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2017 ; 2
(1
): 7-12
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Paediatric bone and joint infection
#MMPMID28607765
Iliadis AD
; Ramachandran M
EFORT Open Rev
2017[Jan]; 2
(1
): 7-12
PMID28607765
show ga
Despite advances in understanding and management, paediatric osteoarticular
infections continue to pose diagnostic difficulties for clinicians. Delays in
diagnosis can lead to potentially devastating morbidity.No single investigation,
including joint aspiration, is sufficiently reliable to diagnose conclusively
paediatric bone and joint infection. Diagnosis should be based on a combination
of clinical signs, imaging and laboratory investigations. Algorithms should
supplement, and not replace, clinical decision making in all cases.The roles of
aspiration, arthrotomy and arthroscopy in the treatment of septic arthritis are
not clearly defined. There is a very limited role for surgery in the management
of acute haematogenous osteomyelitis.The ideal duration and mode of
administration of antibiotic therapy for osteoarticular paediatric infection is
not yet fully defined but there is increasing evidence that shorter courses
(three weeks) and early conversion (day four) to oral administration is safe and
effective in appropriate cases. Clear and concise antibiotic guidelines should be
available based on local population characteristics, pathogens and their
sensitivities.Kingella kingae is increasingly identified through polymerase chain
reaction and is now recognised as the commonest pathogen in children aged under
four years. Methicillin-resistant Staphylococcus aureus and Panton-Valentine
leukocidin-producing strains of Staph. aureus are being increasingly reported.A
multidisciplinary integrated evidence-based approach is required to optimise
outcomes.Further large-scale, multicentre studies are needed to delineate the
optimal management of paediatric osteoarticular infection. Cite this article:
EFORT Open Rev 2017;1:7-12. DOI: 10.1302/2058-5241.2.160027.
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