Clinical characteristics of neonatal and infant osteomyelitis and septic arthritis: a multicenter retrospective study

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.

Septic Arthritis of the Elbow in a Premature Neonate: An Uncommon Disease in an Uncommon Location

Septic arthritis (SA) is an infrequent diagnosis in the neonate. This case illustrates the presentation of SA within the elbow, an atypical location for neonatal SA. SA should be considered in any neonate with joint swelling, as symptoms are often subtle. Constitutional symptoms of infection, including fever, may not be present in the neonate. Staphylococcus aureus is the most common etiologic organism, and neonatal SA is often caused by hematogenous spread partially due to unique neonatal intraosseous anatomy. Joint aspiration can provide a definitive diagnosis and aid in targeted antimicrobial therapy. Other laboratory tests, including C-reactive protein and erythrocyte sedimentation rate, can aid in diagnosis. Ultrasound and magnetic resonance imaging can demonstrate joint effusion along with osteomyelitis, which is often seen concurrently with neonatal SA. There are no definitive guidelines for the treatment of neonatal SA. Conservative therapy with antimicrobials along with surgical intervention are the mainstays of treatment. Prompt diagnosis and treatment are crucial to decrease permanent joint damage. [Pediatr Ann. 2023;52(8):e292-e296.].

Distal Tibia Epiphysiodesis After Saphenous Vein Catheterization During Treatment for Prematurity

Extravasation injuries are frequent complications, especially in extremely preterm neonates treated in neonate intensive care units (NICU). Depending on the type of the extravasated substance, the duration, and the amount of the leak, extravasation may result in necrosis of the soft tissues adjacent to the leak, compartment syndrome, and limb amputation. However, in some cases, the results of extravasation may be evident years after NICU treatment. In this case report, we describe a rare case of physeal arrest of the distal tibia in a preterm and discuss the possible causes.

Osteoarticular infections in infants under 3 months of age

BACKGROUND

Acute osteoarticular infections (OAI) in infants under 3 months of age (≤3M) are rare and remain a diagnostic challenge. Orthopedic complications and functional sequelae have been less well described in this age group. Our aims were to evaluate trends in aetiology, management, and outcomes of OAI ≤ 3M, and to compare these younger children who have OAI with older children.

METHODS

A longitudinal observational study was conducted of OAI cases admitted to tertiary care pediatric hospital from 2008 to 2018. OAI ≤ 3M was compared with children above 3 months. Clinical, microbiological, imaging, and outcome data were analyzed.

RESULTS

We identified 24 (9.1%) of the 263 OAI in children under 3 months. Analyzing OAI ≤ 3M there was a twofold increase since 2014; 54% were males with a median age of 28 days (IQR: 13.5-60.0), 10 (41.7%) were premature and nine (37.5%) had healthcare-associated infections. Microbiological causes were identified in 87.5%, mostly Staphylococcus aureus (57.1%) and Group B Streptococcus (23.8%), and 25% were multidrug-resistant (5 methicillin-resistant S. aureus and 1 Enterobacter cloacae). Bacteremia (100% vs 36.8%, P = 0.037), multidrug resistant bacteria (75% vs 16, P = 0.04), and healthcare-associated infections (100% vs 26.3%, P = 0.014) were associated with sequelae. Comparing OAI ≤ 3M with older children, OAI ≤ 3M were treated with longer antibiotic courses, had more complications and sequelae (17.4% vs 3.2%, P = 0.002).

CONCLUSIONS

S. aureus is still the most common cause of OAI ≤ 3M, and 25% of causative bacteria were multidrug-resistant bacteria. Complications and sequelae were more frequent in OAI ≤ 3M when compared with older children.

Clinical, biological and bacteriological characteristics of osteoarticular infections in infants less than 12 months of age

Aim: This retrospective study's objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children <6 months, whereas Kingella kingae has become the most frequently isolated microorganism in infants aged from 6 to 12 months old.

Physeal separation and complete resorption of femoral head associated with chronic osteomyelitis of femoral diaphysis in a young child: rare case report

We report the case of a two and a half-year-old girl who presented with injury to the right thigh along with a discharging sinus in the midthigh region following a nonorthopaedic surgical procedure. Radiographs of the thigh indicated osteomyelitis of the femoral diaphysis with pathological fracture. During follow-up examination, shortening was observed in the affected limb, along with complete separation of the femoral epiphysis with partial resorption of the femoral head. A few cases of physeal separation of the femoral head following osteomyelitis of the femoral diaphysis have been reported in the published literature, but still it may go undiagnosed until late stages because of the lack of awareness among orthopaedicians about this entity. There was no history of any precipitating trauma to the hip. This case is of interest because of the difficulty in making differential diagnosis at the first evaluation; there was an orthopaedic misdiagnosis on the basis of the lack of complete preoperative imaging. Because of the devastating sequelae on immature skeleton including limb shortening, osteomyelitis, epiphyseal separation of proximal epiphysis and pathological fracture of shaft femur, the importance of early diagnosis, complete preoperative imaging and prompt treatment must be overemphasized.

A Neonatal Septic Arthritis Case Caused by Klebsiella pneumoniae: A Case Report

Septic arthritis is encountered very rarely during the neonatal period and its diagnosis can delay because of atypical symptoms, thus it may lead to serious sequelae. The sequale can be prevented by early diagnosis and concomitant treatment. In neonates, pain can be experienced as a result of pseudoparalysis and of movement of the effected joints. A 17-day-old neonatal patient was brought to our hospital with complaint of unrest and then diagnosed with septic arthritis due to propagation of Klebsiella pneumoniae in joint fluid culture was represented because of the rarity of such a case.

Clinical and epidemiological differences between septic arthritis of the knee and hip caused by oxacillin-sensitive and -resistant s. aureus

OBJECTIVE

To establish the risk factors for joint infection by oxacillin-resistant Staphylococcus aureus (MRSA) using clinical and epidemiological data.

METHODS

All septic arthritis cases of the knee and hip diagnosed and treated in our institution from 2006 to 2012 were evaluated retrospectively. Only patients with cultures identified as microbial agents were included in the study. The clinical and epidemiological characteristics of the patients were analyzed, seeking the differences between populations affected by MRSA and oxacillin-sensitive Staphylococcus aureus (MSSA).

RESULTS

S. aureus was isolated in thirty-five patients (46.0%) in our total sample, 25 in the knee and 10 in the hip. Of these 35 patients, 22 presented with MSSA and 13 presented with MRSA. Provenance from a health service-related environment, as described by the Centers for Disease Control and Prevention, was the only variable associated with oxacillin-resistant strains of this bacterium (p = 0.001).

CONCLUSION

Provenance from a health service-related environment was associated with a higher incidence of MRSA-related septic arthritis, suggesting that this agent should be considered in the initial choice of antibiotic treatment. Previous surgeries of the knee or affected limb and the absence of leukocytes might also be related to infection with this agent.

Acute osteomyelitis as cause of late sepsis in a nigerian neonate

Neonatal osteomyelitis (NO) is said to be rare and uncommonly reported in the sub-region. Although this may be true, either because the cases are under-diagnosed, unreported or under-reported. The diagnosis is clinical and supported with blood culture or the aspiration of pus with radiological findings. We report a case of a neonate with acute osteomyelitis of the right femur, diagnosed at 10(th) day of life, which was confirmed with blood culture and radiogram findings of the right upper thigh of the baby. To the best of our knowledge, this is the first documented reported case of NO from the south-eastern Nigeria. It is imperative to recognize the clinical presentation necessary to raise the suspicion of NO and other focal infection in the newborn. With thorough examination and selected investigation the focus of infection in the neonate can be detected.

Epidemiology of septic arthritis of the knee at Hospital das Clínicas, Universidade de São Paulo

Background

Septic arthritis is an infrequent disease although very important due to the possibility of disastrous outcomes if treatment is not adequately established. Adequate information concerning the epidemiology of septic arthritis is still lacking due to the uncommon nature of the disease as well as the struggle to establish a correct case-definition.

Objective

To epidemiologically characterize the population seen at Hospital das Clínicas, University of São Paulo with a diagnosis of septic arthritis between 2006 and 2011.

Methods

Sixty-one patients diagnosed with septic arthritis of the knee between 2006 and 2011 were retrospectively evaluated. The patients’ clinical and epidemiological characteristics, the microorganisms that caused the infection and the patients’ treatment and evolution were analyzed.

Results

Septic arthritis of the knee was more common among men, with distribution across a variety of age ranges. Most diagnoses were made through positive synovial fluid cultures. The most prevalent clinical comorbidities were systemic arterial hypertension and diabetes mellitus, and the most commonly reported joint disease was osteoarthritis. Staphylococcus aureus was the prevailing pathogen. Fever was present in 36% of the cases. All patients presented elevation in inflammatory tests. Gram staining was positive in only 50.8% of the synovial fluid samples analyzed. Six patients presented complications and unfavorable evolution of their condition.

Conclusion

S. aureus is still the most common pathogen in acute knee infections in our environment. Gram staining, absence of fever and normal leukocyte count cannot be used to rule out septic arthritis.

Osteomyelitis as a manifestation of perinatal Human Immunodeficiency Virus disease

We report a premature neonate born of Human Immunodeficiency Virus (HIV)-1 positive mother presenting with extensive osteomyelitis and massive periosteal reaction involving both femurs and left tibia. There was no collection of fluid in soft tissue or joints in ultrasonography and Doppler examination showed normal venous return in both the lower limbs. Blood culture revealed growth of Candida albicans sensitive to fluconazole. The mother did not take any antenatal care and her HIV status was evident only after delivery during routine screening. DNA PCR for HIV-1 of the neonate done on day 45 and day 48 were positive with a viral load of 12 million copies/mL and his CD4 count was 24%. He was diagnosed as severe HIV-associated clinical disease with severe immunosuppression as per WHO classification and was put on combination antiretroviral therapy, Pneumocystis chemoprophylaxis and fluconazole. He responded well to treatment, repeat x-ray done at 4 months was normal except mild bowing of both the femurs. In the present case we wanted to emphasize the need of proper antenatal care and universal HIV-testing as the key to prevent mother-to-child transmission and severe HIV disease as in this case.

Hematogenous infantile infection presenting as osteomyelitis and septic arthritis: a case report

The case of a 6-month old male infant presenting at the emergency department with fever and swelling at the left knee joint is discussed. Laboratory tests showed an inflammatory condition. Left knee plain radiograph demonstrated local soft tissue oedema. Percutaneous needle aspiration of articular fluid showed a positive culture for Staphylococcus aureus. The diagnosis of septic arthritis was confirmed. Because of inadequate response to treatment an MRI study was followed to evaluate possible abscesses. The presence of an abscess in the suprapatellar bursa was confirmed and an additional inflammatory process of the bone marrow was revealed, consistent with osteomyelitis. The pathophysiology, the imaging findings, the patient's management and a review of septic arthritis and osteomyelitis coexistence are presented in this paper.