ABSTRACT
Background: Bone and joint infections (BJI) are relatively common in children, and community -acquired methicillin resistant Staphylococcus aureus (CA-MRSA) is the leading cause in some countries. Aim: To evaluate epidemiological data, clinical and microbiological features and outcome of BJI. Methods: A prospective descriptive study was conducted. Results: 40 patients (p) completed the study. Bacterial cultures were positives in 30 p (75%): CA-MRSA was found in 19 p, methicillin-sensitive S. aureus in 6 p, and others in 5 p. Cultures were negatives in 10 p (25%). Median treatment duration was 28 days (r: 21-40 d); Analyzing patients with CA-MRSA positive cultures separately, initial CRP was higher (Md 76 vs 50 mg/L, p < 0.02), normalization occurred later (Md 14 days vs 7days, p < 0.03), and duration of treatment (Md 32 days vs 23, p < 0.004) as well as hospital stay (Md 9 days vs 7, p = 0.12) were longer. Sequelae were present in 3 p and 1 relapsed: All of them with CA-SAMR. Conclusion: CA-MRSA was the leading cause of BJI and was associated with higher CRP on admission, later normalization and longer treatment duration. Complications as drainage requirement, and sequelae were common in those p.
Introducción: Las infecciones osteo-articulares (IOA) son relativamente comunes en los niños, siendo la infección por Staphylococcus aureus resistente a meticilina de la comunidad (SARM-Co) una de las más frecuentes. Objetivo: Evaluar los datos epidemiológicos, características clínicas, microbiológicas y de evolución en niños con IOA. Métodos: Estudio descriptivo prospectivo. Resultados: Se incluyeron 40 pacientes (p). Los cultivos fueron positivos en 30 p (75%). Se aisló SARM-Co en 19 p; S. aureus sensible a meticilina en 6 p; otros microorganismos en 5 p. La duración del tratamiento fue de 28 días Md (r: 21-40 d). En los p con cultivos positivos para SARM-Co, la PCR inicial fue mayor (Md 76 vs 50 mg/L, p < 0,02), la normalización se produjo después (Md 14 días vs 7 días, p < 0,03) y la duración del tratamiento (Md 32 días vs 23, p < 0,004), así como la estancia hospitalaria (Md 9 días vs 7, p = 0,12) fueron más prolongados. En la evolución 1 p recayó y 3 tuvieron secuelas; en todos se aisló SARM-Co. Conclusión: SARM-Co fue la causa más frecuente de las IOA y se asoció con mayor valor de PCR al ingreso, normalización tardía, mayor duración del tratamiento, y complicaciones.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/microbiology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Osteomyelitis/microbiology , Staphylococcal Infections/microbiology , Anti-Bacterial Agents/pharmacology , Arthritis, Infectious/drug therapy , Community-Acquired Infections/drug therapy , Community-Acquired Infections/microbiology , Microbial Sensitivity Tests , Methicillin-Resistant Staphylococcus aureus/drug effects , Osteomyelitis/drug therapy , Prospective Studies , Staphylococcal Infections/drug therapyABSTRACT
The value of the bone scan in pyogenic bone and joint infections is demonstrated in patients who had signs and symptoms suggestive of bone or joint infection. Nineteen patients were evaluated with 99m Tc-methylene diphosphonate bone scan and roentgenogram. The diagnosis of acute osteomyelitis was made in eight patients, chronic osteomyelitis in six patients, septic arthritis in three patients and two patients had soft tissue infection only. Seven of the eight patients with acute osteomyelitis had focal increase of radiopharmaceutical uptake in the bone well before the bony change appeared on roentgenogram. Five of six chronic osteomyelitis patients had not only bony change on roentgenogram but also increased radiopharmaceutical uptake of bone. But the remaining one had only the former, and the lesion was interpreted as inactive. In two of three septic arthritis patients, the lesion was in S-I joint and both of them had no abnormality on roentgenogram but had increased uptake of radiopharmaceutical agent in the joint. Two patients with soft tissue infection had no abnormal radiological bony change and no increase of the radiopharmarceutical uptake in bone on bone scan. From the above data, we concluded that bone scan is recommended in the evaluation of the patients with signs and symptoms suggestive of bone or joint infection for the earlier diagnosis and differential diagnosis in acute case and for the determination of the activity and location of the lesion in chronic case.