Abstract
Osteoarticular infections (OAI) in children provide both diagnostic and therapeutic challenges. Recent data suggest that management of OAI can be simplified with shorter treatment duration and earlier switch to oral antibiotics. The aim of the study was to evaluate management and outcome of OAI in children at our center.
A retrospective review of all cases of osteoarticular infections (OAI) in children <15 years of age treated at our institution, from May, 2006 to April, 2015 was performed. Treatment duration and outcome in two periods, 2006–2011 and 2012–2015 were compared.
In a 9-year period there were 164 cases (93 cases in 2006–2011 and 71 cases in 2012–2015) of OAI with 12–24 cases annualy. A male preponderance among patients was observed with a male-to-female ratio of 1,88:1. There were 86 osteomyelitis (OM) cases, 52 septic arthritis (SA) cases and 26 OM and SA cases. The majority of cases involved lower limbs. One-third of children with OAI were either active in sport and/or had a recent history of mild trauma. In 13 (8%) cases OAI developed after varicella. There were 74 microbiologically confirmed infections and the main causative agent was Staphylococcus aureus (47 cases), followed by Streptococcus pyogenes (8 cases), S. pneumoniae (5), Kingella kingae and Salmonella (3 cases, respectively).
Surgical treatment was required in 46 cases, further 18 required one or multiple joint aspirations. One child with S. aureus bacteremia had endocarditis. In one child with sepsis and multiorgan failure necrosis of the femur developed and in two bone abscesses were drained 3 and 12 months after acute episode. All 3 children had Panton-Valentine leukocidin (PVL)-positive S. aureus infection. All other children recovered without permanent sequelae.
When comparing treatment duration, average treatment was shorter in 2012–2015 (31,3 days) than in 2006–2011 (38,1 days, p=0,0003), particularly due to shortening of parenteral treatment (9,0 days vs. 16,1 days, p<0,0005). The outcome was similar in both periods.
OAI often occur in children who engage in sports or have a history of recent trauma. The majority of infections are caused by S. aureus, which can be severe and/or complicated if the isolate is PVL-positive. Antimicrobial treatment can be shortened and early switch to oral treatment seems to be safe. In general, prognosis of OAI in children is excellent.
