Predictors of Outcome in Pediatric Osteomyelitis

Martin, Andrew C.; Anderson, Denise; Lucey, Julie; Guttinger, Robin; Jacoby, Peter; Mok, Tabitha; Whitmore, Timothy J; Whitewood, Colin; Burgner, David; Blyth, Christopher C

doi:10.1097/inf.0000000000001031

Cited by 43 publications

(26 citation statements)

References 21 publications

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“…To our knowledge this is one of the largest studies on paediatric AHOM performed in Europe. Similar cohort studies have been previously conducted in Spain [14], and France [21], as well as in other extra-European countries including Israel [22], Thailand [23], Australia [3], and the United States [24]. …”

Section: Discussionsupporting

confidence: 65%

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Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.

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Section: Discussionsupporting

confidence: 65%

“…Children below 5 years of age and males are more frequently affected [3]. Early detection of acute hematogenous osteomyelitis (AHOM) is crucial, given that a delay in the diagnosis of only 5 days is a major risk factor for complications [4].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Chiappini

Camposampiero

Lazzeri

et al. 2017

IJERPH

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“…Acute osteomyelitis in children is a serious disease that, when detected and treated early, can heal without severe sequelae [ 37 ]. It is of primary importance to recognize the signs and symptoms at the onset of the disease and to properly use the available diagnostic tools [ 38 , 39 ]. The role of serum markers as predictive factors for diagnosis has not been completely established.…”

Section: Discussionmentioning

confidence: 99%

A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Chiappini

Mastrangelo

Lazzeri

2016

IJERPH

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Osteomyelitis in children is a serious disease in children requiring early diagnosis and treatment to minimize the risk of sequelae. Therefore, it is of primary importance to recognize the signs and symptoms at the onset and to properly use the available diagnostic tools. It is important to maintain a high index of suspicion and be aware of the evolving epidemiology and of the emergence of antibiotic resistant and aggressive strains requiring careful monitoring and targeted therapy. Hereby we present an instructive case and review the literature data on diagnosis and treatment.

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“…and Cryptococcus spp.) [ 4 , 5 , 6 ]. These pathogens should be considered mainly in immunocompromised children.…”

Section: Controversies In Managementmentioning

confidence: 99%

“…There is a higher incidence in males, most likely because they are more physically active, which predisposes them to repeated microtrauma [ 1 , 2 , 3 ]. Hips, knees, and ankles are the most frequently involved joints [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

Castellazzi

Mantero

Esposito

2016

IJMS

140

119

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Acute osteomyelitis and septic arthritis are two infections whose frequencies are increasing in pediatric patients. Acute osteomyelitis and septic arthritis need to be carefully assessed, diagnosed, and treated to avoid devastating sequelae. Traditionally, the treatment of acute osteoarticular infection in pediatrics was based on prolonged intravenous anti-infective therapy. However, results from clinical trials have suggested that in uncomplicated cases, a short course of a few days of parenteral antibiotics followed by oral therapy is safe and effective. The aim of this review is to provide clinicians an update on recent controversies and advances regarding the management of acute osteomyelitis and septic arthritis in children. In recent years, the emergence of bacterial species resistant to commonly used antibiotics that are particularly aggressive highlights the necessity for further research to optimize treatment approaches and to develop new molecules able to fight the war against acute osteoarticular infection in pediatric patients.

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Predictors of Outcome in Pediatric Osteomyelitis

Abstract: A risk prediction model, utilizing information available shortly after hospitalization, allows early identification of children at greatest risk of developing complicated osteomyelitis.

Cited by 43 publications

References 21 publications

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

A Case of Acute Osteomyelitis: An Update on Diagnosis and Treatment

Update on the Management of Pediatric Acute Osteomyelitis and Septic Arthritis

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