Sequelae of pediatric osteoarticular infection

Abstract

The epidemiology and diagnosis of osteoarticular infections (OAI) have changed considerably in recent years, partly due to the development of molecular biology. Kingella kingae is now recognized as the most frequent pathogen in children under 4 years of age, while methicillin-resistant Staphylococcus aureus (SA) has been increasingly reported. Although the clinical course of OAI is mostly benign, with shorter antibiotic regimens and simplified treatments, serious functional impairments and life-threatening complications can still occur, especially in case of delayed diagnosis or infection caused by Panton-Valentine leukocidin-producing strains of SA. Newborns and patients with sickle cell disease have greater risk of orthopaedic sequelae, which need to be detected and managed early. The main sequelae of osteomyelitis are angular limb deformity, due to partial growth arrest, and lower limb discrepancy. Therapeutic options are guided by the patient's age and predictions at maturity. The main complications of septic arthritis are joint stiffness and osteonecrosis. The procedures to consider are arthrodesis, joint reconstruction in immature children, and arthroplasty at the end of growth.

Delayed treatment of septic arthritis in the neonate

“…Therapeutic delay is considered an important risk factor of sequelae, a 4-day delay has been suggested as acceptable in the treatment of uncomplicated osteomyelitis. [16] In this series, the average delay time was 14.9 days, only 7 patients (13.5%) had delay time for less than 4 days. Most patients sought treatment too late, when significant damage to bone and epiphysis had already happened, even surgical drainage could not change the final outcomes.…”

“…The low recovery rate of hip may be attributed to the relative narrow space of the hip joint and the special blood supply of the femoral head, which will potentially predispose the joint capsular and the vascularization of the femoral head to be destroyed by the hyper pressure in the hip joint, subsequently leading to dislocation of the hip and AVN of the femoral head. [16] Thus, we recommend surgery for septic arthritis of the hip, even if the delay time is more than 2 weeks.…”

Orthopedic Complications in Former Bacillus Calmette-GuÉrin Osteitis Patients

“…2 Although the clinical course of osteitis is mostly benign, functional impairments can still occur. 3 Newborns have a greater risk of orthopedic sequelae, which need to be detected and treated early. 3 The main sequelae of osteitis are angular limb deformity because of partial growth arrest, and lower limb discrepancy.…”

“…3 Newborns have a greater risk of orthopedic sequelae, which need to be detected and treated early. 3 The main sequelae of osteitis are angular limb deformity because of partial growth arrest, and lower limb discrepancy. 3 In Finland, BCG vaccination of newborns was included in the national vaccination program from 1941 to 2006, and the coverage of the vaccinations was nearly 100%.…”

Synthesis and characterization of CaO-loaded electrospun matrices for bone tissue engineering

“…Staphylococcus aureus ( S. aureus ) was chosen as the bacterial agent in this study, because it is a common pathogen found in osteomyelitis cases [31, 32]. The antibacterial activity against S. aureus (ATCC 6538) was tested using an agar diffusion assay (n=3/group), which was aerobically cultivated in Brain Heart Infusion (BHI) broth supplemented with 5 g yeast extract/L at 37°C.…”