Diagnosis and management of osteoarticular infections in children: An overview of the literature and retrospective cohort study in a single tertiary care centre

Abstract

Objective: To perform a systematic review on the diagnosis and management of osteoarticular infections and to describe the cohort of patients with osteoarticular infections in a Belgian tertiary care centre over a 5-year period.
Methods: A systematic literature search was conducted in MEDLINE. Secondly, we did a retrospective cohort study.
Results: We included 69 patients, median age 1,25 years (interquartile range: 0,9-6,0). They were diagnosed with osteomyelitis in 32/69 (46,4%), septic arthritis in 25/69 (36,2%), spondylodiscitis in 8/69 (11,6%) and combined osteomyelitis and septic arthritis in 4/69 (5,8%). Delay in presentation was longer in the spondylodiscitis group (p=0,003). C-reactive protein and white blood cell count were significantly higher in the septic arthritis group (p=0,014 and p<0,001).
Blood cultures identified the causative organism in 18/66 (27,3%). Samples from infectious site were positive in 18/34 (52,9%) of whom 10 had negative blood cultures. Polymerase chain reaction  identified the organism in 3/6 (50%). In total, 30/69 (43,5%) had a microbiological diagnosis. Total antibiotic course varied from 20 to 64 days. Treatment duration was significantly longer for the Staphylococcus aureus group.
Conclusion: An increase in cultures from the infectious site and the use of polymerase chain reaction techniques could greatly improve microbiological diagnosis and enable targeted antimicrobial therapy. Magnetic resonance imaging remains the most sensitive and specific investigation and should be more easily available to avoid a delay in diagnosis. These findings should be taken into consideration when setting up local and national guidelines/protocols, currently still lacking for the management of paediatric osteoarticular infections.