Acute infectious osteomyelitis in children: new treatment strategies for an old enemy

Congedi, Sabrina; Minotti, Chiara; Giaquinto, Carlo; Dalt, Liviana Da; Donà, Daniele

doi:10.1007/s12519-020-00359-z

Cited by 20 publications

(55 citation statements)

References 64 publications

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“…The necessary duration of intravenous versus oral antibacterial treatment remains controversial. Nowadays, a shorter duration (2 to 7 days) of intravenous antibiotics prior to oral treatment is advocated for [3,30,31,54], as it may reduce the duration of hospitalization, and thus provide economic benefits, as well as prevent complications associated with prolonged intravenous access, while studies show that it can be equally effective [30,31]. However, facts such as the clinical improvement and decrease in inflammatory markers after the initial intravenous therapy, the presence or absence of complications, and the prevalence of methicillin-resistance and other virulence factors should be taken into account when deciding when the cessation of the intravenous treatment is possible [3].…”

Section: Discussionmentioning

confidence: 99%

“…In order to optimize the strategies for switch from IV to oral antibiotic treatment in both hospitals, a consensus for locally applicable guidelines should be made, stating objectively measurable factors that support either the early or late cessation of intravenous treatment. The factors allowing for an early switch to oral antibiotics include the absence of complications (such as sepsis, haematogenous spread of the infection to other organs (pneumonia) and deep vein thrombosis), the absence of fever for at least 48 h, a significant clinical improvement (reduced or absent pain and erythema), a significant reduction in inflammatory markers (30-50% decrease in CRP levels), the absence of virulent microorganisms (such as Salmonella, MRSA, or PVL+ S. aureus), and the absence of pathogens in the repeated blood culture (if initially present) [3,54].…”

Section: Discussionmentioning

confidence: 99%

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A Comparison of the Epidemiology, Clinical Features, and Treatment of Acute Osteomyelitis in Hospitalized Children in Latvia and Norway

2021

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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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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Comparison of the Epidemiology, Clinical Features, and Treatment of Acute Osteomyelitis in Hospitalized Children in Latvia and Norway

2021

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“…11 It is common, with an incidence of 13 in 100,000, usually affecting young children. 12,13 The fastest growing bones are often more frequently affected. Therefore, the proximal humerus and tibia, and distal femur and radius are common sites of disease.…”

Section: Bacterial Osteomyelitismentioning

confidence: 99%

Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians

Furman

Restrepo

Kritsaneepaiboon

et al. 2021

Semin Musculoskelet Radiol

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Infants and children often present with a wide range of musculoskeletal (MSK) infections in daily clinical practice. This can vary from relatively benign superficial infections such as cellulitis to destructive osseous and articular infections and life-threatening deep soft tissue processes such as necrotizing fasciitis. Imaging evaluation plays an essential role for initial detection and follow-up evaluation of pediatric MSK infections. Therefore, a clear and up-to-date knowledge of imaging manifestations in MSK infections in infants and children is imperative for timely and accurate diagnosis that, in turn, can result in optimal patient management. This article reviews an up-to-date practical imaging techniques, the differences between pediatric and adult MSK infections, the spectrum of pediatric MSK infections, and mimics of pediatric MSK infections encountered in daily clinical practice by radiologists and clinicians.

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“…Staphylococcus aureus is the most commonly isolated pathogen, accounting for 70-90% of AHOM culture-positive cases [4]. Other microorganisms include Group-A Streptococcus pyogenes, Streptococcus pneumoniae, and Gram-negative rods [5]. Kingella kingae is an emergent pathogen, particularly in children aged <4 years [6].…”

Section: Introductionmentioning

confidence: 99%

“…Amoxicillin-clavulanic acid therapy would be more feasible in children. However, only a few studies are available in children with AHOM [4,5,19], and bone penetration varies from 10 to 20% [20][21][22]. The aim of our study was to evaluate the management and outcome of AHOM in a third-level Italian university hospital over ten years, with particular consideration to the possible role of amoxicillin-clavulanic acid in the empirical oral therapy in children with AHOM.…”

Section: Introductionmentioning

confidence: 99%

Amoxicillin-Clavulanic Acid Empirical Oral Therapy for the Management of Children with Acute Haematogenous Osteomyelitis

et al. 2020

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According to the Guidelines of the European Society of Pediatric Infectious Diseases (ESPID), in low methicillin-resistant Staphylococcus aureus (MRSA) prevalence settings, short intravenous therapy is recommended in uncomplicated cases of acute haematogenous osteomyelitis (AHOM), followed by empirical oral therapy, preferentially with first/second-generation cephalosporin or dicloxacillin or flucloxacillin. However, several practical issues may arise using some of the first-line antibiotics such as poor palatability or adherence problems. Clinical, laboratory and therapeutic data from children with AHOM hospitalized in one Italian Paediatric Hospital between 2010 and 2019 were retrospectively collected and analyzed. The aim of the study was to highlight the extent of the use and the possible role of amoxicillin-clavulanic acid in the oral treatment of children with AHOM. Two hundred and ten children were included. S.aureus was identified in 42/58 children (72.4% of identified bacteria); 2/42 S.aureus isolates were MRSA (4.8%). No Kingella kingae was identified. Amoxicillin-clavulanic acid was the most commonly used oral drug (60.1%; n = 107/178) and it was associated with clinical cure in all treated children. Overall, four children developed sequelae. One (0.9%) sequela occurred among the 107 children treated with amoxicillin-clavulanic acid. Our results suggest that amoxicillin-clavulanic acid might be an option for oral antibiotic therapy in children with AHOM.

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Acute infectious osteomyelitis in children: new treatment strategies for an old enemy

Cited by 20 publications

References 64 publications

A Comparison of the Epidemiology, Clinical Features, and Treatment of Acute Osteomyelitis in Hospitalized Children in Latvia and Norway

A Comparison of the Epidemiology, Clinical Features, and Treatment of Acute Osteomyelitis in Hospitalized Children in Latvia and Norway

Updates and Advances: Pediatric Musculoskeletal Infection Imaging Made Easier for Radiologists and Clinicians

Amoxicillin-Clavulanic Acid Empirical Oral Therapy for the Management of Children with Acute Haematogenous Osteomyelitis

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