Clinical and Microbiological Characterization of Osteoarticular Infections in Children from a clinic in Rionegro, Antioquia

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DOI:

https://doi.org/10.17533/udea.iatreia.328

Keywords:

Anti-Bacterial Agents, Osteomyelitis, Staphylococcus aureus

Abstract

Introduction: Osteomyelitis and septic arthritis are common invasive bacterial infections in children.

Objective: To describe the microorganisms, antimicrobial susceptibility, and microbiological diagnostic procedures.

Methods: case series in children with confirmed diagnosis, between 2017 – 2022.

Results: 48/84 patients were studied. Cases of osteomyelitis, septic arthritis and osteoarthritis were 20.8%, 37.5% and 41.6%, respectively.  Isolated microorganisms included Methicillin-Susceptible Staphylococcus aureus (MSSA) 30.7%, Methicillin-Resistant S. aureus (MRSA) 28.8%, Pseudomonas aeruginosa 5.7%, S. epidermidis 3.8%, Escherichia coli 3.8%, Enterococcus faecalis 3.8%, Aeromonas hydrophila 3.8%, Mycobacterium tuberculosis 1.9%, Salmonella spp. 1.9%, among others. In 40 infections originating from skin and soft tissues, orthopedic hardware, limb trauma, and without an identified source, MSSA/MRSA predominated (75%). MSSA/MRSA showed susceptibility to vancomycin at 100%, trimethoprim-sulfamethoxazole at 100% and 93%, and clindamycin at 100% and 86.6%, respectively. Blood cultures (n=22), synovial tissue cultures (n=7), bone cultures (n=28), and bone pus or synovial fluid in blood culture bottles (n=3) were positive in 100%.

Conclusions: S. aureus was the most frequent microorganism with a high proportion of MRSA. MRSA exhibited high susceptibility to trimethoprim-sulfamethoxazole and vancomycin. The high positivity of primary cultures suggests the importance of always obtaining them.

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Author Biographies

Dr, Clínica Somer, Rionegro, Colombia

Pediatra especialista en enfermedades infecciosas, Clínica Somer, Rionegro, Colombia.

Dra, Clínica Somer, Rionegro, Colombia

Médica general, Clínica Somer, Rionegro, Colombia.

Dr, Clínica Somer, Rionegro, Colombia

Médico general, Clínica Somer, Rionegro, Colombia.

Jhojan Herrera-Vargas, Clínica Somer, Rionegro, Colombia

Terapeuta respiratorio y epidemiólogo, Clínica Somer, Rionegro, Colombia.

References

(1) Ju KL, Zurakowski D, Kocher MS. Differentiating between methicillin-resistant and methicillin-sensitive Staphylococcus aureus osteomyelitis in children: an evidence-based clinical prediction algorithm. J Bone Joint Surg Am [Internet]. 2011;93(18):1693-1701. https://doi.org/10.2106/JBJS.J.01154

(2) Pääkkönen M, Peltola H. Bone and joint infections. Pediatr Clin North Am [Internet]. 2013;60(2):425-436. https://doi.org/10.1016/j.pcl.2012.12.006

(3) Grammatico-Guillon L, Maakaroun-Vermesse Z, Baron S, Gettner S, Rusch E, Bernard L. Paediatric bone and joint infections are more common in boys and toddlers: a national epidemiology study. Acta Paediatr [Internet]. 2013;102(3):e120-e125. https://doi.org/10.1111/apa.12115

(4) Yi J, Wood JB, Creech CB, Williams D, Jimenez-Truque N, Yildrim I, et al. Clinical epidemiology and outcomes of pediatric musculoskeletal infections. J Pediatr [Internet]. 2021;234:236-244.e2. https://doi.org/10.1016/j.jpeds.2021.03.028

(5) Autore G, Bernardi L, Esposito S. Update on acute bone and join infections in paediatrics: a narrative review on the most recent evidence-based recommendations and appropriate antinfective therapy. Antibiotics [Internet]. 2020;9(8):486. https://doi.org/10.3390/antibiotics9080486

(6) Kini AR, Shetty V, Kumar AM, Shetty SM, Shetty A. Community-associated, methicillin-susceptible, and methicillin-resistant Staphylococcus aureus bone and joint infections in children: experience from India. J Pediatr Orthop B [Internet]. 2013;22(2):158-166. https://doi.org/10.1097/BPB.0b013e32835c530a

(7) Hänel A, Rodriguez P, Silva A, Meza G, Piñera C. Infecciones osteoarticulares en niños: experiencia de 5 años. Rev Chilena Infectol [Internet]. 2020;37(6):742-749. http://dx.doi.org/10.4067/S0716-10182020000600742

(8) Cañeta-Campos I, Moller-Macherone F, Figueroa-Gatica MJ, Monge-Iriarte M, Le Corre-Pérez N, Vizcaya-Altamirano MC, et al. Infecciones osteoarticulares en población pediátrica: clínica y microbiología de los últimos 15 años. Rev Chilena Infectol [Internet]. 2022;39(6):706-712. http://dx.doi.org/10.4067/S0716-10182022000600706

(9) Highton E, Pérez MG, Cedillo-Vilamagua C, Sormani MI, Mussini MS, Isasmendi A, et al. Infecciones osteoarticulares en un hospital pediátrico de alta complejidad: epidemiología y características clínicas asociadas con bacteriemia. Arch Argent Pediatr [Internet]. 2018;116(2):e204-e209. http://dx.doi.org/10.5546/aap.2018.e204

(10) Rosanova MT, Berberian G, Bologna R, Giménez S, Sarkis C, Buchovsky A, et al. Estudio descriptivo de infecciones osteo-articulares en niños en tiempos de Staphylococcus aureus resistente a meticilina de la comunidad (SARM-Co). Rev Chilena Infectol [Internet]. 2015;32(3):321-325. https://doi.org/10.4067/S0716-10182015000400010

(11) Zuníno C, Vomero A, Pandolfo S, Gutiérrez C, Algorta G, Píerez MC, et al. Etiología y evolución de las infecciones osteo-articulares 2009-2015. Hospital Pediátrico del Centro Hospitalario Pereira Rossell, Uruguay. Rev Chilena Infectol [Internet]. 2017;34(3):235-242. https://doi.org/10.4067/S0716-10182017000300005

(12) Jaña-Neto FC, Sartori-Ortega C, De Oliveira-Goiano E. Epidemilogical study of osteoarticular infections in children. Acta Ortop Bras [Internet]. 2018;26(3):201-205. https://doi.org/10.1590/1413-785220182603145650

(13) Álvarez-Olmos MI, Enríquez SP, Pérez-Roth E, Méndez Álvarez S, Escobar J, Vanegas N, et al. Pediatric cases from Colombia caused by a Panton-Valentine Leukocidin-positive community-acquiered methicillin-resistant Staphylococcus aureus ST8-SCCmecIVc clone. Pediatr Infect Dis J [Internet]. 2009;28(10):935. https://doi.org/10.1097/INF.0b013e3181b2102b

(14) Machuca MA, González CI, Sosa LM. Staphylococcus aureus resistente a meticilina causante de infecciones comunitarias y de infecciones asociadas a la atención en salud en pacientes pediátricos del Hospital Universitario de Santander. Biomédica [Internet]. 2014;34(Supl.1):163-169. https://doi.org/10.7705/biomedica.v34i0.1648

(15) Sosa-Ávila LM, Machuca-Pérez MA, Sosa-Ávila CA, González-Rugeles CI. Infecciones por Staphylococcus aureus meticilino resistente en niños de Bucaramanga Colombia. Salud UIS [Internet]. 2010;42(3):248-255. Disponible en: https://revistas.uis.edu.co/index.php/revistasaluduis/article/view/1680

(16) Jiménez JN, Ocampo AM, Vanegas JM, Rodríguez EA, Garcés CG, Patiño LA, et al. Characterization of virulence genes in methicillin susceptible and resistant Staphylococcus aureus isolates from a paediatric population in a university hospital of Medellín, Colombia. Mem Inst Oswaldo Cruz [Internet]. 2011;106(8):980-985. https://doi.org/10.1590/s0074-02762011000800013

(17) Congedi S, Minotti C, Giaquinto C, Da Dalt L, Donà D. Acute infectious osteomylitis in children: new treatment strategies for an old anemy. World J Pediatr [Internet]. 2020;16:446-455. https://doi.org/10.1007/s12519-020-00359-z

(18) Schmitt SK. Osteomyelitis. Infect Dis Clin Noth Am [Internet]. 2017;31(2):325-338. https://doi.org/10.1016/j.idc.2017.01.010

(19) Atehortua S, Woodcock S, Naranjo J, Faraco F, Uribe-Ríos A. Diagnóstico microbiológico de artritis séptica en niños usando botellas de hemocultivos como un método alternativo. Infectio [Internet]. 2020;24(2):100-104. https://doi.org/10.22354/in.v24i2.840

(20) Sierra M, Manjarres G, Ramírez LA, Felipe O, Uribe O. Artritis séptica no gonococcica en el Hospital Universitario San Vicente de Paúl (1984-1991). Iatreia [Internet]. 1994;7(1):29-33. https://doi.org/10.17533/udea.iatreia.3538

(21) Zuluaga AF, Galvis W, Saldarriaga JG, Agudelo M, Salazar BE, Vesga O. Etiologic diagnosis of chronic osteomielitis. A prospective study. Arch Intern Med [Internet]. 2006;166(1):95-100. https://doi.org/10.1001/archinte.166.1.95

(22) Urrego-Rendón JD, Uribe-Ríos A. Perfil epidemiológico de los pacientes entre 0 y 15 años con infección osteoarticular en el Hospital Infantil San Vicente Fundación. Iatreia [Internet]. 2021;34(4):316-324. Disponible en: https://revistas.udea.edu.co/index.php/iatreia/article/view/342923

(23) Hoyos-Orrego A, Mantilla-Mantilla LF. Microbiology of bone-joint infections in children seen at a university clinic in the city of Medellín, Colombia. Infectio [Internet]. 2023;27(1):29-35. https://doi.org/10.22354/24223794.1116

(24) Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, Girschick H, Harwig N, Kaplan S, et al. Bone and joint infections. Pediatr Infect Dis J [Internet]. 2017;36(8):788-799. https://doi.org/10.1097/INF.0000000000001635

(25) World Health Organization. International Classification of Diseases, Eleventh Revision (ICD-11) [Internet]. World Health Organization (WHO); 2019/2021. [Consulted 01 Jul 2022]. Available from: https://www.who.int/classifications/classification-of-diseases

(26) OPS/OMS. Manual para el diagnóstico bacteriológico de la tuberculosis: Normas y guía técnica. Parte I Baciloscopía [Internet]. Organización Panamericana de la Salud; 2008. [Consulted 01 Jul 2022]. Disponible en: https://iris.paho.org/handle/10665.2/782

(27) Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing [Internet]. 32nd ed. CLSI supplement M100. Clinical and Laboratory Standards Institute; 2022. Available from: https://clsi.org/media/wi0pmpke/m100ed32_sample.pdf

(28) Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am [Internet]. 2015;29(3):557-574. https://doi.org/10.1016/j.idc.2015.05.012

(29) Dormans JP, Drummond DS. Pediatric Hematogenous Osteomyelitis: New Trends in Presentation, Diagnosis, and Treatment. J Am Acad Orthop Surg [Internet]. 1994;2(6):333-341. https://doi.org/10.5435/00124635-199411000-00005

(30) Pääkkönen M, Kallio MJT, Lankinen P, Peltola H, Kalillo PE. Preceding trauma in childhood hematogenous bone and joint infections. J Pediatr Orthop B [Internet]. 2014;23(5):196-199. https://doi.org/10.1097/BPB.0000000000000006

(31) Camacho-Cruz J, Gutierrez IF, Brand-López K, Sosa-Rodriguez YA; Vásquez-Hoyos P, Gómez-Cortés LC, et al. Differences between methicillin-susceptible versus methicillin-resistant Staphylococcus aureus infections in pediatrics. Multicenter cohort study conducted in Bogotá, Colombia, 2014-2018. Pediatr Infect Dis J [Internet]. 2022;41:12-19. https://doi.org/10.1097/INF.0000000000003349

(32) Lima AL, Oliveira PR, Carvalho VC, Cimerman S, Savio E. Directrices panamericanas para el tratamiento de las osteomielitis e infecciones de tejidos blandos. Recommendations for the treatment of osteomyelitis. Braz J Infect Dis [Internet]. 2014;18(5):526-534. https://doi.org/10.1016/j.bjid.2013.12.005

(33) Ratnayake K, Davis AJ, Brown L, Young TP. Pediatric acute osteomyelitis in the postvaccine, methicillin-resistant Staphylococcus aureus era. Am J Emerg Med [Internet]. 2015;33(10):1420-1424. https://doi.org/10.1016/j.ajem.2015.07.011

(34) Burnett RSJ, Aggarwal A, Givens SA, McClure TJ, Morgan PM, Barrack RL. Prophylactic antibiotics do not affect cultures in the treatment of an infected TKA: A prospective trial. Clin Orthop Relat Res [Internet]. 2010;468(1):127-134. https://doi.org/10.1007/s11999-009-1014-4

(35) Saavedra-Lozano J, Calvo C, Huguet R, Rodrigo C, Nuñez E, Pérez C, et al. Documento de consenso SEIP-SERPE-SEOP sobre etiopatogenia y diagnóstico de la osteomielitis aguda y artritis séptica no complicadas. An Pediatr (Barc) [Internet]. 2015;83(3):216.e1-216.e10. https://doi.org/10.1016/j.anpedi.2014.08.006

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Published

2025-02-27

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1.
Hoyos-Orrego A, Echeverri-Ramirez N, Moreno-Ramirez S, Herrera-Vargas J. Clinical and Microbiological Characterization of Osteoarticular Infections in Children from a clinic in Rionegro, Antioquia . Iatreia [Internet]. 2025 Feb. 27 [cited 2025 Apr. 1];1(1). Available from: https://revistas.udea.edu.co/index.php/iatreia/article/view/356671

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