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Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center

Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single cent...

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Autores principales: Chiappini, Elena, Camposampiero, Caterina, Lazzeri, Simone, Indolfi, Giuseppe, De Martino, Maurizio, Galli, Luisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451928/
https://www.ncbi.nlm.nih.gov/pubmed/28471400
http://dx.doi.org/10.3390/ijerph14050477
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author Chiappini, Elena
Camposampiero, Caterina
Lazzeri, Simone
Indolfi, Giuseppe
De Martino, Maurizio
Galli, Luisa
author_facet Chiappini, Elena
Camposampiero, Caterina
Lazzeri, Simone
Indolfi, Giuseppe
De Martino, Maurizio
Galli, Luisa
author_sort Chiappini, Elena
collection PubMed
description Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data.
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spelling pubmed-54519282017-06-05 Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center Chiappini, Elena Camposampiero, Caterina Lazzeri, Simone Indolfi, Giuseppe De Martino, Maurizio Galli, Luisa Int J Environ Res Public Health Article Background: Paediatric acute hematogenous osteomyelitis (AHOM) is a serious disease requiring early diagnosis and treatment. To review the clinical presentation, management and organisms responsible for AHOM, and to explore risk factors for complicated AHOM, a large cohort referring to a single center over a 6-year period was evaluated. Methods: Data from children with AHOM, hospitalized between 2010 and 2015, and aged > 1 month, were retrospectively collected and analyzed. Results: 121 children (median age 4.8 years; 55.4% males) were included. Fever at onset was present in 55/121 children (45.5%); the lower limb was most frequently affected (n = 68/121; 56.2%). Microbiological diagnosis (by culture and/or polymerase chain reaction (PCR)) was reached in 33.3% cases. Blood and pus/biopsy culture sensitivities were 32.4% and 46.4%, respectively. PCR sensitivity was 3.6% (2/55) on blood, and 66.6% (16/24) on pus/biopsy sample. Staphylococcus aureus was the most commonly identified pathogen (n = 20); no methicillin-resistant Staphylococcus aureus (MRSA) was isolated, 10.0% (n = 2) strains were Panton-Valentine-Leukocidin (PVL) producer; 48.8% (59/121) cases were complicated. At univariate analysis, factors associated with complicated AHOM were: recent fever episode, fever at onset, upper limb involvement, white blood count (WBC) ≥ 12,000/µL, C reactive protein (CRP) ≥ 10 mg/L, S. aureus infection. At multivariate analyses S. aureus infection remained the only risk factor for complicated AHOM (aOR = 3.388 (95%CI: 1.061–10.824); p-value = 0.039). Conclusions: In this study microbiological diagnosis was obtained in over one third of cases. Empiric treatment targeting methicillin-sensitive Staphylococcus aureus seems to be justified by available microbiological data. MDPI 2017-05-04 2017-05 /pmc/articles/PMC5451928/ /pubmed/28471400 http://dx.doi.org/10.3390/ijerph14050477 Text en © 2017 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chiappini, Elena
Camposampiero, Caterina
Lazzeri, Simone
Indolfi, Giuseppe
De Martino, Maurizio
Galli, Luisa
Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center
title Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center
title_full Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center
title_fullStr Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center
title_full_unstemmed Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center
title_short Epidemiology and Management of Acute Haematogenous Osteomyelitis in a Tertiary Paediatric Center
title_sort epidemiology and management of acute haematogenous osteomyelitis in a tertiary paediatric center
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5451928/
https://www.ncbi.nlm.nih.gov/pubmed/28471400
http://dx.doi.org/10.3390/ijerph14050477
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