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World Journal of Pediatrics : WJP Oct 2020Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis... (Review)
Review
BACKGROUND
Acute osteomyelitis still represents a significant clinical challenge, with an increasing incidence in paediatric population. A careful assessment and a rapid diagnosis with proper timing and choice of empirical antimicrobial therapy are necessary to avoid sequelae. The initial treatment should consist of empirical antibiotic therapy, to cover the major responsible pathogens in each age group.
DATA SOURCES
We made a literature search with PubMed and Cochrane database from 2000 to 2019 in English, French, and Spanish languages using the key words "osteomyelitis, children, clinical, diagnosis, and treatment".
RESULTS
The child's clinical features, age, and the microbiological profile of the geographic area should be evaluated for diagnosis and in the choice of antibiotic treatment. Latest data suggest the administration of intravenous antibiotics for a short period, with subsequent oral therapy, according to the improvement of clinical status and inflammatory markers. For children older than 3 months, the shift to oral medications is already possible after a short course of intravenous therapy, until recovery. The timing for the shift from cefazolin to cephalexin or cefuroxime, intravenous clindamycin to oral clindamycin, and intravenous ceftriaxone + oxacillin to oral equivalents will be decided according to the improvement of clinical status and inflammatory markers. We also present the approach to osteomyelitis due to difficult pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL)-positive S. aureus infections.
CONCLUSION
In this review, we present the current approach to the clinical diagnosis and management of osteomyelitis in childhood, with an update on recent recommendations, as a useful instrument to understand the rationale of antibiotic therapy.
Topics: Acute Disease; Anti-Bacterial Agents; Child; Diagnosis, Differential; Humans; Osteomyelitis
PubMed: 32394145
DOI: 10.1007/s12519-020-00359-z -
Pediatric Emergency Medicine Practice Dec 2019Septic arthritis and osteomyelitis in pediatric patients represent true emergencies, and can quickly threaten life and limb. A high index of suspicion should be... (Review)
Review
Septic arthritis and osteomyelitis in pediatric patients represent true emergencies, and can quickly threaten life and limb. A high index of suspicion should be maintained, as these conditions often present with a subacute course of illness and vague signs and symptoms. Septic arthritis and osteomyelitis can occur concurrently, so suspicion for one should also prompt investigation for the other. The diagnostic evaluation should include blood work as well as samples from the infected joint or bone for culture. Management with antibiotics is a standard approach, but the duration of antibiotic therapy is controversial. This issue reviews the current literature and provides an evidence-based approach for the evaluation and management of pediatric patients with septic arthritis and osteomyelitis.
Topics: Anti-Bacterial Agents; Arthritis, Infectious; Child; Diagnosis, Differential; Drug Administration Schedule; Emergency Service, Hospital; Humans; Osteomyelitis; Retrospective Studies
PubMed: 31765551
DOI: No ID Found -
Current Opinion in Rheumatology Sep 2020To describe the main clinical differences of children and adults with chronic nonbacterial osteomyelitis (CNO). (Review)
Review
PURPOSE OF REVIEW
To describe the main clinical differences of children and adults with chronic nonbacterial osteomyelitis (CNO).
RECENT FINDINGS
CNO is a severe systemic autoinflammatory syndrome characterized by multiple bone lesions because of inflammatory osteitis. Delay to diagnosis of CNO can lead to functional impairment, fractures, and chronic pain. Key clinical aspects and disease patterns differ in children and adults, including onset and time to diagnosis, symptom localization, associated comorbidities (i.e. skin, joints), bone lesion distribution pattern, and treatment approach. Novel biomarkers, such as urine N-terminal telopeptide in children and serum IgG4 in adults, are being studied for possible future use in improving diagnosis and guiding treatment. Despite recent advances in our understanding of CNO, many children and adults have a high disease burden and poor long-term outcomes. Recent findings suggest that adults with CNO tend to have a more chronic disease course and are less likely to achieve remission in follow-up.
SUMMARY
The clinical presentation of CNO differs in children and adults, highlighting the importance of these key features for the accurate diagnosis and early treatment in CNO.
Topics: Adult; Age Factors; Child; Chronic Disease; Cost of Illness; Disease Progression; Humans; Osteomyelitis; Severity of Illness Index
PubMed: 32744822
DOI: 10.1097/BOR.0000000000000734 -
Annals of Medicine 2023To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early...
OBJECTIVE
To investigate the risk factors for deep vein thrombosis (DVT) in children with osteomyelitis and provide diagnostic and treatment strategies for the prevention, early detection and treatment of DVT.
STUDY DESIGN
The clinical data of nine children diagnosed with osteomyelitis and DVT between July 2012 and March 2021 were collected at our hospital, including age, sex, clinical manifestations, body temperature, coagulation function and other data, as well as the clinical data of 27 children diagnosed with osteomyelitis without DVT during the same period. Thirty-six children were divided into thrombus and thrombus-free groups. The clinical characteristics and risk factors for DVT in children with osteomyelitis were analysed.
RESULTS
Among the 36 children in this study, nine cases of thrombus formation mainly occurred in the femoral vein, popliteal vein and iliac vein, all near the infection site. The main clinical manifestations were lower extremity pain, swelling and pulmonary embolism in three cases. Among them, intensive care unit (ICU) admission, sepsis, higher D-dimer, higher body temperature during hospitalization, and pathogen culture showed that methicillin-resistant (MRSA) was associated with DVT. MRSA was the independent risk factor for DVT.
CONCLUSIONS
Admission to ICU, sepsis, higher D-dimer, higher body temperature during hospitalization, and MRSA are risk factors for thrombosis. MRSA is the independent risk factor for DVT. For patients with related risk factors, timely ultrasound examination of the infected site should be considered to achieve early detection and treatment.
Topics: Humans; Child; Methicillin-Resistant Staphylococcus aureus; Osteomyelitis; Sepsis; Fever; Risk Factors; Venous Thrombosis
PubMed: 37624766
DOI: 10.1080/07853890.2023.2249011 -
Radiologia Oct 2023Emphysematous osteomyelitis is an extremely rare entity consisting of the presence of intraosseous gas that can extend to the joints and adjacent soft tissues. It is an...
Emphysematous osteomyelitis is an extremely rare entity consisting of the presence of intraosseous gas that can extend to the joints and adjacent soft tissues. It is an aggressive infectious process associated with high mortality, especially in patients with risk factors such as tumors or diabetes mellitus. Because early diagnosis and immediate treatment are crucial to prevent the potentially devastating consequences of this condition, imaging tests such as computed tomography play a fundamental role in its diagnosis and management. Therefore, radiologists must be aware that intraosseous gas is a rare but alarming sign that is pathognomonic of emphysematous osteomyelitis, especially in the axial skeleton.
Topics: Humans; Osteomyelitis; Emphysema; Risk Factors; Tomography, X-Ray Computed; Diagnosis, Differential
PubMed: 37858355
DOI: 10.1016/j.rxeng.2023.09.004 -
Animal Models and Experimental Medicine Mar 2021Infection of bone tissue, or osteomyelitis, has become a growing concern in modern healthcare due in no small part to a rise in antibiotic resistance among bacteria,... (Review)
Review
Infection of bone tissue, or osteomyelitis, has become a growing concern in modern healthcare due in no small part to a rise in antibiotic resistance among bacteria, notably . The current standard of care involves aggressive, prolonged antibiotic therapy combined with surgical debridement of infected tissues. While this treatment may be sufficient for resolving a portion of cases, recurrences of the infection and associated risks including toxicity with long-term antibiotic usage have been reported. Therefore, there exists a need to produce safer, more efficacious options of treatment for osteomyelitis. In order to test treatment regimens, animal models that closely mimic the clinical condition and allow for accurate evaluation of therapeutics are necessary. Establishing a model that replicates features of osteomyelitis in humans continues to be a challenge to scientists, as there are many variables involved, including choosing an appropriate species and method to establish infection. This review addresses the refinement of animal models of osteomyelitis to reflect the clinical disease and test prospective therapeutics. The aim of this review is to explore studies regarding the use of animals for osteomyelitis therapeutics research and encourage further development of such animal models for the translation of results from the animal experiment to human medicine.
Topics: Animals; Bone and Bones; Disease Models, Animal; Osteomyelitis; Prostheses and Implants; Staphylococcal Infections; Staphylococcus aureus
PubMed: 33738438
DOI: 10.1002/ame2.12149 -
The Veterinary Quarterly Dec 2022Osteomyelitis is a challenging infectious disease affecting humans and animals. It is difficult to diagnose because, in many cases, symptoms are non-specific and, for... (Review)
Review
Osteomyelitis is a challenging infectious disease affecting humans and animals. It is difficult to diagnose because, in many cases, symptoms are non-specific and, for example in implant-related cases, can appear long time after surgery. In addition to this, it is also difficult to treat due to the need to find the appropriate antibiotic regime and delivery system to reach the site of infection and to avoid development of bacterial resistance. The central purpose of this review is to compare the microbiological aspects of osteomyelitis in human and veterinary medicine, with the aim of improving the microbiological diagnosis and treatment of this infection in animals. Furthermore, the study of osteomyelitis in animals may help to improve the development of animal models for testing new treatments in humans. Host factors and underlying conditions have been studied mainly in humans, although aspects as immunodeficiency have been described in some veterinary cases. Even when is still considered the most prevalent causing microorganism, this prevalence should be reviewed using molecular diagnostic techniques, and this could affect treatment options. New approaches to treatment include local delivery of antibiotics using different biomaterials, antimicrobial photodynamic therapy, and new antimicrobial compounds. We would like to remark the need of large, high-quality clinical trials and of the development of guides for the diagnosis and treatment of osteomyelitis in different animal species.
Topics: Animals; Anti-Bacterial Agents; Disease Models, Animal; Humans; Osteomyelitis; Staphylococcal Infections; Staphylococcus aureus
PubMed: 34936853
DOI: 10.1080/01652176.2021.2022244 -
La Radiologia Medica Feb 2020Bone and soft tissue infection involving the foot is a serious complication of diabetes mellitus and represents a major public health and socioeconomic burden to... (Review)
Review
Bone and soft tissue infection involving the foot is a serious complication of diabetes mellitus and represents a major public health and socioeconomic burden to National Health Services worldwide. Research in the past decade has improved diagnosis and treatment of these frequent and potentially devastating complications of diabetic foot which often remain difficult to be diagnosed and treated despite the availability of various clinical, serological, and imaging modalities. Furthermore, neuropathic osteoarthropathy can share many clinical and imaging features of osteomyelitis, and infection is often superimposed in patients with neuropathic disease. Thus, distinguishing between the two abnormalities is further complicated. Although the reference standard for diagnosis remains microbiologic analysis of bone specimens, in most clinical practice, soft tissue and bone infection involving the diabetic foot is diagnosed solely on the basis of a combination of clinical evaluation, serum inflammatory markers, and imaging modalities. Correlation between imaging findings and clinical features is very important as well as a common knowledge base for treatment team members rather than a compartmentalized view. Thus, the primary purpose of this review article was to provide radiologist and clinician with important clinical knowledge and relevant radiological semiotics, respectively, in order to facilitate a prompt diagnosis and personalised treatment of diabetic foot infections.
Topics: Diabetic Foot; Diagnosis, Differential; Humans; Osteomyelitis; Soft Tissue Infections
PubMed: 31650327
DOI: 10.1007/s11547-019-01096-8 -
Expert Review of Anti-infective Therapy Jul 2021: Traumatic bone infection represents a clinical challenge for orthopedic surgeons. Traditional treatments include surgical debridement and antibiotic, but prolonged use... (Review)
Review
: Traumatic bone infection represents a clinical challenge for orthopedic surgeons. Traditional treatments include surgical debridement and antibiotic, but prolonged use of antibiotic may lead to colonization of resistant bacteria and other adverse reactions.: Platelet-rich plasma (PRP), a biological product extracted from the peripheral blood of patients, has been widely used in the field of tissue repair in recent years. Because if its structural and antibacterial properties, PRP is an innovative option for the prevention and treatment of infections. This review assesses the recent scientific literature on PRP, specifically its in the treatment of infections. To this end, a literature review was conducted using the PubMed and Web of Science databases with the following keywords 'platelet-rich plasma (PRP)'; 'PRP AND traumatic bone infections'; 'PRP AND bone defect'; 'PRP AND antibiotics'; and 'PRP AND wound healing'.: This review focuses on the mechanism of action, preparation methods, clinical applications and other aspects related to PRP to provide a reference for its use in the treatment of traumatic bone infections, thereby enhancing the therapeutic effectiveness and improving the prognosis of patients.
Topics: Animals; Humans; Osteomyelitis; Platelet-Rich Plasma; Treatment Outcome; Wound Healing; Wounds and Injuries
PubMed: 33259253
DOI: 10.1080/14787210.2021.1858801 -
The Journal of Foot and Ankle Surgery :... 2020Osteomyelitis of the foot and ankle is a challenge to treat and creates a significant demand on both the patient and the healthcare system. The purposes of this study...
Osteomyelitis of the foot and ankle is a challenge to treat and creates a significant demand on both the patient and the healthcare system. The purposes of this study were to determine the microorganisms associated with foot and ankle osteomyelitis, to evaluate the change in methicillin-resistant Staphylococcus aureus (MRSA) between 2005 and 2010, and to determine the relationship between these infecting organisms and patient comorbidities. The medical records for 302 patients diagnosed with osteomyelitis of the foot and ankle, 151 in 2005 and 151 in 2010, were randomly selected and evaluated. The authors reviewed the demographics, comorbidities, microorganism(s) confirmed with bone biopsy and culture, location, and use of antibiotics before bone biopsy. Gram-positive bacteria were the most prevalent, composing 81.9% of the isolates in 2005 and 59.6% in 2010. Methicillin-sensitive Staphylococcus aureus was the most common in both cohorts. Conversely, the incidence of MRSA statistically decreased from 28.3% to 10.6% from 2005 to 2010 (p < .0001). Gram-negative bacteria were found in 39.5% of the 2005 isolates and 31.8% of those from 2010. Pseudomonas sp. was the most common gram-negative bacteria. Patients with peripheral vascular disease had a significantly higher incidence of gram-negative bacteria (odds ratio 2.1, 95% confidence interval, 1.3 to 3.6, p = .003). The results of this study reveal that MSSA was the most common bacteria, incidence of MRSA decreased between the 2005 to 2010, and patients with peripheral vascular disease have a significantly higher incidence of gram-negative bacteria.
Topics: Aged; Anti-Bacterial Agents; Female; Foot Bones; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Incidence; Male; Middle Aged; Osteomyelitis; Retrospective Studies; Tarsal Bones
PubMed: 32354506
DOI: 10.1053/j.jfas.2019.08.032