Epidemiology of paediatric pyogenic musculoskeletal infections in a developing country

Abstract

Background: Epidemiological data regarding paediatric pyogenic musculoskeletal infections from developing countries of Asia and Africa are sparse and is further complicated by presence of factors like malnutrition, delay in initiating treatment, belief in alternative form of treatment and under vaccination. The aim of this study is to retrospectively analyse the cases of paediatric pyogenic musculoskeletal infections in a tertiary care centre in India. Methods: It is a retrospective study including patients below 18 years of age who had been diagnosed with any pyogenic musculoskeletal infection. Demographic, clinical, laboratory and radiological details were collected. Results: A total of 216 children with mean age of 12.8±4.9 years (10 days – 18 years) were included in the study. The causative organism could be isolated in 98 cases (45.3%). Escherichia coli and methicillin sensitive Staphylococcus aureus were the most common pathogens isolated in infants and children, respectively. Imipenem and linezolid were the commonest sensitive antibiotics for children up to 10 years and after 10 years, respectively. Linezolid was the antibiotic of choice in culture negative cases. The majority (78.3%, n = 169) of the children underwent a surgical procedure during the stay at the hospital. Higher relapse rate (61%) was noted in negative culture patients. Conclusion: Improved methods of pathogen detection should be explored to improve the rate of positive cultures. Additional prospective studies with longer patient follow-up and the creation of care protocols are necessary to improve therapeutic decision-making and the prognosis for children with suspected musculoskeletal infection.

Neighborhood Deprivation and Treatment Challenges in Pediatric Musculoskeletal Infections: A Socioeconomic Analysis

“…The present study found that osteomyelitis was the most prevalent pediatric MSK infection, consistent with prior research indicating a higher incidence of osteomyelitis compared to cellulitis and septic arthritis in this population [ 5 , 13 , 14 ]. Additionally, Staphylococcus aureus was identified as the primary causative organism, accounting for 82.8% of cases.…”

“…This could potentially skew the study results, especially in areas where housing prices are high but disadvantaged communities still exist [ 18 ]. Furthermore, the inclusion of pyomyositis, although not typically managed by orthopedic surgeons, was done due to its association with MSK infectious pathologies as indicated in the literature [ 5 , 13 ]. However, it is important to note that the management of these pathologies often involves a multi-specialty approach, whereas this study focused solely on orthopedic management [ 19 ].…”

“…Musculoskeletal (MSK) infections, such as osteomyelitis, septic arthritis, and pyomyositis, are increasingly prevalent among pediatric populations, affecting approximately 80 out of 100,000 children annually [ 1 ]. Staphylococcus aureus remains the most common causative organism, isolated in about 40% to 90% of cases of MSK infection, although other pathogens like Kingella kingae are also emerging as notable pathogens, particularly in younger children [ 2 - 4 ] Without timely treatment, these infections can lead to severe complications such as chronic infections, bacteremia, and sepsis, emphasizing the critical need for prompt diagnosis and appropriate treatment [ 5 ].…”

Comparison of Various Joint Decompression Techniques in Septic Arthritis of the Hip in Children: A Systematic Review and Meta-Analysis

“…The choice of empirical antibiotic should be as per the local antibiogram and a specialty opinion regarding infectious diseases may be obtained. Clindamycin and linezolid are the antibiotics of choice in areas with methicillin-sensitive S. aureus endemicity 32) . Once the clinical and biochemical markers show improvement, oral antibiotics can be administered for replacement of the intravenous route.…”

“…Once the clinical and biochemical markers show improvement, oral antibiotics can be administered for replacement of the intravenous route. The ideal duration of antibiotic administration has not yet been determined; however, a two-week course of intravenous antibiotics followed by four weeks of oral antibiotics seems reasonable 31 32) .…”