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Clinical Presentations and Causative Organisms in Children and Adolescents with Osteoarticular Infections: A Retrospective Study
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  • Journal title : Pediatric Infection and Vaccine
  • Volume 22, Issue 3,  2015, pp.154-163
  • Publisher : The Korean Society of Pediatric Infectious Diseases
  • DOI : 10.14776/piv.2015.22.3.154
 Title & Authors
Clinical Presentations and Causative Organisms in Children and Adolescents with Osteoarticular Infections: A Retrospective Study
Lee, Soyoung; Kim, Han Wool; Cho, Hye-Kyung; Yun, Yoe Hon; Ryu, Kyung Ha; Kim, Kyung-Hyo;
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 Abstract
Purpose: Osteoarticular infections in children and adolescents are important because it can cause functional compromise if appropriate treatment is delayed. Therefore, this study was designed to describe the clinical presentations and causative organisms of osteoarticular infections in children and adolescents in order to propose early diagnosis method and an appropriate empiric antimicrobial therapy. Methods: Forty-two medical records were reviewed retrospectively, which were confirmed as osteomyelitis (OM) or septic arthritis (SA) at Department of Pediatrics or Orthopedic Surgery in patients under 18 years old of Ewha Womans University Mokdong Hospital from March 2008 to March 2015. Results: We identified 21 cases of OM, 13 cases of SA and 8 cases of OM with SA. There were 31 males and 11 females and mean age was 7.1 years old. The most common symptoms were pain and tenderness of involved site. Major involved bones were femur (10 cases, 34.5%), tibia (7 cases, 24.1%) and major involved joints were hip (9 cases, 42.9%), and knee (5 cases, 23.8%). Increased serum C-reactive protein and erythrocyte sedimentation rate were observed in 37 cases (88.1%) respectively. Magnetic resonance imaging was performed in 40 cases among 42 cases and was used to demonstrate osteoarticular infections and other adjacent infections. Nine cases (23.7%) among 38 cases and 20 cases (50.0%) among 40 cases were positive in blood culture and infected site culture respectively. The most common causative organism was Staphylococcus aureus, which was represented in 22 cases (75.9%), of which nine cases (40.9%) were resistant to methicillin. Conclusions: S. aureus was the most common causative organism of osteoarticular infections in children and adolescents and the proportion of MRSA was high in this study. Therefore, we recommend vancomycin as the first empiric antimicrobial therapy and suggest that further study is necessary to elucidate an appropriate guideline for treatment which takes into account MRSA proportion.
 Keywords
Osteomyelitis;Septic arthritis;
 Language
Korean
 Cited by
 References
1.
Bonhoeffer J, Haeberle B, Schaad UB, Heininger U. Diagnosis of acute haematogenous osteomyelitis and septic arthritis: 20 years experience at the University Children's Hospital Basel. Swiss Med Wkly 2001;131:575-81.

2.
Peltola H, Paakkonen M. Acute osteomyelitis in children. N Engl J Med 2014;370:352-60. crossref(new window)

3.
Paakkonen M, Peltola H. Bone and joint infections. Pediatr Clin North Am 2013;60:425-36. crossref(new window)

4.
Chen WL, Chang WN, Chen YS, Hsieh KS, Chen CK, Peng NJ, et al. Acute community-acquired osteoarticular infections in children: high incidence of concomitant bone and joint involvement. J Microbiol Immunol Infect 2010;43:332-8. crossref(new window)

5.
Dodwell ER. Osteomyelitis and septic arthritis in children: current concepts. Curr Opin Pediatr 2013;25:58-63. crossref(new window)

6.
Russell CD, Ramaesh R, Kalima P, Murray A, Gaston MS. Microbiological characteristics of acute osteoarticular infections in children. J Med Microbiol 2015;64:446-53. crossref(new window)

7.
Williams DJ, Deis JN, Tardy J, Creech CB. Culture-negative osteoarticular infections in the era of community-associated methicillin-resistant Staphylococcus aureus . Pediatr Infect Dis J 2011;30:523-5. crossref(new window)

8.
Goergens ED, McEvoy A, Watson M, Barrett IR. Acute osteomyelitis and septic arthritis in children. J Paediatr Child Health 2005;41:59-62. crossref(new window)

9.
Montgomery NI, Rosenfeld S. Pediatric osteoarticular infection update. J Pediatr Orthop 2015;35:74-81. crossref(new window)

10.
Grammatico-Guillon L, Maakaroun Vermesse Z, Baron S, Gettner S, Rusch E, Bernard L. Paediatric bone and joint infections are more common in boys and toddlers: a national epidemiology study. Acta Paediatr 2013;102:e120-5. crossref(new window)

11.
Choi JH, Choe YJ, Hong KB, Lee J, Yoo WJ, Kim HS, et al. The etiology and clinical features of acute osteoarthritis in children; 2003-2009. Korean J Pediatr Infect Dis 2011;18:31-9.

12.
Gillespie WJ. Epidemiology in bone and joint infection. Infect Dis Clin North Am 1990;4:361-76.

13.
Rasmont Q, Yombi JC, Van der Linden D, Docquier PL. Osteoarticular infections in Belgian children: a survey of clinical, biological, radiological and microbiological data. Acta Orthop Belg 2008;74:374-85.

14.
Paakkonen M, Kallio MJ, Kallio PE, Peltola H. Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections. Clin Orthop Relat Res 2010;468:861-6. crossref(new window)

15.
Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H. Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics 1994;93:59-62.

16.
Riise OR, Kirkhus E, Handeland KS, Flato B, Reiseter T, Cvancarova M, et al. Childhood osteomyelitis-incidence and differentiation from other acute onset musculoskeletal features in a population-based study. BMC Pediatr 2008;8:45. crossref(new window)

17.
Butbul-Aviel Y, Koren A, Halevy R, Sakran W. Procalcitonin as a diagnostic aid in osteomyelitis and septic arthritis. Pediatr Emerg Care 2005;21:828-32. crossref(new window)

18.
Park SS, Lee SH, Sim GB. MRI in suspected acute septic arthritis of the hip joint in children. Hip Pelvis 2012;24: 295-301. crossref(new window)

19.
Levy PY, Fournier PE, Fenollar F, Raoult D. Systematic PCR detection in culture-negative osteoarticular infections. Am J Med 2013;126:1143.e25-33.

20.
Ceroni D, Cherkaoui A, Ferey S, Kaelin A, Schrenzel J. Kingella kingae osteoarticular infections in young children: clinical features and contribution of a new specific real-time PCR assay to the diagnosis. J Pediatr Orthop 2010;30:301-4. crossref(new window)

21.
Dubnov-Raz G, Ephros M, Garty BZ, Schlesinger Y, Maayan-Metzger A, Hasson J, et al. Invasive pediatric Kingella kingae infections: a nationwide collaborative study. Pediatr Infect Dis J 2010;29:639-43. crossref(new window)

22.
Dubnov-Raz G, Scheuerman O, Chodick G, Finkelstein Y, Samra Z, Garty BZ. Invasive Kingella kingae infections in children: clinical and laboratory characteristics. Pediatrics 2008;122:1305-9. crossref(new window)

23.
Park JH, Lee TJ. Increasing rates of community associated methicillin-resistant Staphylococcus aureus in children with muscular-skeletal infections in Korea: a single center experience from 2000 to 2012. Korean J Pediatr Infect Dis 2013;20: 63-70.

24.
Kwak YH, Park SE, Hong JY, Jung HS, Park JY, Choi JH, et al. Etiologic agents and clinical features of acute pyogenic osteoarthritis in children. J Korean Pediatr 2000;43:506-13.

25.
Koo M, Kim D. The clinical aspects of septic arthritis in children. J Korean Pediatr 1997;40:1737-44.