplantes
- Department of Pediatric Onco-Hematology, Dijon University Hospital, Dijon, France
| | - Pascal Chavanet
- Infectious Diseases Department, Dijon University Hospital, Dijon, France
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19
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Pain for Greater Than 4 Days Is Highly Predictive of Concomitant Osteomyelitis in Children With Septic Arthritis. J Pediatr Orthop 2021; 41:255-259. [PMID: 33577239 DOI: 10.1097/bpo.0000000000001771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is no evidence-based consensus on the risk factors for concomitant osteomyelitis and septic arthritis. The purpose of this study was to investigate clinical parameters predictive of concomitant osteomyelitis in children with septic arthritis. METHODS A retrospective review was conducted on patients with septic arthritis with magnetic resonance imaging (MRI) between January 2004 and October 2016 at a tertiary care pediatric hospital. Medical charts were reviewed for information including symptoms, diagnosis of osteomyelitis, serum laboratory studies, joint fluid analyses, imaging results, and treatment. Positive diagnosis of osteomyelitis was defined as a hyperintense signal of osseous structures on T2-weighted MRI consistent with infection per attending pediatric radiologist final read. RESULTS A total of 71 patients with 73 septic joints were included. The mean age was 6±4 (0.1 to 17) years and the mean follow-up was 14.9±24.1 (1.0 to 133.1) months. Septic arthritis with concomitant osteomyelitis occurred in 43 of 71 (61%) patients, whereas 28 of 71 (39%) patients had septic arthritis alone. Inflammatory markers such as white blood cell count, erythrocyte sedimentation rate, and C-reactive protein on admission were not associated with concomitant osteomyelitis. Multivariate logistic regression revealed that positive joint fluid bacterial culture (P=0.021) and pain for >4 days before admission (P=0.004) are independent risk factors for concomitant osteomyelitis in children with septic arthritis. Among the 24 septic arthritis patients with pain for >4 days before presentation, 96% (23/24) had concomitant osteomyelitis, whereas 43% (20/47) of patients with pain for ≤4 days had concomitant osteomyelitis. CONCLUSION Pain for >4 days before presentation is an independent predictor of osteomyelitis in children with septic arthritis. In pediatric septic arthritis, MRI should be considered, particularly in patients presenting with pain for >4 days as 96% of these patients had concomitant osteomyelitis. LEVEL OF EVIDENCE Level III-retrospective comparative study.
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20
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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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21
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Intracapsular pressure in children with septic arthritis of the hip. J Pediatr Orthop B 2021; 30:80-84. [PMID: 32301824 DOI: 10.1097/bpb.0000000000000727] [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: 11/26/2022]
Abstract
Elevated intracapsular pressure in the hip causes occlusion of the retinacular vessels and may result in avascular necrosis of the proximal femoral epiphysis (ANPFE) and growth disturbances. Our goal is to study intraarticular pressure in children with septic arthritis of the hip and its potential correlation with body weight, systemic blood pressure and the volume of synovial fluid aspirated from the joint. Thirteen septic arthritis of the hip were studied. Inclusion criteria: pain, limping, fever, leukocytosis, elevated C-reactive protein and ultrasonographic effusion >5 mm. Traumatic, inflammatory, rheumatic or tumoral origin were excluded. Mean age was 3.7 years. Girls were 58%. Mean time to articular drainage was 15 h. Arthrocentesis was performed. An STIC self-calibrating monitoring system with an error of ±1 mmHg was used. Measurements were taken: intracapsular pressure, volume of fluid aspirated, systolic and diastolic pressures and weight. Follow-up was 6.3 years. Descriptive and nonparametric tests were performed: U Mann-Whitney and Kruskal-Wallis. Statistical significance was P <0.05. Mean intracapsular pressure was 50.5 mmHg; fluid aspirated was 2.9 ml; systolic and diastolic pressures were 107.5 and 44.3 mmHg, respectively; weight was 16.2 kg. Intracapsular pressure exceeded 30 mmHg in eight children (61.5%) and was lower than 50 mmHg in 73%. Variables studied had no significance on intracapsular pressure. Complications: coxa magna in three patients (23%) and Harris lines in three (23%). Surgical drainage of septic arthritis of hip must be performed urgently, within the first 24 hours, to reduce the time with high intracapsular pressure and to avoid risk of ANPFE.
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Bréhin C, Claudet I, Dubois D, Sales de Gauzy J, Vial J, Chaix Y, Grouteau E. Assessing the management of pediatric bone and joint infections according to French guidelines. Med Mal Infect 2020; 50:515-519. [DOI: 10.1016/j.medmal.2019.07.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 09/04/2018] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
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23
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Gornitzky AL, Kim AE, O’Donnell JM, Swarup I. Diagnosis and Management of Osteomyelitis in Children. JBJS Rev 2020; 8:e1900202. [DOI: 10.2106/jbjs.rvw.19.00202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Cohen E, Katz T, Rahamim E, Bulkowstein S, Weisel Y, Leibovitz R, Fruchtman Y, Leibovitz E. Septic arthritis in children: Updated epidemiologic, microbiologic, clinical and therapeutic correlations. Pediatr Neonatol 2020; 61:325-330. [PMID: 32184066 DOI: 10.1016/j.pedneo.2020.02.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 11/12/2019] [Accepted: 02/15/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Septic arthritis (SA) is an infection characterized by significant epidemiologic and microbiologic differences between developed and developing regions and between age groups. OBJECTIVES To determine the epidemiologic, clinical, microbiologic and therapeutic aspects of pediatric SA in Southern Israel. METHODS A retrospective case-series study based on the records of children <16 years of age admitted with SA at Soroka Medical Center, Beer-Sheva, during 2006-2013. RESULTS 189 patients were enrolled. There were 119 (63%) Bedouin and 70 (37%) Jewish children. The knee (39.7%), hip (28%) and ankle (13.8%) were the most commonly involved joints. Blood and/or synovial fluid cultures were positive in 48 (25.4%) patients. Overall SA incidence among children <16 years and <5 years was 11.7 and 25.4/100,000, respectively, without changes throughout the study period. SA incidence among Bedouin children was higher than among Jewish children (15.4 vs. 8.3/100,000 cases). Staphylococcus aureus was the most commonly isolated pathogen (18, 19.5% of all patients), followed by Kingella kingae (10, 5.3%)-(37.5% and 20.8% among culture-positive patients, respectively). The number of children with culture-positive SA that required surgery was higher than those with culture-positive SA treated conservatively (P < 0.001). Hospitalization was longer in children treated surgically than in those treated conservatively (P < 0.001). CONCLUSION This study is the largest single-center series on pediatric SA published in the last five years and provided an updated picture on incidence and the microbiologic, clinical and therapeutic aspects of pediatric SA in Southern Israel. The study supports a regional presentation pattern of SA and may guide its therapeutic management.
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Affiliation(s)
- Eugen Cohen
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Tiberiu Katz
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Eldad Rahamim
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Shlomi Bulkowstein
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Yaron Weisel
- Orthopaedic Department, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Ron Leibovitz
- Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Yariv Fruchtman
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Division of Pediatrics, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel.
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Clerc A, Zeller V, Marmor S, Senneville E, Marchou B, Laurent F, Lucht F, Desplaces N, Lustig S, Chidiac C, Ferry T. Hematogenous osteomyelitis in childhood can relapse many years later into adulthood: A retrospective multicentric cohort study in France. Medicine (Baltimore) 2020; 99:e19617. [PMID: 32443285 PMCID: PMC7254121 DOI: 10.1097/md.0000000000019617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
To describe the epidemiological, clinical, laboratory, and radiological features and the management of adult patients who experienced a relapse between 2003 and 2015 of an acute hematogenous osteomyelitis acquired in childhood.A retrospective multicentric cohort study was conducted in 5 centers in France.Thirty-seven patients were included. The median age was 40 years (28-56), and 26 (70%) were male. The first site of infection was the distal femur (n = 23, 62%). The median time between the osteomyelitis in childhood and the relapse in adulthood was 26 years (13-45). Thirty-four (92%) patients reported inflammatory local clinical manifestations, 17 (46%) draining fistula, 10 (27%) fever. Most patients had intramedullary gadolinium deposition (with or without abscess) on magnetic resonance imaging. Most relapses were monomicrobial infections (82%). Staphylococcus aureus was the most commonly found microorganism (82%), expressing a small colony variant phenotype in 3 cases. Most patients (97%) had a surgical treatment, and the median duration of antibiotics for the relapse was 12 weeks. All patients had a favorable outcome, no patient died and no further relapse occurred. We count 2 femoral fractures on osteotomy site.Osteomyelitis in childhood can relapse later in adulthood, especially in patients with lack of care during the initial episode. Osteotomy and prolonged antimicrobial therapy are required for clinical remission.
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Affiliation(s)
- Axelle Clerc
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04
- Université Claude Bernard 1, Lyon
| | - Valerie Zeller
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris
| | - Simon Marmor
- Service de Chirurgie Osseuse et Traumatologique, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris
| | - Eric Senneville
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Gustave Dron, Tourcoing
| | - Bruno Marchou
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Toulouse, Toulouse
| | - Frederic Laurent
- Université Claude Bernard 1, Lyon
- Laboratoire de Bactériologie, Hospices Civils de Lyon - Hôpital de la Croix-Rousse, Lyon
| | - Frederic Lucht
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne
| | - Nicole Desplaces
- Laboratoire de Biologie Médicale, Groupe Hospitalier Diaconesses - Croix Saint-Simon, Paris
| | - Sebastien Lustig
- Service de Chirurgie Orthopédique, Hospices Civils de Lyon - Hôpital de la Croix-Rousse, Lyon, France
| | - Christian Chidiac
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04
- Université Claude Bernard 1, Lyon
| | - Tristan Ferry
- Service de Maladies Infectieuses et Tropicales, Hospices Civils de Lyon - Hôpital de la Croix-Rousse Lyon, Cedex 04
- Université Claude Bernard 1, Lyon
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Luís MS, Cardosa F, Reis F, Fraga AS, Victor M, Santos JG, Calhau P. RIB OSTEOMYELITIS: A RARE COMPLICATION OF VARICELLA. REVISTA PAULISTA DE PEDIATRIA 2019; 37:510-515. [PMID: 31291442 PMCID: PMC6821478 DOI: 10.1590/1984-0462/;2019;37;4;00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 04/29/2018] [Indexed: 11/24/2022]
Abstract
Objective: To report a case of varicella complicated by acute osteomyelitis in order to
remind of a rare and potentially serious complication of a very common
pediatric disease. Case description: A previously healthy 3-month-old female infant with 10-day history of
varicella was admitted to the hospital for fever, groan and prostration. The
initial laboratorial evaluation was compatible with bacterial sepsis. By the
third day after admission, a swelling of the seventh left rib had developed.
The ultrasound and scintigraphy evaluation suggested rib osteomyelitis.
Blood cultures were negative. The patient completed six weeks of antibiotics
with favorable clinical, laboratorial and imaging evolution. Comments: Varicella is one of the most frequent exanthematic diseases of childhood and
it is usually self-limited. The most frequent complication is bacterial
infection of cutaneous lesions. Osteoarticular complications are rare, and
rib osteomyelitis is described in less than 1% of cases. The main route of
dissemination is hematogenic, and the most frequent etiological agent is
Staphylococcus aureus. The prognosis is generally good
and depends on early detection and antibiotic initiation.
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Affiliation(s)
- Madalena Sales Luís
- Hospital São Francisco Xavier, Hospital Center "Lisboa Ocidental", EPE, Lisbon, Portugal
| | | | - Filipa Reis
- Hospital Garcia de Orta E.P.E, Almada, Portugal
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Abstract
Septic arthritis is an emergent condition caused by bacterial infection of a joint space. The most common etiology is hematogenous spread from bacteremia, but it can also occur from direct inoculation from bites, injection injuries, cellulitis, abscesses, or local trauma. Septic arthritis occurs most frequently in the lower extremities, with the hips and knees serving as the most common locations. The most sensitive findings include pain with motion of the joint, limited range of motion, tenderness of the joint, new joint swelling, and new effusion. Laboratory testing and imaging can support the diagnosis, but the criterion standard is diagnostic arthrocentesis. Treatment involves intravenous antibiotics and joint decompression.
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Mediamolle N, Mallet C, Aupiais C, Doit C, Ntika S, Vialle R, Grimprel E, Pejin Z, Bonacorsi S, Lorrot M. Bone and joint infections in infants under three months of age. Acta Paediatr 2019; 108:933-939. [PMID: 30188592 DOI: 10.1111/apa.14569] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/20/2018] [Accepted: 09/04/2018] [Indexed: 01/04/2023]
Abstract
AIM Studies on bone and joint infections (BJI) in infants under three months are rare. We described the clinical and paraclinical features and outcomes of infants hospitalised with BJI under three months of age. METHODS The French National Hospital Discharge Database provided data on BJIs in infants under three months of age from January 2004 to 2015 in three Parisian Paediatric teaching hospitals. RESULTS We included 71 infants under three months of age with BJI, the median age was 25 days, and the interquartile range (IQR) was 17-43 days. The most common infection sites were the hip (32%) and knee (32%). Symptoms included pain (94%), limited mobility (87%) and/or fever (52%). There were 11 (15.5%) cases of nosocomial BJI. A pathogen was identified in 51 infants (71.8%), including Streptococcus agalactiae (45%), Staphylococcus aureus (22%) and Escherichia coli (18%). The initial median C-reactive protein test rate was 31 mg/L (IQR 17-68). Of the 34 infants followed for more than one year, four developed severe orthopaedic conditions such as epiphysiodesis, limb length discrepancy, bone necrosis and/or impaired limb function. CONCLUSION Streptococcus agalactiae was the most common cause of BJI in infants under three months. Orthopaedic sequelae were rare, but severe, and required long-term follow-up.
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Affiliation(s)
- Nicolas Mediamolle
- Paediatric Department‐Division of infectious disease Armand Trousseau Hospital, AP‐HP Paris France
| | - Cindy Mallet
- Department of Pediatric Orthopedic Surgery Robert Debré Hospital AP‐HP Paris France
| | - Camille Aupiais
- Department of Pediatric Emergency Care Inserm U1123 and CIC‐EC 1426, Inserm, U1138, Equipe 22 Robert Debré Hospital AP‐HP Université Paris Diderot Sorbonne Paris‐Cité Paris France
| | - Catherine Doit
- Department of Microbiology Associated‐National Reference Center for Escherichia Coli UMR 1137, INSERM Robert Debré Hospital APHP Paris France
| | - Serge Ntika
- Pediatric Department Centre hospitalier de Blois Blois France
| | - Raphael Vialle
- Department of Pediatric Orthopedic Surgery Armand Trousseau Hospital APHP Paris France
| | - Emmanuel Grimprel
- Paediatric Department‐Division of infectious disease Armand Trousseau Hospital, AP‐HP Paris France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique Société Française de Pédiatrie Paris France
| | - Zagorka Pejin
- Pediatric Orthopedic Surgery Necker‐Enfants‐Malades Hospital AP‐HP Paris France
| | - Stephane Bonacorsi
- Department of Microbiology Associated‐National Reference Center for Escherichia Coli UMR 1137, INSERM Robert Debré Hospital APHP Paris France
| | - Mathie Lorrot
- Paediatric Department‐Division of infectious disease Armand Trousseau Hospital, AP‐HP Paris France
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique Société Française de Pédiatrie Paris France
- Inserm UMR 1123 ECEVE Sorbonne Paris Cité France
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Kim J, Lee MU, Kim TH. Nationwide epidemiologic study for pediatric osteomyelitis and septic arthritis in South Korea: A cross-sectional study of national health insurance review and assessment service. Medicine (Baltimore) 2019; 98:e15355. [PMID: 31027117 PMCID: PMC6831362 DOI: 10.1097/md.0000000000015355] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Epidemiologic studies of pediatric bone and joint infection have been done mostly by developed Western countries, and such results could be expected to be biased. Therefore, an epidemiologic study to identify the distinct features of an Eastern country would be beneficial to improve their health outcomes and to reduce health care cost. A study was planned to investigate the epidemiology of pediatric osteomyelitis and septic arthritis in South Korea and to find out epidemiologic factors related with the occurrence of surgery.We conducted a cross-sectional study among hospitalized pediatric patients (<18 years old) with osteomyelitis and septic arthritis using nationwide cohort based on the Health Insurance Review and Assessment Service (HIRA) from 2008 to 2016. Percentage of hospitalization was additionally calculated according to several epidemiologic factors including age, month, site of infection, and region of residence. Logistic regression analysis was performed to find out the association between epidemiologic factors and occurrence of surgeryAnnual hospitalization rates (per 100,000) in our country were 7.8 to 9.1 for osteomyelitis, and 11.9 to 20.8 for septic arthritis. Frequent sites of osteomyelitis and septic arthritis were pelvis and lower extremity. The hospitalization rates of osteomyelitis and septic arthritis showed increasing trend with age. After multivariate logistic regression analysis, female gender, children, and adolescents rather than infants, rural area rather than urban area were associated with significantly increased odd ratios for surgery.The hospitalization rate of septic arthritis (11.9 to 20.8 per 100,000) in South Korea was higher than the Western countries (1.1 to 11 per 100,000), and the hospitalization rate of osteomyelitis (peak at 12 years) and septic arthritis (peak at 17 years) showed increasing trend with age, which was different from those of the developed Western countries showing higher incidence in children aged under 5 years. After multivariate logistic regression analysis, our study identified female gender, higher age group including children, and adolescents, and rural residence as epidemiologic risk factors associated with surgery.
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Affiliation(s)
- Jihye Kim
- Division of Infection, Department of Pediatrics, Kangdong Sacred Heart Hospital, Seoul
| | - Min Uk Lee
- Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
| | - Tae-Hwan Kim
- Department of Orthopedics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, South Korea
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Yagupsky P. Microbiological Diagnosis of Skeletal System Infections in Children. Curr Pediatr Rev 2019; 15:154-163. [PMID: 30961502 DOI: 10.2174/1573396315666190408114653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 03/23/2019] [Accepted: 03/26/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND If not timely diagnosed and adequately treated, skeletal system infections in children may result in severe and permanent disability. Prompt identification of the etiology of the disease and determination of its antibiotic susceptibility are crucial for the successful management of septic arthritis, osteomyelitis, and spondylodiscitis. However, the bacteriological diagnosis of these infections has been traditionally limited by the low yield of conventional cultures and, on average, one-third of cases of pediatric joint and bone infections remained unconfirmed. OBJECTIVE To review the medical literature to summarize the current approach diagnosing the pediatric skeletal system infections. METHODS The relevant publications for the last three decades were reviewed. RESULTS In recent years, the detection of skeletal system pathogens has been revolutionized by the use of improved laboratory methods, including seeding of synovial fluid and bone exudates into blood culture vials, and the development and implementation of sensitive nucleic acid amplification assays. These advances have resulted in the recognition of Kingella kingae as the predominant etiology of hematogenous infections of bones, joints, intervertebral discs and tendon sheaths in children aged 6-48 months, and reduced the fraction of culture-negative osteoarthritis. CONCLUSION As the exudate and tissue samples obtained from young children with skeletal system infections are frequently insufficient for a comprehensive laboratory workup, physicians should take in consideration the patient's age, predisposing medical conditions and possible exposure to zoonotic organisms, and use a judicious combination of Gram's stain, culture on blood culture vials, and molecular tests to maximize the microbiological diagnosis of these diseases.
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Affiliation(s)
- Pablo Yagupsky
- Clinical Microbiology Laboratory, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
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31
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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Laurent E, Petit L, Maakaroun-Vermesse Z, Bernard L, Odent T, Grammatico-Guillon L. National epidemiological study reveals longer paediatric bone and joint infection stays for infants and in general hospitals. Acta Paediatr 2018; 107:1270-1275. [PMID: 28477437 DOI: 10.1111/apa.13909] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/06/2017] [Accepted: 05/03/2017] [Indexed: 11/30/2022]
Abstract
AIM Published studies have suggested that two to five days of intravenous treatment could effectively treat paediatric bone and joint infections (PBJI), allowing a faster discharge. This study analysed the factors associated with PBJI hospital stays lasting longer than five days using the French National Hospital Discharge Database. METHODS We selected children under 15 years hospitalised in 2013 with haematogenous PBJIs using a validated French algorithm based on specific diagnosis and surgical procedure codes. Risk factors for stays of more than five days were analysed using logistic regression. RESULTS In 2013, 2717 children were hospitalised for PBJI, with 49% staying more than five days. The overall incidence of 22 per 100 000, was highest in males and toddlers. The main causes were septic arthritis (50%) and osteomyelitis (46%) and 50% of the pathogens were Staphylococci. The odd ratios for stays of five days or more were infancy, coded bacteria and sickle cell disease (7.0), having spondylodiscitis rather than septic arthritis (2.2) and being hospitalised in a general hospital rather than a teaching hospital (1.6). CONCLUSION Half of the hospital stays exceeded five days, despite scientific evidence supporting a shorter intravenous antibiotherapy regimen. Greater knowledge and widespread use of short treatment regimens are needed.
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Affiliation(s)
- E Laurent
- Epidemiology Unit; Teaching Hospital of Tours; Tours France
- Research Team EE1 EES; François Rabelais University; Tours France
| | - L Petit
- Epidemiology Unit; Teaching Hospital of Tours; Tours France
- Paediatric Unit; Teaching Hospital of Tours; Tours France
| | - Z Maakaroun-Vermesse
- Paediatric Unit; Teaching Hospital of Tours; Tours France
- Infectious Diseases Unit; Teaching Hospital of Tours; Tours France
| | - L Bernard
- Infectious Diseases Unit; Teaching Hospital of Tours; Tours France
- François Rabelais University; Tours France
| | - T Odent
- François Rabelais University; Tours France
- Paediatric Orthopaedic Unit; Teaching Hospital of Tours; Tours France
| | - L Grammatico-Guillon
- Epidemiology Unit; Teaching Hospital of Tours; Tours France
- François Rabelais University; Tours France
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JAÑA NETO FREDERICOCARLOS, ORTEGA CAROLINESARTORI, GOIANO ELLENDEOLIVEIRA. EPIDEMIOLOGICAL STUDY OF OSTEOARTICULAR INFECTIONS IN CHILDREN. ACTA ORTOPEDICA BRASILEIRA 2018; 26:201-205. [PMID: 30038548 PMCID: PMC6053965 DOI: 10.1590/1413-785220182603145650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the characteristics of patients diagnosed with pediatric osteoarticular infections treated in a level III trauma center in São Paulo, Brazil. METHODS We retrospectively analyzed patients admitted between September 2012 and August 2014. The outcomes analyzed were: age, sex, diagnosis, etiologic agent, anatomic location, time to diagnosis, history of previous trauma and infection, laboratory tests, treatment, and complications. RESULTS Twenty patients were included, 50% with septic arthritis, 35% with osteomyelitis, and 15% with both. Boys were predominant (80%), and the mean age was 6.6 years. The most common etiologic agent was Staphylococcus aureus. C-reactive protein value and erythrocyte sedimentation rate were elevated. The infections were treated with antibiotic therapy (intravenous and oral) and oxacillin was most frequently used. Most patients underwent at least one surgical procedure, and 35% of patients had complications. CONCLUSION This epidemiological mapping identified clinical and demographic characteristics which are useful for improving preparation for care. Future prospective studies with longer patient follow-up and the development of treatment protocols are needed to improve therapeutic decision-making and the prognosis of children with suspected osteoarticular infections. Evidence Level II; Prognostic studies - Investigation of the effect of patient characteristics on the outcome of the disease.
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French hospital discharge database (PMSI) and bacterial resistance: Is coding adapted to hospital epidemiology? Med Mal Infect 2018; 48:465-473. [PMID: 29673880 DOI: 10.1016/j.medmal.2018.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/27/2017] [Accepted: 03/20/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE A preliminary analysis of data consistency on different types of bacterial resistance by infection site and causative agents was conducted using the French hospital discharge database (French acronym PMSI) to assess the use of the database in a national cartography tool. MATERIAL AND METHODS Hospital stays in medical, surgical, and obstetrical units were extracted from the 2014 PMSI database using the ICD-10 diagnosis codes. Bacterial infections, causative agents, and resistance corresponding to these stays were also identified. RESULTS Data from 1258462 patients, corresponding to a total of 1617893 stays, was extracted. Among these stays, 46% were associated with a bacteria code and 7% with a resistance code. Lower respiratory tract infections were the most frequent infections (32% of stays; pneumonia in 95% of cases), followed by genitourinary infections (26%), intra-abdominal infections and diarrhoeas (24%), and skin and soft tissue infections (15%). Inconsistencies were observed between the types of infection and associated bacteria and between bacteria and associated resistance. These inconsistencies are likely due to initial coding errors. CONCLUSION The cartography of bacterial infections cannot be developed using the data of the current PMSI coding. These results underline the need to improve the coding of PMSI data for its use as a complementary tool of epidemiological surveillance of bacterial infections.
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35
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Pfaller MA, Flamm RK, Castanheira M, Sader HS, Mendes RE. Dalbavancin in-vitro activity obtained against Gram-positive clinical isolates causing bone and joint infections in US and European hospitals (2011–2016). Int J Antimicrob Agents 2018; 51:608-611. [DOI: 10.1016/j.ijantimicag.2017.12.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 10/13/2017] [Accepted: 12/16/2017] [Indexed: 10/18/2022]
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Osteomyelitis in Cat-Scratch Disease: A Never-Ending Dilemma-A Case Report and Literature Review. Case Rep Pediatr 2018; 2018:1679306. [PMID: 29808150 PMCID: PMC5902065 DOI: 10.1155/2018/1679306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 12/20/2022] Open
Abstract
Background We performed a review of published case studies of osteomyelitis associated with cat-scratch disease to consolidate existing information on clinical presentation, diagnostic tools, therapy, and outcome, as well as presenting a case of disseminated cat-scratch disease in a 12-year-old female with skull osteomyelitis and spleen involvement. Methods A search for articles indexed in PubMed, Embase, and Google Scholar was performed with the search terms "Bartonella," "bone," "osteomyelitis," "osteolytic," and "cat-scratch disease" limited to the immunocompetent pediatric population and articles in English. Results 51 cases were identified. The average age was 7.8 years with equal sex distribution. Fever (84.3%), often with a prolonged course (64.7%), and osteoarticular pain (88.2%) were the most common clinical findings. Lymphadenopathy was present in 64.7% of patients. Vertebral body was mainly involved (51.9%). MRI (50%) and bone scintigraphy (48.1%) were favored to confirm osteomyelitis, while serology was the preferred microbiological diagnostic. Various antibiotics were prescribed in combined or sequential regimens, with median duration of therapy of 23 days. About 12.5% of patients did not receive any treatment. Most patients had excellent prognosis; in particular, all patients not receiving any therapy showed complete recovery and no recurrence of symptoms. Conclusions Bartonella henselae should be considered in differential diagnosis of localized lymphadentitis. Osteoarticular pain or limitation during cat-scratch disease in children should always be investigated for bone spreading. Owing to good prognosis, invasive procedures to obtain the bone material should be avoided. Serology is the gold standard diagnostic tool and MRI is the best radiographic technique to define bone and surrounding tissue involvement. Treatment represents a never-ending dilemma: surgical intervention or use of antibiotics is still controversial, and more studies are needed to define the best antimicrobial regimen.
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Laurent E, Gras G, Druon J, Rosset P, Baron S, Le-Louarn A, Rusch E, Bernard L, Grammatico-Guillon L. Key features of bone and joint infections following the implementation of reference centers in France. Med Mal Infect 2018. [PMID: 29526340 DOI: 10.1016/j.medmal.2018.02.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES French reference centers for bone and joint infections (BJI) were implemented from 2009 onwards to improve the management of complex BJIs. This study compared BJI burden before and after the implementation of these reference centers. PATIENTS AND METHODS BJI hospital stays were selected from the 2008 and 2013 national hospital discharge database using a validated algorithm, adding the new complex BJI code created in 2011. Epidemiology and economic burden were assessed. RESULTS BJI prevalence increased in 2013 (70 vs. 54/100,000 in 2008). Characteristics of BJI remained similar between 2008 and 2013: septic arthritis (50%), increasing prevalence with age and sex, case fatality 5%, mean length of stay 17.5 days, rehospitalization 20%. However, device-associated BJIs increased (34 vs. 26%) as well as costs (€421 million vs. €259 in 2008). Similar device-associated BJI characteristics between 2008 and 2013 were: septic arthritis (70%), case fatality (3%), but with more hospitalizations in reference centers (34 vs. 30%) and a higher cost per stay. Among the 7% of coded complex BJIs, the mean length of stay was 22.2 days and mean cost was €11,960. CONCLUSIONS BJI prevalence highly increased in France. Complex BJI prevalence assessment is complicated by the absence of clinical consensus and probable undercoding. A validation of clinical case definition of complex BJI is required.
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Affiliation(s)
- E Laurent
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Équipe de Recherche EE1 EES, université de Tours, 37000 Tours, France.
| | - G Gras
- Service de maladies infectieuses, CHRU de Tours, 37000 Tours, France
| | - J Druon
- Service de chirurgie orthopédique, CHRU de Tours, 37000 Tours, France
| | - P Rosset
- Service de chirurgie orthopédique, CHRU de Tours, 37000 Tours, France; Faculté de médecine, université de Tours, 37000 Tours, France
| | - S Baron
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Équipe de Recherche EE1 EES, université de Tours, 37000 Tours, France
| | - A Le-Louarn
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France
| | - E Rusch
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Équipe de Recherche EE1 EES, université de Tours, 37000 Tours, France
| | - L Bernard
- Service de maladies infectieuses, CHRU de Tours, 37000 Tours, France; Faculté de médecine, université de Tours, 37000 Tours, France
| | - L Grammatico-Guillon
- Unité régionale d'épidémiologie hospitalière (UREH), Centre-Val de Loire, Centre Hospitalier régional universitaire (CHRU) de Tours, 37000 Tours, France; Faculté de médecine, université de Tours, 37000 Tours, France
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Pouliquen L, Daoudal A, Rabier V, Marleix S, Lucas G, Fraisse B, Violas P. Monoarthrite à Neisseria meningitidis : quelles consignes pour les personnes contact ? Presse Med 2018; 47:72-74. [DOI: 10.1016/j.lpm.2017.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 09/19/2017] [Accepted: 10/25/2017] [Indexed: 11/28/2022] Open
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Parisi MT, Otjen JP, Stanescu AL, Shulkin BL. Radionuclide Imaging of Infection and Inflammation in Children: a Review. Semin Nucl Med 2017; 48:148-165. [PMID: 29452618 DOI: 10.1053/j.semnuclmed.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
With the exception of radiolabeled monoclonal antibodies, antibody fragments and radiolabeled peptides which have seen little application in the pediatric population, the nuclear medicine imaging procedures used in the evaluation of infection and inflammation are the same for both adults and children. These procedures include (1) either a two- or a three-phase bone scan using technetium-99m methylene diphosphonate; (2) Gallium 67-citrate; (3) in vitro radiolabeled white blood cell imaging (using 111Indium-oxine or 99mTechnetium hexamethyl-propylene-amine-oxime-labeled white blood cells); and (4) hybrid imaging with 18F-FDG. But children are not just small adults. Not only are the disease processes encountered in children different from those in adults, but there are developmental variants that can mimic, but should not be confused with, pathology. This article discusses some of the differences between adults and children with osteomyelitis, illustrates several of the common developmental variants that can mimic disease, and, finally, focuses on the increasing use of 18F-FDG PET/CT in the diagnosis and response monitoring of children with infectious and inflammatory processes. The value of and need for pediatric specific imaging protocols are reviewed.
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Affiliation(s)
- Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA.; Department of Pediatrics, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA..
| | - Jeffrey P Otjen
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - A Luana Stanescu
- Department of Radiology, University of Washington School of Medicine and Seattle Children's Hospital, Seattle, WA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN
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Bruce D, Kocialkowski C, Bintcliffe F, Monsell F, Barnes J, Brown R. Analysis of a paediatric orthopaedic network: a six-year experience in the South West of the United Kingdom. J Child Orthop 2017; 11:404-413. [PMID: 29081857 PMCID: PMC5643936 DOI: 10.1302/1863-2548.11.170076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE We report our experience of a paediatric orthopaedic network, based on a 'hub and spoke' model, covering the South West of the United Kingdom. We identify the areas of most clinical concern, the effect of the network on stream-lining patient management and the benefits of the network to the clinician. METHODS Prospective data were collected from the minutes of the bi-annual meetings of the South West Paediatric Network (UK) between November 2006 and May 2012. Data collected included details of the condition, previous treatment, problems, complications and advice given. Cases continue to be followed up in subsequent meetings. RESULTS In total 131 cases were included and hip conditions were discussed most frequently (35.1%). The most common indication for discussion was to support and confirm the local management plan. In total, a mean average of 8.75 cases in total were presented per consultant during the study period, with those within ten to 12 years of starting independent practice presenting the majority. The clinical outcome for patients discussed in this forum was local provision of care in 74%, with transfer to the regional centre in 15.7%. Following advice, 14% of direct referrals were given appropriate advice and avoided a journey to the tertiary centre. CONCLUSION The network has enabled local provision of care, reduced the burden of travel on patients and prevented unnecessary referrals to the tertiary centre. Additionally, it provides a mechanism to reassure and educate clinicians.
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Affiliation(s)
- D. Bruce
- Royal United Hospital, Bath BA1 3NG, UK,Correspondence should be sent to: D. Bruce, Orthopaedic Trauma Department, Southmead hospital, Southmead Road, Bristol, BS10 5NB, United Kingdom. E-mail:
| | | | - F. Bintcliffe
- Eastbourne District General Hospital, Eastbourne BN21 2UD, UK
| | - F. Monsell
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - J. Barnes
- Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK
| | - R. Brown
- Cheltenham General Hospital, Cheltenham GL53 7AN, UK
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Mahmoudi S, Pourakbari B, Borhani K, Khodabandeh M, Valian SK, Aziz-Ahari A, Mamishi S. Acute osteomyelitis and septic arthritis in children : A referral hospital-based study in Iran. Wien Med Wochenschr 2017; 167:259-263. [PMID: 28744778 DOI: 10.1007/s10354-017-0583-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/26/2017] [Indexed: 11/25/2022]
Abstract
Information concerning the epidemiology of acute osteomyelitis (OM), septic arthritis (SA) and concurrent OM and SA in children is limited. The aim of this study was to describe the epidemiology of OM, SA and concurrent OM and SA in children. During the 4 years of the study, 63,999 patients were admitted to the Children's Hospital, Tehran, Iran. We identified 111 patients with OM and/or SA during the 4‑year period. There were 72 cases of OM (11 cases per 10,000 children) and 90 cases of SA (11 cases per 10,000 children). Concurrent OM and SA accounted for 0.17% of all cases (n = 51). The erythrocyte sedimentation rate and C‑reactive protein were elevated in the majority of both infections. Staphylococcus aureus was the most frequent pathogen responsible for both OM and SA in any age group. The lower limb was the most frequently affected (femur: 33/72, 46%; tibia or fibula: 22/72, 31%; foot: 5/72, 7%). The most frequent involved joints were hips (n = 31, 34%) and knees (n = 31, 34%). The present study showed high frequency of patients with concurrent SA and OM. Therefore, prompt recognition and proper diagnosis of pediatric OM and SA is highly recommended.
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Affiliation(s)
- Shima Mahmoudi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib St., Tehran, Iran
| | - Babak Pourakbari
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib St., Tehran, Iran
| | - Katayoun Borhani
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Khodabandeh
- Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Alireza Aziz-Ahari
- Radiology Department, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Setareh Mamishi
- Pediatric Infectious Diseases Research Center, Tehran University of Medical Sciences, No. 62, Dr. Gharib St., Tehran, Iran. .,Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
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Fonteneau L, Le Meur N, Cohen-Akenine A, Pessel C, Brouard C, Delon F, Desjeux G, Durand J, Kirchgesner J, Lapidus N, Lemaitre M, Tala S, Thiébaut A, Watier L, Rudant J, Guillon-Grammatico L. [The use of administrative health databases in infectious disease epidemiology and public health]. Rev Epidemiol Sante Publique 2017. [PMID: 28624133 DOI: 10.1016/j.respe.2017.03.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The public health burden resulting from infectious diseases requires efforts in surveillance and evaluation of health care. The use of administrative health databases (AHD) and in particular the French national health insurance database (SNIIRAM) is an opportunity to improve knowledge in this field. The SNIIRAM data network (REDSIAM) workshop dedicated to infectious diseases conducted a narrative literature review of studies using French AHD. From the results, benefits and limits of these new tools in the field of infectious diseases are presented. METHODS Publications identified by the members of the workgroup were collected using an analytical framework that documented the pathology of interest, the aim of the study, the goal of the developed algorithm, the kind of data, the study period, and the presence of an evaluation or a discussion of the performance of the performed algorithm. RESULTS Fifty-five articles were identified. A majority focused on the field of vaccination coverage and joint infections. Excluding vaccine coverage field, the aim of 28 studies was epidemiological surveillance. Twenty-six studies used hospital databases exclusively, 18 used ambulatory databases exclusively and 4 used both. Validation or discussion of the performed algorithm was present in 18 studies. CONCLUSIONS The literature review confirmed the interest of the French AHD in the infectious diseases field. The AHD are additional tools of the existing surveillance systems and their use will probably be more frequent in the coming years given their advantage and reliability. However, incoming users need to be assisted. Thus, the workgroup will contribute to a reasonable use of AHD and support future developments.
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Affiliation(s)
- L Fonteneau
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France.
| | | | - A Cohen-Akenine
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Pessel
- Haute Autorité de santé, Saint-Denis la Plaine, France
| | - C Brouard
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - F Delon
- REDSIAM, groupe de travail infectieux, France; Centre d'épidémiologie et de santé publique des armées, Marseille, France
| | - G Desjeux
- REDSIAM, groupe de travail infectieux, France; Caisse nationale militaire de sécurité sociale, Toulon, France
| | - J Durand
- REDSIAM, groupe de travail infectieux, France; Santé publique France, direction des maladies infectieuses, 12, rue du Val-d'Osne, 94415 Saint-Maurice cedex, France
| | - J Kirchgesner
- REDSIAM, groupe de travail infectieux, France; Inserm, unité mixte de recherche en santé 1136, institut Pierre-Louis d'épidémiologie et de santé publique, Paris, France
| | - N Lapidus
- REDSIAM, groupe de travail infectieux, France; Département de santé publique, Inserm, institut Pierre-Louis d'épidémiologie et de santé publique (IPLESP UMRS 1136), Sorbonne universités, UPMC université Paris 06, hôpital Saint-Antoine, AP-HP, 75000 Paris, France
| | - M Lemaitre
- REDSIAM, groupe de travail infectieux, France; Haute Autorité de santé, Saint-Denis la Plaine, France
| | - S Tala
- REDSIAM, groupe de travail infectieux, France; Département études sur l'offre de soins, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - A Thiébaut
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - L Watier
- REDSIAM, groupe de travail infectieux, France; Biostatistics, biomathematics, pharmacoepidemiology and infectious diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, université Paris-Saclay, 75000 Paris, France
| | - J Rudant
- REDSIAM, groupe de travail infectieux, France; Département études de santé publique, direction de la stratégie, des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, 26-50, avenue du Professeur-André-Lemierre, 75986 Paris cedex 20, France
| | - L Guillon-Grammatico
- REDSIAM, groupe de travail infectieux, France; Service d'information médicale d'épidémiologie et d'économie de la santé, unité régionale d'épidémiologie hospitalière (UREH), université F.-abelais, CHRU de Tours, 37000 Tours, France
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[Acute haematogenous osteomyelitis in children : Diagnostic algorithm and treatment strategies]. DER ORTHOPADE 2017; 46:541-556. [PMID: 28534215 DOI: 10.1007/s00132-017-3431-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute haematogenous osteomyelitis (AHO) in children is a severe condition. A delay in diagnosis and insufficient treatment may result in deformities, chronicity and sepsis. Therefore a structured diagnostic workup has to be followed in order to diagnose or rule out osteomyelitis. To identify the causative agent for targeted antibiotic treatment, a bone biopsy or puncture should be performed. However, approximately 25% of cases are culture-negative even after biopsy. The knowledge of the typical age-dependent bacterial spectrum is essential for empirical antibiotic therapy. The principal causative organism is Staphylococcus aureus. Surgery is not routinely required in paediatric acute osteomyelitis but surgical intervention is indicated if an abscess is detected. Secondary septic arthritis is a serious complication which has to be treated immediately by surgical intervention. Nevertheless, complete regeneration can be expected in up to 80% of children with AHO.
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Signore A, Glaudemans AWJM, Gheysens O, Lauri C, Catalano OA. Nuclear Medicine Imaging in Pediatric Infection or Chronic Inflammatory Diseases. Semin Nucl Med 2017; 47:286-303. [PMID: 28417857 DOI: 10.1053/j.semnuclmed.2016.12.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In this review article, we focus on the most recent applications of nuclear medicine techniques (mainly 99mTc/111In white blood cells (WBC) scan, [18F]-FDG-PET/CT, [18F]-FDG-PET/MRI, and 99mTc-IL-2 scintigraphy) in the study of children affected by peripheral bone osteomyelitis, fungal infections, inflammatory bowel diseases, and type 1 diabetes, owing to recent important published evidences of their role in the management of these diseases. For osteomyelitis in children, both bone scintigraphy and [18F]-FDG-PET have a major advantage of assessing the whole body in one imaging session to confirm or exclude multifocal involvement, whereas WBC scan has a limited role. In children with fungal infections, [18F]-FDG-PET can help in defining the best location for biopsy and can help in evaluating the extent of the infection and organs involved (also sites that were not yet clinically apparent), although its main role is for therapy monitoring. In inflammatory bowel diseases, and Crohn disease in particular, WBC scan has been successfully used for many years, but it is now used only in case of doubtful magnetic resonance (MR) or when MR cannot be performed and endoscopy is inconclusive. By contrast, there is an accumulating evidence of the role of [18F]-FDG-PET in management of children with Crohn disease, and PET/MR could be a versatile and innovative hybrid imaging technique that combines the metabolic information of PET with the high soft tissue resolution of MR, particularly for distinguishing fibrotic from active strictures. Finally, there are several new radiopharmaceuticals that specifically target inflammatory cells involved in the pathogenesis of insulitis aiming at developing new specific immunotherapies and to select children candidates to these treatments for improving their quality of life.
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Affiliation(s)
- Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy.
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Olivier Gheysens
- Department of Nuclear Medicine and Molecular imaging, University Hospitals Leuven, Leuven, Belgium
| | - Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and Translational Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Abstract
For a child with a suspected bone or joint infection, knowledge of the workup and initial therapy is important to provide quality care. Fever and pain are hallmarks of a pediatric osteoarticular infection, although occasionally the signs and symptoms can be more subtle. The use of C-reactive protein to diagnose and validate effective management of treatment has become standard. Multiple reports confirm the success of much shorter intravenous (IV) courses than traditionally taught. The ideal IV and oral antibiotic duration, as well as defining the markers indicating need for surgical intervention, are questions yet to be answered.
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Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis. Int J Mol Sci 2016; 17:ijms17060855. [PMID: 27258258 PMCID: PMC4926389 DOI: 10.3390/ijms17060855] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 12/15/2022] Open
Abstract
Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.
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Grammatico-Guillon L, Baron S, Gaborit C, Rusch E, Astagneau P. Quality Assessment of Hospital Discharge Database for Routine Surveillance of Hip and Knee Arthroplasty–Related Infections. Infect Control Hosp Epidemiol 2016; 35:646-51. [DOI: 10.1086/676423] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.Surgical site infection (SSI) surveillance represents a key method of nosocomial infection control programs worldwide. However, most SSI surveillance systems are considered to be poorly cost effective regarding human and economic resources required for data collection and patient follow up. This study aims to assess the efficacy of using hospital discharge databases (HDDs) as a routine surveillance system for detecting hip or knee arthroplasty–related infections (HKAIs).Methods.A case-control study was conducted among patients hospitalized in the Centre region of France between 2008 and 2010. HKAI cases were extracted from the HDD with various algorithms based on the International Classification of Diseases, Tenth Revision, and procedure codes. The control subjects were patients with hip or knee arthroplasty (HKA) without infection selected at random from the HDD during the study period. The gold standard was medical chart review. Sensitivity (Se), specificity (Spe), positive predictive value (PPV), and negative predictive value (NPV) were calculated to evaluate the efficacy of the surveillance system.Results.Among 18,265 hospital stays for HKA, corresponding to 17,388 patients, medical reports were checked for 1,010 hospital stays (989 patients). We identified 530 cases in total (incidence rate, 1% [95% confidence interval (CI), 0.4%–1.6%), and 333 cases were detected by routine surveillance. As compared with 480 controls, Se was 98%, Spe was 71%, PPV was 63%, and NPV was 99%. Using a more specific case definition, based on a sample of 681 hospital stays, Se was 97%, Spe was 95%, PPV was 87%, and NPV was 98%.Conclusions.This study demonstrates the potential of HDD as a tool for routine SSI surveillance after low-risk surgery, under conditions of having an appropriate algorithm for selecting infections.Infect Control Hosp Epidemiol 2014;35(6):646–651
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Le Meur N, Grammatico-Guillon L, Wang S, Astagneau P. Health insurance database for post-discharge surveillance of surgical site infection following arthroplasty. J Hosp Infect 2016; 92:140-6. [DOI: 10.1016/j.jhin.2015.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/11/2015] [Indexed: 12/23/2022]
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49
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Jouan Y, Grammatico-Guillon L, Espitalier F, Cazals X, François P, Guillon A. Long-term outcome of severe herpes simplex encephalitis: a population-based observational study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:345. [PMID: 26387515 PMCID: PMC4576407 DOI: 10.1186/s13054-015-1046-y] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 08/21/2015] [Indexed: 12/30/2022]
Abstract
Introduction Herpes simplex encephalitis (HSE) is a rare disease with a poor prognosis. No recent evaluation of hospital incidence, acute mortality and morbidity is available. In particular, decompressive craniectomy has rarely been proposed in cases of life-threatening HSE with temporal herniation, in the absence of evidence. This study aimed to assess the hospital incidence and mortality of HSE, and to evaluate the characteristics, management, the potential value of decompressive craniectomy and the outcome of patients with HSE admitted to intensive care units (ICUs). Methods Epidemiological study: we used the hospital medical and administrative discharge database to identify hospital stays, deaths and ICU admissions relating to HSE in 39 hospitals, from 2010 to 2013. Retrospective monocentric cohort: all patients with HSE admitted to the ICU of the university hospital during the study were included. The use of decompressive craniectomy and long-term outcome were analyzed. The initial brain images were analyzed blind to outcome. Results The hospital incidence of HSE was 1.2/100,000 inhabitants per year, 32 % of the patients were admitted to ICUs and 17 % were mechanically ventilated. Hospital mortality was 5.5 % overall, but was as high as 11.9 % in ICUs. In the monocentric cohort, 87 % of the patients were still alive after one year but half of them had moderate to severe disability. Three patients had a high intracranial pressure (ICP) with brain herniation and eventually underwent decompressive hemicraniectomy. The one-year outcome of these patients did not seem to be different from that of the other patients. It was not possible to predict brain herniation reliably from the initial brain images. Conclusions HSE appears to be more frequent than historically reported. The high incidence we observed probably reflects improvements in diagnostic performance (routine use of PCR). Mortality during the acute phase and long-term disability appear to be stable. High ICP and brain herniation are rare, but must be monitored carefully, as initial brain imaging is not useful for identifying high-risk patients. Decompressive craniectomy may be a useful salvage procedure in cases of intractable high ICP. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1046-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Youenn Jouan
- Service de Réanimation Polyvalente, CHRU Tours, 2 boulevard Tonnellé, 37000, Tours, France. .,Faculté de médecine, Université François Rabelais, 10 boulevard Tonnellé, 37032, Tours, France.
| | - Leslie Grammatico-Guillon
- Service d'information médicale, d'épidémiologie et d'économie de la santé, UREH, EE EES, Hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37000, Tours, France. .,Faculté de médecine, Université François Rabelais, 10 boulevard Tonnellé, 37032, Tours, France.
| | - Fabien Espitalier
- Faculté de médecine, Université François Rabelais, 10 boulevard Tonnellé, 37032, Tours, France. .,Département d'Anesthésie & Réanimation, Hôpital Trousseau, CHRU Tours, 2 boulevard Tonnellé, 37000, Tours, France.
| | - Xavier Cazals
- Service de Neuroradiologie, Hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37000, Tours, France.
| | - Patrick François
- Faculté de médecine, Université François Rabelais, 10 boulevard Tonnellé, 37032, Tours, France. .,Service de Neurochirurgie, Hôpital Bretonneau, CHRU Tours, 2 boulevard Tonnellé, 37000, Tours, France.
| | - Antoine Guillon
- Service de Réanimation Polyvalente, CHRU Tours, 2 boulevard Tonnellé, 37000, Tours, France. .,Faculté de médecine, Université François Rabelais, 10 boulevard Tonnellé, 37032, Tours, France.
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Saavedra-Lozano J, Calvo C, Huguet Carol R, Rodrigo C, Núñez E, Pérez C, Merino R, Rojo P, Obando I, Downey F, Colino E, García J, Cilleruelo M, Torner F, García L. Documento de Consenso SEIP-SERPE-SEOP sobre etiopatogenia y diagnóstico de la osteomielitis aguda y artritis séptica no complicadas. An Pediatr (Barc) 2015; 83:216.e1-10. [DOI: 10.1016/j.anpedi.2014.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/18/2014] [Indexed: 10/24/2022] Open
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