Musculoskeletal Infection in Pediatrics

Cooper, A.; Shope, Alexander J.; Javid, Mahzad; Parsa, Ali; Chinoy, Muhammad Amin; Parvızı, Javad

doi:10.2106/jbjs.19.00572

Cited by 22 publications

(12 citation statements)

References 16 publications

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“…Though great efforts have been made to reach a consensus regarding the development of evidence-based guidelines for the diagnosis and management of musculoskeletal infections in children [1,3], little evidence was obtained from randomized control studies with large patient populations [3], as acute osteomyelitis in children living in developed countries is rare [6][7][8]. Rather, the consensus largely relies on expert opinions, case series, and cohort studies [1,3,10]. Deviations from clinical practice guidelines, such as the recommended duration of intravenous antibacterial therapy, have been observed due to the clinical judgement of physicians as to what is more appropriate for their patients [32].…”

Section: Discussionmentioning

confidence: 99%

“…In CCUH, the proportion of patients in whom antimicrobial therapy was initiated on the day of admission was also higher than in SSK. As the outcome of acute osteomyelitis is time-sensitive [1][2][3], a greater emphasis on the early recognition of osteomyelitis should be placed, and the necessary access to healthcare should be rapidly provided for patients with suspected musculoskeletal infections.…”

Section: Discussionmentioning

confidence: 99%

“…Paediatric musculoskeletal infections are a wide spectrum of disorders that may result in major life-threatening and limb-threatening complications if they are not recognized and treated early [1][2][3]. Acute haematogenous bone and joint infections in children may clinically manifest as osteomyelitis, septic arthritis, a combination of osteomyelitis and septic arthritis, or pyomyositis [3].…”

Section: Introductionmentioning

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%

Section: Introductionmentioning

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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“…Whether or not these host responses can safely be targeted to mitigate bone destruction without significantly impacting critical innate immune responses remains to be determined. Recently, the International Consensus Meeting on Musculoskeletal Infection was convened, which outlined additional major challenges in the field and future research objectives (156)(157)(158). In summary, understanding both the bacterial and host factors that contribute to antibiotic tolerance or failure is therefore a key direction for future research.…”

Section: Conclusion and Opportunities For Future Researchmentioning

confidence: 99%

Staphylococcus aureus Osteomyelitis: Bone, Bugs, and Surgery

2020

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Osteomyelitis, or inflammation of bone, is most commonly caused by invasion of bacterial pathogens into the skeleton. Bacterial osteomyelitis is notoriously difficult to treat, in part because of the widespread antimicrobial resistance in the preeminent etiologic agent, the Gram-positive bacterium Staphylococcus aureus. Bacterial osteomyelitis triggers pathological bone remodeling, which in turn leads to sequestration of infectious foci from innate immune effectors and systemically delivered antimicrobials. Treatment of osteomyelitis therefore typically consists of long courses of antibiotics in conjunction with surgical debridement of necrotic infected tissues. Even with these extreme measures, many patients go on to develop chronic infection or sustain disease comorbidities. A better mechanistic understanding of how bacteria invade, survive within, and trigger pathological remodeling of bone could therefore lead to new therapies aimed at prevention or treatment of osteomyelitis as well as amelioration of disease morbidity. In this minireview, we highlight recent developments in our understanding of how pathogens invade and survive within bone, how bacterial infection or resulting innate immune responses trigger changes in bone remodeling, and how model systems can be leveraged to identify new therapeutic targets. We review the current state of osteomyelitis epidemiology, diagnostics, and therapeutic guidelines to help direct future research in bacterial pathogenesis.

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“…Infection is the most drastic complication following arthroplasty. In general, the risk of infection is considered to be low (1–2%), but increases by up to 50% in patients with a wide range of cumulative morbidities ( 1 , 2 ). Debridement and implant retention with mobile part exchange of the prosthesis is the recommended treatment for patients with an acute prosthetic joint infection (PJI) ( 2 , 3 ).…”

Section: Introductionmentioning

confidence: 99%

Economic Study of 2-Stage Exchange in Patients With Knee or Hip Prosthetic Joint Infection Managed in a Referral Center in France: Time to Use Innovative(s) Intervention(s) at the Time of Reimplantation to Reduce the Risk of Superinfection

et al. 2021

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Objective: Chronic prosthetic joint infections (PJI) are serious complications in arthroplasty leading to prosthesis exchange and potential significant costs for health systems, especially if a subsequent new infection occurs. This study assessed the cost of chronic PJI managed with 2-stage exchange at the Lyon University Hospital, CRIOAc Lyon reference center, France. A threshold analysis was then undertaken to determine the reimbursement tariff of a hypothetical preventive device usable at the time of reimplantation, which possibly enables health insurance to save money according to the risk reduction of subsequent new infection. This analysis was also performed for a potential innovative device already available on the market, a dual antibiotic loaded bone cement used to fix cemented prosthesis that releases high concentrations of gentamicin and vancomycin locally (G+V cement).Method: Patients >18 years, admitted for a hip or knee chronic PJI managed with 2-stage exchange, between January 1, 2013, and December 31, 2015, were retrospectively identified. Following, resource consumption in relation to inpatient hospital stay, hospitalization at home, rehabilitation care, outpatient antibiotic treatments, imaging, laboratory analysis, and consultations were identified and collected from patient records and taken into account in the evaluation. Costs were assessed from the French health insurance perspective over the 2 years following prosthesis reimplantation.Results: The study included 116 patients (median age 67 y; 47% hip prosthesis). Mean cost of chronic PJI was estimated over the 2 years following prosthesis reimplantation at €21,324 for all patients, and at €51,697 and €15,745 for patients with (n = 18) and without (n = 98) a subsequent new infection after reimplantation, respectively. According to the threshold analysis the reimbursement tariff (i) should not exceed €2,820 for a device which can reduce the risk of a new infection by 50% and (ii) was between €2,988 and €3,984 if the G + V cement can reduce the risk of a new infection by 80% (this reduction risk is speculative and has to be confirmed by clinical trials).Conclusion: This study revealed that chronic PJI requiring a 2-stage revision is costly, with significant costs in relation to the reimplantation procedure (about 15 k€). However, following reimplantation the rate of subsequent new infection remained high, and the cost of reimplantation following a new infection is considerable, reaching 50k€ per patient. These first cost estimates of managing chronic PJI with 2-stage exchange in France underline the economic interest of preventing new infections.

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Musculoskeletal Infection in Pediatrics

Cited by 22 publications

References 16 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

Staphylococcus aureus Osteomyelitis: Bone, Bugs, and Surgery

Economic Study of 2-Stage Exchange in Patients With Knee or Hip Prosthetic Joint Infection Managed in a Referral Center in France: Time to Use Innovative(s) Intervention(s) at the Time of Reimplantation to Reduce the Risk of Superinfection

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