Bone and Joint Infections in Children: Septic Arthritis

2015 ◽  
Vol 83 (8) ◽  
pp. 825-833 ◽  
Author(s):  
Anil Agarwal ◽  
Aditya N. Aggarwal
Keyword(s):  
Septic Arthritis ◽  
Joint Infections ◽  
Bone And Joint Infections

scholarly journals Bone and Joint Infections among Hematopoietic Stem Cell Transplant Recipients

2019 ◽  
Vol 4 (5) ◽  
pp. 209-215
Author(s):  
Cybele Lara Abad ◽  
Vania Phuoc ◽  
Prashant Kapoor ◽  
Pritish K. Tosh ◽  
Irene G. Sia ◽  
...  
Keyword(s):  
Stem Cell ◽  
Septic Arthritis ◽  
Hematopoietic Stem Cell ◽  
Joint Infection ◽  
Cell Transplant ◽  
Hematopoietic Stem ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Prosthetic Joint ◽  
Increased Risk

Abstract. Background: Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk for infection. This study describes bone and joint infections (BJI) among HSCT recipients.Methods: We reviewed 5861 patients who underwent HSCT at Mayo Clinic, Rochester, MN from January 1, 2005 through January 1, 2015 for study inclusion. BJI was defined as native septic arthritis, prosthetic joint infection, osteomyelitis, and orthopedic implant infection. All adults with BJI after HSCT were included in the analysis.Results: Of 5861 patients, 33 (0.6%) developed BJI. Native joint septic arthritis was the most common BJI occurring in 15/33 (45.4%) patients. Patients were predominantly male (24/33, 72.7%), with median age of 58 (range 20-72) years. BJI was diagnosed a median of 39 (range 1-114) months after allogeneic (14/33, 42.4%) or autologous (19/33, 57.6%) HSCT. Organisms were recovered via tissue (24/27, 88.9%), synovial fluid (13/17, 76.5%), and/or blood cultures (16/25, 64%). Most underwent surgical debridement (23/33, 69.7%). Patients were followed a median of 78.3 months (range 74-119). Therapy was unsuccessful in 4/33 (12.1%), with death related to the underlying BJI in two (50%). Failure occurred a median of 3.4 (0.1-48.5) months from diagnosis. At last follow up, 7/33 (21.2%) patients were alive. Median overall survival was 13 months (0.07-70.6).Conclusion: BJI among HSCT recipients is infrequent. The most common infection is native joint septic arthritis. Pathogens appear similar to patients without HSCT. Treatment involving surgical-medical modalities is successful, with most patients surviving >1 year after BJI.

Bone and Joint Infections

2019 ◽  
Author(s):  
Jayshree Dave ◽  
Rohma Ghani
Keyword(s):  
Septic Arthritis ◽  
Group A Streptococcus ◽  
Clinical History ◽  
Liver Function Tests ◽  
Joint Disease ◽  
Joint Fluid ◽  
Response To Treatment ◽  
Range Of Movement ◽  
Joint Infections ◽  
Bone And Joint Infections

Patients with bone and joint infections can present with native joint septic arthritis, osteomyelitis, or implant-associated bone and joint infections. Patients often present with an acute onset of hot, swollen, painful joint with restricted function in one or more joints over a couple of weeks. On examination the affected joint is painful with a limited range of movement, and fever is present. Risk factors for septic arthritis include an abnormal joint architecture due to pre-existing joint disease, e.g. patients with rheumatoid arthritis, or patients on haemodialysis, with diabetes mellitus, or older than 80 years of age. The differential diagnosis includes reactive arthritis, pre-patellar bursitis, gout, Lyme disease, brucellosis, and Whipples disease. Staphylococcus aureus is the most common cause of septic arthritis, followed by Group A streptococcus and other haemolytic streptococci including B, C and G. Gram-negative rods such as Escherichia coli are implicated in the elderly, immunosuppressed, or patients with comorbidities. Pseudomonas aeruginosa is implicated in intravenous (IV) drug users and patients post-surgery or intra-articular injections. Kingella kingae causes septic arthritis in children younger than four years of age. Neisseria gonorrhoeae, Neisseria meningitidis, and Salmonella species can also cause septic arthritis as part of a disseminated infection. Septic monoarthritis commonly occurs in patients with disseminated gonococcal infection. Blood cultures, white blood cell count, C reactive protein (CRP), electrolytes, and liver function tests are indicated. Serial CRP is useful in monitoring response to treatment. If there is a history of unprotected sexual intercourse, gonococcal testing is recommended. Brucella serology and Tropheryma whippei serology may be considered based on the clinical history. Joint fluid aspiration should be performed by a specialist within the hospital. Joint fluid aspirate is processed in the laboratory for microscopy, culture, and sensitivity. Gram stain can show an increase in neutrophils and presence of bacteria. The guidelines provided by the British Society for Rheumatology on the management of hot swollen joints in adults has provided advice for empirical treatment for suspected septic arthritis, but the local antibiotic policy should also be considered. Initial treatment is with intravenous flucloxacillin 2g four times daily, or 450– 600mg four times daily of intravenous clindamycin to cover S. aureus.

scholarly journals Bone and Joint Infections in Children and Adolescents in Luanda, Angola

Osteology ◽  
2021 ◽  
Vol 1 (2) ◽  
pp. 80-85
Author(s):  
Markus Pääkkönen ◽  
Tuula Pelkonen ◽  
Guilhermino Joaquim ◽  
Luis Bernandino ◽  
Tiina Pöyhiä ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Blood Transfusion ◽  
Septic Arthritis ◽  
Surgical Procedures ◽  
Chart Review ◽  
Pathological Fracture ◽  
Retrospective Chart Review ◽  
Cell Disease ◽  
Joint Infections ◽  
Bone And Joint Infections

We reviewed the characteristics of children hospitalized for bone and joint infections in Luanda, Angola. In a retrospective chart review of 45 patients with childhood osteomyelitis or septic arthritis, 51% of the patients had sickle cell disease, and these patients presented with lower hemoglobin and needed blood transfusion more frequently (p < 0.05). Out of all patients, 64% underwent surgical procedures; a pathological fracture occurred in 31% of the patients.

scholarly journals Radiologic Mimics of Osteomyelitis and Septic Arthritis: A Pictorial Essay

2021 ◽  
Vol 2021 ◽  
pp. 1-18
Author(s):  
Wanyin Lim ◽  
Christen D. Barras ◽  
Steven Zadow
Keyword(s):  
Septic Arthritis ◽  
Imaging Techniques ◽  
Routine Practice ◽  
Imaging Features ◽  
Cross Sectional ◽  
Musculoskeletal Infection ◽  
Neoplastic Processes ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Pictorial Review

Various imaging techniques may be employed in the investigation of suspected bone and joint infections. These include ultrasound, radiography, functional imaging such as positron emission tomography (PET) and nuclear scintigraphy, and cross-sectional imaging, including computed tomography (CT) and magnetic resonance imaging (MRI). The cross-sectional modalities represent the imaging workhorse in routine practice. The role of imaging also extends to include assessment of the anatomical extent of infection, potentially associated complications, and treatment response. The imaging appearances of bone and joint infections are heterogeneous and depend on the duration of infection, an individual patient’s immune status, and virulence of culprit organisms. To add to the complexity of radiodiagnosis, one of the pitfalls of imaging musculoskeletal infection is the presence of other conditions that can share overlapping imaging features. This includes osteoarthritis, vasculopathy, inflammatory, and even neoplastic processes. Different pathologies may also coexist, for example, diabetic neuropathy and osteomyelitis. This pictorial review aims to highlight potential mimics of osteomyelitis and septic arthritis that are regularly encountered, with emphasis on specific imaging features that may aid the radiologist and clinician in distinguishing an infective from a noninfective aetiology.

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

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 486 ◽  
Author(s):  
Giovanni Autore ◽  
Luca Bernardi ◽  
Susanna Esposito
Keyword(s):  
Septic Arthritis ◽  
Laboratory Data ◽  
Underlying Disease ◽  
Narrative Review ◽  
Empiric Antibiotic Therapy ◽  
Evidence Based ◽  
First Line ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
Empiric Antibiotic

Acute bone and joint infections (BJIs) in children may clinically occur as osteomyelitis (OM) or septic arthritis (SA). In clinical practice, one-third of cases present a combination of both conditions. BJIs are usually caused by the haematogenous dissemination of septic emboli carried to the terminal blood vessels of bone and joints from distant infectious processes during transient bacteraemia. Early diagnosis is the cornerstone for the successful management of BJI, but it is still a challenge for paediatricians, particularly due to its nonspecific clinical presentation and to the poor specificity of the laboratory and imaging first-line tests that are available in emergency departments. Moreover, microbiological diagnosis is often difficult to achieve with common blood cultures, and further investigations require invasive procedures. The aim of this narrative review is to provide the most recent evidence-based recommendations on appropriate antinfective therapy in BJI in children. We conducted a review of recent literature by examining the MEDLINE (Medical Literature Analysis and Retrieval System Online) database using the search engines PubMed and Google Scholar. The keywords used were “osteomyelitis”, OR “bone infection”, OR “septic arthritis”, AND “p(a)ediatric” OR “children”. When BJI diagnosis is clinically suspected or radiologically confirmed, empiric antibiotic therapy should be started as soon as possible. The choice of empiric antimicrobial therapy is based on the most likely causative pathogens according to patient age, immunisation status, underlying disease, and other clinical and epidemiological considerations, including the local prevalence of virulent pathogens, antibiotic bioavailability and bone penetration. Empiric antibiotic treatment consists of a short intravenous cycle based on anti-staphylococcal penicillin or a cephalosporin in children aged over 3 months with the addition of gentamicin in infants aged under 3 months. An oral regimen may be an option depending on the bioavailability of antibiotic chosen and clinical and laboratory data. Strict clinical and laboratory follow-up should be scheduled for the following 3–5 weeks. Further studies on the optimal therapeutic approach are needed in order to understand the best first-line regimen, the utility of biomarkers for the definition of therapy duration and treatment of complications.

scholarly journals Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 105
Author(s):  
Jatapat Hemapanpairoa ◽  
Dhitiwat Changpradub ◽  
Sudaluck Thunyaharn ◽  
Wichai Santimaleeworagun
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Proportional Hazards Model ◽  
Significant Risk ◽  
Vancomycin Resistance ◽  
Cox Proportional Hazards Model ◽  
Factors Associated ◽  
Joint Infections ◽  
Bone And Joint Infections ◽  
The Impact

The prevalence of enterococcal infection, especially E. faecium, is increasing, and the issue of the impact of vancomycin resistance on clinical outcomes is controversial. This study aimed to investigate the clinical outcomes of infection caused by E. faecium and determine the risk factors associated with mortality. This retrospective study was performed at the Phramongkutklao Hospital during the period from 2014 to 2018. One hundred and forty-five patients with E. faecium infections were enrolled. The 30-day and 90-day mortality rates of patients infected with vancomycin resistant (VR)-E. faecium vs. vancomycin susceptible (VS)-E. faecium were 57.7% vs. 38.7% and 69.2% vs. 47.1%, respectively. The median length of hospitalization was significantly longer in patients with VR-E. faecium infection. In logistic regression analysis, VR-E. faecium, Sequential Organ Failure Assessment (SOFA) scores, and bone and joint infections were significant risk factors associated with both 30-day and 90-day mortality. Moreover, Cox proportional hazards model showed that VR-E. faecium infection (HR 1.91; 95%CI 1.09–3.37), SOFA scores of 6–9 points (HR 2.69; 95%CI 1.15–6.29), SOFA scores ≥ 10 points (HR 3.71; 95%CI 1.70–8.13), and bone and joint infections (HR 0.08; 95%CI 0.01–0.62) were significant risk factors for mortality. In conclusion, the present study confirmed the impact of VR-E. faecium infection on mortality and hospitalization duration. Thus, the appropriate antibiotic regimen for VR-E. faecium infection, especially for severely ill patients, is an effective strategy for improving treatment outcomes.

scholarly journals Novel therapeutic interventions towards improved management of septic arthritis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jian Wang ◽  
Liucai Wang
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Clinical Success ◽  
Treatment Protocol ◽  
Current Treatment ◽  
Therapeutic Interventions ◽  
Medical Emergency ◽  
Success Rates ◽  
Joint Infections ◽  
Novel Therapeutic

AbstractSeptic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

Bone and joint infections caused by Clostridium perfringens: a case series

2021 ◽  
Author(s):  
Margaux Visse ◽  
Véronique Vernet-Garnier ◽  
Odile Bajolet ◽  
Delphine Lebrun ◽  
Morgane Bonnet ◽  
...  
Keyword(s):  
Clostridium Perfringens ◽  
Case Series ◽  
Joint Infections ◽  
Bone And Joint Infections
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