Bone and joint infections in infants under three months of age

Médiamolle, Nicolas; Mallet, Cindy; Aupiais, Camille; Doit, Catherine; Ntika, S.; Vialle, Raphaël; Grimprel, E.; Péjin, Zagorka; Bonacorsi, Stéphane; Lorrot, Mathie

doi:10.1111/apa.14569

Cited by 19 publications

(40 citation statements)

References 25 publications

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“…The aetiology, however, largely depends on the patient’s age ( Table 1 ). A recent multicentre study conducted in France on 71 patients aged under 3 months reported that Streptococcus agalactiae is the main community-acquired pathogen accounting for 45% of these cases, followed by S. aureus (22% of all cases) which was the most frequent microorganism in infants aged over 2 months, and Escherichia coli (18%) [ 22 ]. These findings were confirmed by Juchler et al in infants aged 0–6 months, reporting S. aureus , S. agalactiae , and E. coli as the most frequently isolated pathogens, accounting for 31%, 15%, and 8% of these cases, respectively [ 23 ].…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

“…These findings were confirmed by Juchler et al in infants aged 0–6 months, reporting S. aureus , S. agalactiae , and E. coli as the most frequently isolated pathogens, accounting for 31%, 15%, and 8% of these cases, respectively [ 23 ]. In this age group, both studies observed that Klebsiella pneumoniae and Candida albicans are particularly frequent nosocomial pathogens, and they each account for 7% of cases [ 22 ]. Among children aged between 6 months and 5 years, K. kingae is the most frequent cause of osteoarticular infections, accounting for half of these cases [ 23 ].…”

Section: Aetiology and Pathogenesismentioning

confidence: 99%

“…Although osteomyelitis is rare in this age group, it should be considered for the differential diagnosis in infants with skin infections, urinary tract anomalies, prematurity, and neonatal sepsis. Mediamolle et al reported that 94% of infants aged under 3 months showed pain, and 87% of them had functional limitations, but only 52% were febrile [ 22 ]. BJI should also be suspected in older children presenting with fever without a source, bacteraemia, and abnormal radiological findings in the evaluation of trauma.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…In the context of a paediatric emergency department, Akinkugbe et al reported microbiological isolation in only 38% of their cases [ 30 ]. On the other hand, a significantly higher success rate, approximately 70%, was reported in a population of patients aged under 3 months [ 22 ]. Calvo et al also observed that the rate of microbiological diagnosis reached 61% in the combined form of OM and SA [ 20 ].…”

Section: Diagnosismentioning

confidence: 99%

“…In neonates younger than two months, empirical treatment should be oxacillin or cefazolin and gentamicin to cover S. agalactiae and other gram-negative organisms that are common causes of BJI in this age group [ 22 , 54 , 55 ]. In children aged 3 months and over, anti-staphylococcal penicillin or a cephalosporin such as cefazolin or cefuroxime should be used to target MSSA, S. pneumoniae , GABHS and K. kingae [ 32 ].…”

Section: Antinfective Treatmentmentioning

confidence: 99%

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Update on Acute Bone and Joint Infections in Paediatrics: A Narrative Review on the Most Recent Evidence-Based Recommendations and Appropriate Antinfective Therapy

2020

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Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

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Section: Aetiology and Pathogenesismentioning

confidence: 99%