EPIDEMIOLOGICAL STUDY OF OSTEOARTICULAR INFECTIONS IN CHILDREN

To analyze the characteristics of patients diagnosed with pediatric osteoarticular infections treated in a level III trauma center in São Paulo, Brazil.

Methods

We retrospectively analyzed patients admitted between September 2012 and August 2014. The outcomes analyzed were: age, sex, diagnosis, etiologic agent, anatomic location, time to diagnosis, history of previous trauma and infection, laboratory tests, treatment, and complications.

Results

Twenty patients were included, 50% with septic arthritis, 35% with osteomyelitis, and 15% with both. Boys were predominant (80%), and the mean age was 6.6 years. The most common etiologic agent was Staphylococcus aureus. C-reactive protein value and erythrocyte sedimentation rate were elevated. The infections were treated with antibiotic therapy (intravenous and oral) and oxacillin was most frequently used. Most patients underwent at least one surgical procedure, and 35% of patients had complications.

Conclusion

This epidemiological mapping identified clinical and demographic characteristics which are useful for improving preparation for care. Future prospective studies with longer patient follow-up and the development of treatment protocols are needed to improve therapeutic decision-making and the prognosis of children with suspected osteoarticular infections. Evidence Level II; Prognostic studies - Investigation of the effect of patient characteristics on the outcome of the disease.

Arthritis, infectious; Osteomyelitis; Pediatrics/epidemiology

Age/ Sex	Diagnosis/ Location (side)	Etiology	History of infection and/or trauma	Lab tests		Hospital stay (days)	Treatment	Complications

				CRP mg/dL	ESR mm/h
1y M	SA R hip	Acinetobacter baumannii	Bronchiolitis	6.2	45	16	SC + oxacillin 6 days and gentamicin 7 days (after culture) Discharge: cephalexin 3 weeks	Reoperated 2 days after the first surgery following recurrence
4y M	SA L hip	No growth	-	19.1	70	16	SC + oxacillin 15 days Discharge: cephalexin 3 weeks	-
5m F	SA L hip	S aureus	BCP	27.1	110	23	SC + oxacillin and gentamicin 3 weeks Discharge: ciprofloxacin 3 weeks	Reoperated 4 days after primary surgery. Sepsis during hospitalization – in ICU 7 days
15y M	SA R elbow	No growth	Bacterial conjunctivitis	8.6	50	12	SC + ciprofloxacin, azithromycin, metronidazole 7 days Discharge: cephalexin 3 weeks	-
11y M	SA R elbow	No growth	-	7.2	65	16	SC + oxacillin 14 days Discharge: cephalexin 2 weeks	-
2y F	SA L knee	No growth	BCP	16.6	125	17	Oxacillin 15 days, amikacin 11 days Discharge: cephalexin 3 weeks	-
15y M	SA L knee	No growth	-	24.8	10	25	Oxacillin 25 days, amikacin 11 days Discharge: cephalexin 3 weeks	-
1y F	SA L knee	No growth	-	1.0	95	16	SC + oxacillin 14 days Discharge: cephalexin 2 weeks	-
4m M	SA R knee	S haemolyticus	BCP	2.9	20	17	SC + clindamycin 14 days Discharge: cephalexin 2 weeks	-
10y M	SA R knee	S aureus	-	36.5	40	26	SC + oxacillin 25 days, amikacin 11 days Discharge: cephalexin 3 weeks	-
7y M	COM R humerus	Streptococcus pyogenes	Elbow fracture - Surgical treatment (10 months prior)	3.0	59	22	Oxacillin 21 days Discharge: cephalexin 2 weeks	Elbow joint stiffness
5y M	COM R scapula	No growth	Tuberculosis	9.0	18	16	Oxacillin and ceftriaxone 14 days Discharge: cephalexin 2 weeks	-
12y M	COM phalanges L foot	Acinetobacter haemolyticus	Snakebite in L leg + COM L hallux (1 year previous)	7.6	9	26	SC + oxacillin 25 days, amikacin 11 days Discharge: cephalexin 3 weeks	Reoperated to amputate distal phalange of the L hallux
12y M	COM of the L femur	Enterobacter cloacae	Femur shaft fracture - Surgical treatment (1 year prior)	0.6	18	19	SC + IMR cephazolin, oxacillin + amikacin 10 days Discharge: ciprofloxacin 2 weeks	-
2m M	COM R distal femur	Oxacillin- resistant S aureus	Bronchiolitis	17.1	70	33	SC + amikacin and vancomycin 21 days Discharge: cephalexin 6 weeks	Reoperated 3 days after the first surgery following recurrence
6y M	COM R distal tibia	Serratia marcelis	BCP	33.1	85	33	SC + amikacin and meropenem 21 days Discharge: ciprofloxacin 8 weeks	-
3y M	COM R elbow	No growth	-	0.5	57	4	Oxacillin 21 days Discharge: cephalexin 3 weeks	-
3y F	SA elbow and ankle + COM R ulna and fibula	S aureus	Pneumonia	41.5	52	73	SC forearm and R leg + vancomycin and Imipenem 9 weeks	-
11y F	SA + COM L hip )	Pseudomonas aeruginosa Acinetobacter baumannii complex	Epiphysiolysis of the femur head - Surgical treatment (30 days previous)	3.3	50	106	SC + IMR vancomycin 50 days, tigecycline, imipenem 56 days Discharge: ciprofloxacin and clindamycin 16 weeks	Resection of the proximal femur (limb shortening 10 cm)
14y M	SA + COM R hip	S aureus	-	23.9	110	22	SC + oxacillin 21 days Discharge: clindamycin 6 weeks	Reoperated 9 days after the first surgery following recurrence

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[1] Correspondence: Frederico Carlos Jaña Neto. Av. Angélica, 2491 - 9° andar, Bela Vista, São Paulo, SP, Brazil. 01227-200. fredericojana@uni9.pro.br