Clinical Epidemiology and Outcomes of Pediatric Musculoskeletal Infections.
Acute Disease
Administration, Oral
Adolescent
Anti-Bacterial Agents
/ therapeutic use
Arthritis, Infectious
/ diagnosis
Child
Child, Preschool
Combined Modality Therapy
Female
Gram-Negative Bacterial Infections
/ diagnosis
Gram-Positive Bacterial Infections
/ diagnosis
Humans
Infant
Logistic Models
Male
Methicillin-Resistant Staphylococcus aureus
/ isolation & purification
Orthopedic Procedures
Osteomyelitis
/ diagnosis
Retrospective Studies
Staphylococcal Infections
/ diagnosis
Treatment Outcome
United States
/ epidemiology
Journal
The Journal of pediatrics
ISSN: 1097-6833
Titre abrégé: J Pediatr
Pays: United States
ID NLM: 0375410
Informations de publication
Date de publication:
Jul 2021
Jul 2021
Historique:
received:
30
09
2020
revised:
02
03
2021
accepted:
18
03
2021
pubmed:
28
3
2021
medline:
20
11
2021
entrez:
27
3
2021
Statut:
ppublish
Résumé
To understand the epidemiology of acute hematogenous osteomyelitis and septic arthritis, including clinical and demographic features, microbiology, treatment approaches, treatment-associated complications, and outcomes. Retrospective cohort study of 453 children with acute hematogenous osteomyelitis and/or septic arthritis from 2009 to 2015. Among the 453 patients, 218 (48%) had acute hematogenous osteomyelitis, 132 (29%) had septic arthritis, and 103 (23%) had concurrent acute hematogenous osteomyelitis/septic arthritis. Treatment failure/recurrent infection occurred in 41 patients (9%). Patients with concurrent acute hematogenous osteomyelitis/septic arthritis had longer hospital stays, longer duration of antibiotic therapy, and were more likely to have prolonged bacteremia and require intensive care. Staphylococcus aureus was identified in 228 (51%) patients, of which 114 (50%) were methicillin-resistant S aureus. Compared with septic arthritis, acute hematogenous osteomyelitis and concurrent acute hematogenous osteomyelitis/septic arthritis were associated with higher odds of treatment failure (OR, 8.19; 95% CI, 2.02-33.21 [P = .003]; and OR, 14.43; 95% CI, 3.39-61.37 [P < .001], respectively). The need for more than 1 surgical procedure was also associated with higher odds of treatment failure (OR, 2.98; 95% CI, 1.18-7.52; P = .021). Early change to oral antibiotic therapy was not associated with treatment failure (OR, 0.64; 95% CI, 0.24-1.74; P = .386). Most (73%) medically attended treatment complications occurred while on parenteral therapy. Musculoskeletal infections are challenging pediatric infections. S aureus remains the most common pathogen, with methicillin-resistant S aureus accounting for 25% of all cases. Concurrent acute hematogenous osteomyelitis/septic arthritis is associated with more severe disease and worse outcomes. Fewer treatment-related complications occurred while on oral therapy. Early transition to oral therapy was not associated with treatment failure.
Identifiants
pubmed: 33771580
pii: S0022-3476(21)00266-3
doi: 10.1016/j.jpeds.2021.03.028
pmc: PMC8238832
mid: NIHMS1686835
pii:
doi:
Substances chimiques
Anti-Bacterial Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
236-244.e2Subventions
Organisme : NCATS NIH HHS
ID : UL1 TR000445
Pays : United States
Organisme : NIAID NIH HHS
ID : HHSN272201300018C
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001863
Pays : United States
Organisme : NIAID NIH HHS
ID : HHSN272201300018I
Pays : United States
Organisme : NIAID NIH HHS
ID : HHSN272201300023I
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR000424
Pays : United States
Organisme : NIAID NIH HHS
ID : HHSN272201500002C
Pays : United States
Organisme : AHRQ HHS
ID : K12 HS026390
Pays : United States
Organisme : NIAID NIH HHS
ID : R01 AI139172
Pays : United States
Organisme : NIAID NIH HHS
ID : HHSN272201300023C
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
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