Osteoarticular Infections in Pediatric Hospitals in Europe: A Prospective Cohort Study From the EUCLIDS Consortium

Abstract

BackgroundPediatric osteoarticular infections (POAIs) are serious diseases requiring early diagnosis and treatment.MethodsIn this prospective multicenter cohort study, children with POAIs were selected from the European Union Childhood Life-threatening Infectious Diseases Study (EUCLIDS) database to analyze their demographic, clinical, and microbiological data.ResultsA cohort of 380 patients with POAIs, 203 with osteomyelitis (OM), 158 with septic arthritis (SA), and 19 with both OM and SA, was analyzed. Thirty-five patients were admitted to the Pediatric Intensive Care Unit; out of these, six suffered from shock, one needed an amputation of the right foot and of four left toes, and two had skin transplantation. According to the Pediatric Overall Performance Score, 36 (10.5%) showed a mild overall disability, 3 (0.8%) a moderate, and 1 (0.2%) a severe overall disability at discharge. A causative organism was detected in 65% (247/380) of patients. Staphylococcus aureus (S. aureus) was identified in 57.1% (141/247) of microbiological confirmed cases, including 1 (0.7%) methicillin-resistant S. aureus (MRSA) and 6 (4.2%) Panton-Valentine leukocidin (PVL)-producing S. aureus, followed by Group A Streptococcus (18.2%) and Kingella kingae (8.9%). K. kingae and PVL production in S. aureus were less frequently reported than expected from the literature.ConclusionPOAIs are associated with a substantial morbidity in European children, with S. aureus being the major detected pathogen. In one-third of patients, no causative organism is identified. Our observations show an urgent need for the development of a vaccine against S. aureus and for the development of new microbiologic diagnostic guidelines for POAIs in European pediatric hospitals.

Pediatric case of septic arthritis due to Streptococcus pneumoniae serotype 19A

“…The most common causative agent of this infection in children is Staphylococcus aureus . 1 , 2 , 3 Bacterial SA is also caused by Streptococcus pyogenes, Kingella kingae , and rarely with Streptococcus pneumoniae . 1 , 2 , 4 According to an European study from 2021, 1 just 6.5% of pediatric osteoarticular infections are caused by S. pneumoniae.…”

“… 1 , 2 , 3 Bacterial SA is also caused by Streptococcus pyogenes, Kingella kingae , and rarely with Streptococcus pneumoniae . 1 , 2 , 4 According to an European study from 2021, 1 just 6.5% of pediatric osteoarticular infections are caused by S. pneumoniae. Cohen et al 2 reported pneumococcal SA in 1.6% of the investigated children.…”

Surveillance of osteoarticular infections caused by Staphylococcus aureus in a paediatric hospital in Mexico City

“…Identifying the etiological agent of the OAIs is essential for an appropriate antimicrobial treatment. Although microbial culture remains the gold standard for the diagnosis of these infections in 35-85.9% of cases the etiological agent cannot be identified despite an adequate sample of blood, joint fluid or bone ( Gornitzky et al., 2020 ; Trobisch et al., 2022 ). Molecular tests have recently been developed for the diagnosis of OAIs, being useful in patients who received antibiotics or to identify fastidious microorganisms ( Church et al., 2020 ; Wallander et al., 2022 ; Lim et al., 2022 ).However, they have limitations since there may be false positives with contaminating microorganisms of the skin or DNA of non-viable bacteria, do not predict susceptibility profile, and require adequate validation and interpretation ( Church et al., 2020 ; Wallander et al., 2022 ; Lim et al., 2022 ).…”

Comparison of Clinical Prediction Rules in Pre-school Aged Children With Septic Hip Arthritis Due to Different Pathogens

“…5,6,9,10 In children with SA, infections are most often caused by Staphylococcus aureus, Group A Streptococcus, and Kingella Kingae. [11][12][13] In children aged < 3 years, K. Kingae has been increasingly recognized as a cause for bone and joint infections, especially since the availability of realtime polymerase chain reaction (PCR) for detection of K. Kingae. 14,15 In Australia and New Zealand (NZ), we recently showed that the prevalence of K. kingae was 23% in pre-school aged children with a confirmed causative microorganism including all bone and joint infections.…”

“…In children with SA, infections are most often caused by Staphylococcus aureus , Group A Streptococcus , and Kingella Kingae 11–13 . In children aged <3 years, K. Kingae has been increasingly recognized as a cause for bone and joint infections, especially since the availability of real-time polymerase chain reaction (PCR) for detection of K. Kingae 14,15 .…”