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 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Modern imaging techniques have become essential components of the management of acute osteomyelitis and septic arthritis in children. This article addresses the role of these techniques, based on clinical practice guidelines recently developed at a children's hospital by an interdisciplinary group. The recommendations reflect a review of the literature and an analysis of our own experience with 84 children treated for musculoskeletal sepsis during the past 3 years. We attempt to optimize imaging resources by analyzing the unique aspects of these infections in the pediatric skeleton, the clinical needs at different stages of the disease, and the relative strengths and weaknesses of the various imaging procedures. Our goal was to define the use of imaging in cases of osteomyelitis and septic arthritis in children in specific clinical scenarios in which additional information is likely to lead to management modification.
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PMID:Osteomyelitis and septic arthritis in children: appropriate use of imaging to guide treatment. 862 67

Serious staphylococcal infections remain a significant clinical problem despite advances in antibacterial therapy. Resistance to penicillin is common and methicillin-resistant staphylococci have become troublesome nosocomial pathogens in many institutions. Penicillinase-resistant penicillins (e.g. flucloxacillin, cloxacillin and oxacillin) are the preferred drugs for all methicillin-susceptible staphylococcal infections, although first generation cephalosporins, beta-lactam/beta-lactamase inhibitor combinations, clindamycin, and occasionally erythromycin and cotrimoxazole (trimethoprim/sulfamethoxazole) are alternatives. Serious infections due to methicillin-resistant staphylococci should be treated with parenteral vancomycin. Teicoplanin, where available, is a suitable alternative. Rifampicin, fusidic acid and some fluoroquinolones may be useful oral alternatives, although resistance develops rapidly if they are used as single agents. Cotrimoxazole and minocycline have also proven useful when strains are susceptible. Staphylococcal toxic shock syndrome often requires aggressive resuscitation and anti-staphylococcal therapy for generally 10 to 14 days. Staphylococcus aureus bacteraemia remains a life-threatening condition which, in all but one-third of cases, is associated with an underlying septic focus such as endocarditis, osteomyelitis or occult abscess. Differentiating between complicated and uncomplicated bacteraemia is critical to define the appropriate treatment regimen. Serious staphylococcal sepsis such as endocarditis and acute osteomyelitis generally requires prolonged (4 to 6 weeks) antibiotic treatment. Coagulase-negative staphylococci are the commonest cause of prosthetic device infection, and generally require prolonged therapy with an agent to which they have proven to be sensitive, e.g. a penicillinase-resistant penicillin or vancomycin. Removal of infected foreign or prosthetic material, and drainage of deep collections remain a critical aspect of all therapy.
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PMID:Optimum treatment of staphylococcal infections. 768 6

The Authors report two cases of acute osteomyelitis, in a newborn and in an infant. Bone and joint sepsis in the first years of life is rare. The metaphases of long bones are the most common sites of hematogenous osteomyelitis. The hip and the knee are especially at risk. The patients were treated with pharmacologic and orthopedic therapy. The Authors describe the clinical features, radiographic changes, the diagnosis and management of this disease.
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PMID:[Acute osteoarthritis in the newborn and infants]. 819 16

Fluids, medications, and blood products can be rapidly administered via intraosseous infusion under emergency conditions, particularly to pediatric patients aged from 0 to 2 years. A five-month-old infant who had been hospitalized with a diagnosis of sepsis developed swelling and hyperemia at the infusion site 10 days after an intraosseous infusion in the right proximal tibia. Physical examination showed a serous discharge from a fistula on the anteromedial side of the right proximal cruris. Plain radiographs demonstrated periosteal reaction in the right tibia and osteolytic areas in the proximal metaphysis. With a diagnosis of acute osteomyelitis, drainage and medullary irrigation were performed and parenteral antibiotic treatment was initiated. Cultures from the surgical site yielded Candida albicans, upon which fluconazole (8 mg/kg) treatment was administered for four weeks. A complete clinical and radiographic improvement was observed at the end of a 12-month follow-up.
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PMID:[Tibial osteomyelitis following intraosseous infusion: a case report]. 1572 19

Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin--Ceftriaxone scheme to surgical intervention.
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PMID:Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: scintigraphic features that contribute to the early diagnosis. 2393 90

Osteoarticular infection in children frequently occurs before 10 years of age. Surgical drainage is sometimes required, whereas acute osteomyelitis can be treated with antibiotic therapy alone. The duration of antibiotic therapy varies, 2 weeks is sufficient for septic arthritis, whereas 6 weeks is often required for complicated cases. Some of these antibiotic drugs present direct complications with low clinical impact in certain individuals. Hypersensitivity to these drugs causes different reactions in children. DRESS syndrome (Drug Reaction with Eosinophilia and Systemic Symptoms) is a severe and potentially life-threatening drug reaction. It is characterised by high fever, malaise, lymphadenopathy and skin rash. From a clinical perspective, these symptoms can lead to an exacerbation of the initial infectious process for which treatment was commenced. The liver is the organ most often affected in DRESS syndrome associated with haematological changes, potentially similar to sepsis. We present two cases of children with osteoarticular infections who developed DRESS syndrome after antibiotic therapy. Both patients made a complete recovery after cessation of the antibiotic drugs used.
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PMID:DRESS syndrome due to antibiotic therapy of osteoarticular infections in children: two case reports. 2505 39

Osteomyelitis is a severe inflammatory disease of the bone that is mainly caused by Staphylococcus aureus. Particularly, bone infections are difficult to treat and can develop into a chronic course with a high relapsing rate despite of antimicrobial treatments. The complex interaction of staphylococci with osseous tissue and the bacterial ability to invade host cells are thought to determine the severity of infection. Yet, defined bacterial virulence factors responsible for the pathogenesis of osteomyelitis have not been clearly identified. The aim of this study was to detect S. aureus virulence factors that are associated with osteomyelitis and contribute to a chronic course of infection. To this purpose, we collected 41 S. aureus isolates, each 11 from acute osteomyelitis (infection period less than 2 months), 10 from chronic osteomyelitis (infection period more than 12 months), 10 from sepsis and 10 from nasal colonization. All isolates were analyzed for gene expression and in functional in-vitro systems. Adhesion assays to bone matrix revealed that all isolates equally bound to matrix structures, but invasion assays in human osteoblasts showed a high invasive capacity of chronic osteomyelitis isolates. The high invasion rate could not be explained by defined adhesins, as all infecting strains expressed a multitude of adhesins that act together and determine the level of adhesion. Following host cell invasion isolates from chronic osteomyelitis induced less cytotoxicity than all other isolates and a higher percentage of Small-colony-variant (SCV)-formation, which represents an adaptation mechanism during long-term persistence. Isolates from acute and chronic osteomyelitis strongly produced biofilm and highly expressed agr and sarA that regulate secreted virulence factors and induced an inflammatory response in osteoblasts. In conclusion, chronic osteomyelitis isolates were characterized by a high host cell invasion rate, low cytotoxicity and the ability to persist and adapt within osteoblasts. Furthermore, isolates from both acute and chronic osteomyelitis strongly produced biofilm and induced high levels of host cell inflammation, which may explain tissue destruction and bone deformation observed as typical complications of long-lasting bone infections.
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PMID:Staphylococcus aureus isolates from chronic osteomyelitis are characterized by high host cell invasion and intracellular adaptation, but still induce inflammation. 2512 55

Acute osteomyelitis is uncommon in full-term neonates and occurs most frequently in those with critical illnesses, often following episodes of sepsis, skin infection, umbilical catheterization, urinary tract anomalies, or a complicated delivery. Here, we report a very rare case of acute rib osteomyelitis due to Staphylococcus aureus in a 13-day-old full-term male neonate. Ultrasonography (US) enabled diagnosis and revealed a coexisting costochondral junction rib fracture, which was not detected on routine chest radiography. Following a 29-day course of intensive parenteral antibiotic therapy, the patient was discharged in good health at 42 days of age without any scar formation. Due to its accessibility and safety, US can be a promising modality for detecting acute osteomyelitis in neonates with clinically highly suspected conditions in the neonatal intensive care unit setting, particularly those involving thin and mobile bones subject to respiratory motion. However, further studies are required to assess the utility of US in these cases and negative results. In low-risk neonates with osteomyelitis, an accompanying fracture should be considered.
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PMID:A Rare Full-Term Newborn Case of Rib Osteomyelitis with Suspected Preceding Fracture. 2692 60

Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication.
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PMID:Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess. 2705 49

Osteomyelitis is a bone infection that requires prolonged antibiotic treatment and potential surgical intervention. If left untreated, acute osteomyelitis can lead to chronic osteomyelitis and overwhelming sepsis. Early treatment is necessary to prevent complications, and the standard of care is progressing to a shorter duration of intravenous (IV) antibiotics and transitioning to oral therapy for the rest of the treatment course. We systematically reviewed the current literature on pediatric patients with acute osteomyelitis to determine when and how to transition to oral antibiotics from a short IV course. Studies have shown that switching to oral after a short course (i.e., 3-7 d) of IV therapy has similar cure rates to continuing long-term IV therapy. Prolonged IV use is also associated with increased risk of complications. Parameters that help guide clinicians on making the switch include a downward trend in fever, improvement in local tenderness, and a normalization in C-reactive protein concentration. Based on the available literature, we recommend transitioning antibiotics to oral after 3-7 d of IV therapy for pediatric patients (except neonates) with acute uncomplicated osteomyelitis if there are signs of clinical improvement, and such regimen should be continued for a total antibiotic duration of four to six weeks.
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PMID:Transitioning antimicrobials from intravenous to oral in pediatric acute uncomplicated osteomyelitis. 2761 Mar 39


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