Clinical manifestations and outcomes of children with bone and joint infections

Yıl 2023, Cilt: 48 Sayı: 4, 1217 - 1227, 29.12.2023

Melis Deniz Tuğba Erat Ali Yavuz Kazım Tasar

https://doi.org/10.17826/cumj.1348227

Öz

Purpose: This study aimed to determine the clinical, laboratory, imaging, and bacteriological features of bone and joint infections in children and to identify their characteristic features for early diagnosis.
Materials and Methods: In this retrospective study patients diagnosed with osteomyelitis and septic arthritis, based on established guidelines, were included. We collected demographic, clinical, and imaging data, along with inflammatory markers and microbiological data, and any invasive procedures performed by orthopedic surgeons. We also reviewed the development of long-term sequelae, the duration of treatments, and the types of antibiotics used for both oral and parenteral therapy.
Results: The study group consisted of 25 patients with osteomyelitis, 10 with septic arthritis, and 5 with combined infection (osteomyelitis and septic arthritis). Inflammatory marker levels were abnormal in most children. The most commonly identified organism was the Staphylococcal species. Radiological findings compatible with bone and joint infections were detected in all patients whose magnetic resonance imaging results were available. Invasive procedures were performed in 44%, 90%, and 100% of the patients with osteomyelitis, septic arthritis, and combined infection, respectively.
Conclusion: Sensitivity increased when all the markers were used together. Magnetic resonance imaging considered the most informative imaging modality for bone and joint infections provided the highest sensitivity in our study. These sensitive indicators can be helpful for the early diagnosis and long-term follow-up of patients with unclear presentations.

Anahtar Kelimeler

osteomyelitis, septic arthritis, children

Kemik ve eklem enfeksiyonları olan çocukların klinik bulguları ve sonuçları

Öz

Amaç: Bu çalışmada çocuklarda kemik ve eklem enfeksiyonlarının klinik, laboratuvar, görüntüleme ve bakteriyolojik özelliklerinin saptanması ve erken tanı için karakteristik özelliklerinin belirlenmesi amaçlandı.
Gereç ve Yöntem: Retrospektif bu çalışmaya pediatrik osteomiyelit ve septik artritin tanı ve tedavisine ilişkin kılavuz kriterlerine göre osteomiyelit ve septik artrit tanısı alan hastalar çalışmaya dahil edildi. Hastaların demografik, klinik ve görüntüleme verilerinin yanı sıra inflamatuar belirteç düzeyleri ve mikrobiyolojik verileri, ortopedi uzmanlarının gerçekleştirdiği invaziv işlemler değerlendirilmiştir. Ayrıca uzun vadeli sekellerin gelişimi, oral ve parenteral tedavide kullanılan antibiyotik türleri ve tedavi sürelerini incelendi.
Bulgular: Çalışma grubunu 25 osteomiyelit, 10 septik artrit ve 5 kombine enfeksiyon (osteomiyelit ve septik artrit) hastası oluşturdu. Çoğu çocukta inflamatuar belirteçler anormal düzeylerdeydi. En sık tanımlanan organizma Stafilokok türleriydi. Manyetik rezonans görüntüleme sonuçları mevcut olan hastaların tamamında kemik ve eklem enfeksiyonları ile uyumlu radyolojik bulgular tespit edildi. Osteomiyelit, septik artrit ve kombine enfeksiyonu olan hastaların sırasıyla %44, %90 ve %100'üne invaziv işlemler uygulanmıştı.
Sonuç: Tüm belirteçlerin bir arada kullanılmasıyla tanıya yönelik sensitivitenin arttığı tespit edildi. Kemik ve eklem enfeksiyonlarında en bilgilendirici görüntüleme yöntemi olarak kabul edilen manyetik rezonans görüntüleme, çalışmamızda en yüksek duyarlılığı sağlamıştır. Bu hassas göstergeler, nonspesifik bulguları olan hastaların erken tanısında ve uzun süreli takibinde yardımcı olabilir.

Anahtar Kelimeler

Çocuk, osteomiyelit, septik artrit

Kaynakça

• Nadau E, Joseph C, Haraux E, Deroussen F, Gouron R, Klein C. Clinical features and outcomes in children with bone and joint infections of the ankle or foot. Arch Pediatr.2020;27:464-8.
• Akinkugbe O, Stewart C, McKenna C. Presentation and investigation of pediatric bone and joint infections in the pediatric emergency department. Pediatr Emerg Care. 2019;35:700-4.
• Spyridakis E, Gerber JS, Schriver E, Grundmeier RW, Porsch EA, St Geme JW et al. Clinical features and outcomes of children with culture-negative septic arthritis. J Pediatric Infect Dis Soc.2019;8:228-34.
• Belthur MV, Palazzi DL, Miller JA, Phillips WA, Weinberg J. A clinical analysis of shoulder and hip joint infections in children. J Pediatr Orthop. 2009;29:828-33.
• Woods CR, Bradley JS, Chatterjee A, Copley LA, Robinson J, Kronman MP et al. Clinical practice guideline by the pediatric infectious diseases society and the infectious diseases society of America: 2021 Guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc. 2021;10:801-44.
• Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br. 2012;94:584-95.
• Manz N, Krieg AH, Heininger U, Ritz N. Evaluation of the current use of imaging modalities and pathogen detection in children with acute osteomyelitis and septic arthritis. Eur J Pediatr. 2018;177:1071-80.
• Abeywickrema M, Liu X, Kelly DF, Theologis T, Pollard AJ, Kadambari S. Bone and joint infections in Oxford: a 10-year retrospective review. Arch Dis Child. 2020;105:515-6.
• Levine MJ, McGuire KJ, McGowan KL, Flynn JM. Assessment of the test characteristics of c-reactive protein for septic arthritis in children. J Pediatr Orthop. 2003;23:373-7.
• Mediamolle N, Mallet C, Aupiais C, Doit C, Ntika S, Vialle R et al. Bone and joint infections in infants under three months of age. Acta Paediatr. 2019;108:933-9.
• Mitha A, Boutry N, Nectoux E, Petyt C, Lagrée M, Happiette L et al. Community-acquired bone and joint infections in children: a 1-year prospective epidemiological study. Arch Dis Child.2015;100:126-9.
• Yeo A, Ramachandran M. Acute haematogenous osteomyelitis in children. BMJ 2014; 348:g66.
• Pant N, Wallis SC, Roberts JA, Eisen DP. In vitro effect of synovial fluid from patients undergoing arthroplasty surgery on MRSA biofilm formation. J Antimicrob Chemother. 2022;77:1041-4.
• Montgomery CO, Siegel E, Blasier RD, Suva LJ. Concurrent septic arthritis and osteomyelitis in children. J Pediatr Orthop. 2013;33:464-7.
• Mehler K, Oberthür A, Yagdiran A, Butzer S, Jung N. Impact of a pediatric infectious disease consultation service on timely step-down to oral antibiotic treatment for bone and joint infections. Infection. 2023;51:831-8.
• Bréhin C, Claudet I, Dubois D, Sales de Gauzy J, Vial J, Chaix Y et al. Assessing the management of pediatric bone and joint infections according to French guidelines. Med Mal Infect. 2020;50:515-9.
• Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, Girschick H, Hartwig N, Kaplan S et al. Bone and joint infections. Pediatr Infect Dis J. 2017;36:788-99.
• Dartnell J, Ramachandran M, Katchburian M. Haematogenous acute and subacute paediatric osteomyelitis: a systematic review of the literature. J Bone Joint Surg Br. 2012;94:584-95.