Presentation and Investigation of Pediatric Bone and Joint Infections in the Pediatric Emergency Department

Abstract

Objective The objective of this study was to evaluate the presenting features of bone and joint infections with a view to identify distinguishing trends that will be useful for pediatric emergency departments. Methods We performed a retrospective review of patient records over a 12-year period in the pediatric emergency department of a large regional pediatric teaching center serving a diverse population. Results There were 88 cases of osteoarticular infections during the study period. Pain, fever, and impaired function were commonly reported, but overall, there was inconsistency in the presenting features. Inflammatory makers were sensitive tools, particularly in combination. When C-reactive protein, total white cell count, and erythrocyte sedimentation rate were all abnormal, 98% of bone and joint infections were identified. Causative organisms were identified in only 38% of cases, mostly from cultures of synovial fluid and bone. Streptococcal organisms were significantly more likely to be isolated in children under 5 years than in children over 5 years (P = <0.014). Staphylococcal organisms were significantly more likely to be isolated in children over 5 years than in children under 5 years (P = <0.001). Identification of virulent organisms such as Panton-Valentine leukocidin Staphylococcus aureus and methicillin-resistant S. aureus in our study should prompt review of diagnostic techniques and antibiotic choices. Conclusions Overall, children under 5 years were significantly more likely to be diagnosed with septic arthritis than osteomyelitis (P = 0. 006). Children over 12 years were significantly more likely to be diagnosed with osteomyelitis than septic arthritis (P = 0. 019). These trends are useful to consider at presentation and in cases of diagnostic uncertainty.

Etiology and Clinical Characteristics of Acute Suppurative Osteomyelitis in Children a Single Center Study in China

“…Pathogen isolation by culture is the key for targeted antibiotic therapy. Most of the bacteria isolated in this study were S. aureus, which is consistent with the results of other studies [3,6,[8][9] . The incidence of MRSA in our study was as high as 43.4%.…”

“…The incidence of MRSA in our study was as high as 43.4%. While this value is consistent with the national resistance rate of 36.1% for Staphylococcus to methicillin in Chinese children [10] , it is signi cantly higher than that reported in other countries [5,9,[11][12] , which suggests that S. aureus is seriously drug resistant in Chinese children. It is generally believed that a long time is required for the antibiotics to reach bone tissues and to achieve effective bactericidal concentrations [13] ; therefore, short-term administration of antibiotics is thought to have little effect on bacterial culture results of bone tissue specimens [14] .…”

“…At different age stages, the common pathogens that cause suppurative osteomyelitis differ. S. aureus is more common in children over 4-5 years, and Streptococcus or Kingella kingae is more common in children under 4 years [8,9] . The age of children with S. aureus infection in this study was signi cantly higher than that of children with non-S. aureus infection, which is consistent with previous reports [8] ; however, the proportion of children with Streptococcus infection was relatively low, which might be related to the use of sensitive antibiotics before sampling.…”

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

“…In the same study, MRSA isolates represented 6% of all cases caused by CA-SA [ 29 ]. Nationwide studies conducted in Spain and the UK observed rates of CA-MRSA ranging from 2.5% to 3% of all community-acquired staphylococcal infections, while PVL-SA has been isolated in 10% of these cases in Italy [ 20 , 30 ]. CA-MRSA seems to be less prevalent in European populations than in the USA, where its prevalence reached 30% in some regions within the last two decades [ 31 ].…”

Pediatric Methicillin-Resistant Staphylococcus aureus Osteoarticular Infections

“…CRP and ESR are of value in dictating the duration of therapy as well as the transition of intravenous to oral antibiotic therapy [ 29 ]. Elevated ESR, white blood cell count, and CRP have been shown to have a sensitivity of 98% in diagnosing acute OSI [ 30 ]. Magnetic resonance imaging (MRI) with gadolinium is recommended as the imaging diagnostic method of choice, and is particularly useful in the diagnosis of early osteomyelitis [ 6 , 29 ].…”