Pediatric pneumococcal bone and joint infections

被引:41
作者
Bradley, JS
Kaplan, SL
Tan, TQ
Barson, WJ
Arditi, M
Schutze, GE
Wald, ER
Givner, LB
Mason, EO
机构
[1] Childrens Hosp, San Diego, CA 92123 USA
[2] Univ Calif San Diego, San Diego, CA 92103 USA
[3] Baylor Coll Med, Houston, TX 77030 USA
[4] Texas Childrens Hosp, Houston, TX 77030 USA
[5] Childrens Mem Hosp, Chicago, IL 60614 USA
[6] Columbus Childrens Hosp, Columbus, OH USA
[7] Childrens Hosp, Los Angeles, CA 90027 USA
[8] Univ Arkansas Med Sci, Little Rock, AR 72205 USA
[9] Arkansas Childrens Hosp, Little Rock, AR 72202 USA
[10] Childrens Hosp Pittsburgh, Pittsburgh, PA USA
[11] Brenner Childrens Hosp, Winston Salem, NC USA
关键词
septic arthritis; osteomyelitis; antibiotic therapy; penicillin resistance; Streptococcus pneumoniae;
D O I
10.1542/peds.102.6.1376
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective, To describe the clinical and microbiological characteristics of infants and children with bone and joint infections caused by penicillin-susceptible and penicillin-nonsusceptible strains of Streptococcus pneumoniae. Design. Multicenter, prospective patient accrual; retrospective chart review of identified patients. Setting. Eight children's hospitals in the United States. Participants, Forty-two children with bone and/or joint infections prospectively enrolled in the United States Pediatric Multicenter Pneumococcal Surveillance Study from September 1, 1993 to August 31, 1996. Outcome Measures. Data were collected on multiple variables, including age, gender, race, days of symptoms before and during hospitalization, antibiotic and surgical therapy, laboratory and imaging studies. Results. Of the 42 children enrolled (21 bone, 21 joint infections), 14 had isolates that were not susceptible to penicillin. Eight of 16 (50%) strains isolated from children who received antibiotics within 4 weeks before hospitalization were not susceptible to penicillin, compared with 4 of 15 (27%) strains isolated from children without previous antibiotic exposure. Clinical response to therapy was similar between children infected by penicillin-susceptible strains compared with those infected by penicillin-nonsusecptible strains, including duration of hospitalization (9.1 days vs 11.2 days), days of intravenous antibiotic therapy (25.3 days vs 24.6 days), days of fever (3.6 days vs 3.1 days), and sequelae (14% vs 7%). The most commonly prescribed single agents for parenteral therapy in definitive treatment were ceftriaxone (36%), penicillin (15%), and clindamycin (15%), Oral therapy followed parenteral therapy in 56% of children. The mean (+/- standard deviation) duration of total antibiotic therapy in children with osteomyelitis was 57.5 +/- 48.6 days (range, 23-196 days) and 29.2 +/- 11.8 days (range, 12-67 days) for arthritis, Late sequelae (lang-term destructive changes of the bone or joint) were documented in 5 (12%) children, 4 with osteomyelitis, and 1 with arthritis. Sequelae occurred in 30% of children with long bone osteomyelitis associated with infection in the adjacent joint. The age of children with sequelae was younger than those without sequelae (6.4 months vs 18.6 months). Conclusions. The demographic characteristics and anatomic sites of infection in our patients were similar to previously published series collected from single institutions before the emergence of significant antibiotic resistance in S pneumoniae, Our analysis suggests that children infected by penicillin-nonsusceptible strains have a similar clinical response to therapy when compared with children infected by penicillin-susceptible strains.
引用
收藏
页码:1376 / 1382
页数:7
相关论文
共 38 条
[1]   Septic arthritis and osteomyelitis caused by penicillin and cephalosporin-resistant Streptococcus pneumoniae in a children's hospital [J].
Abbasi, S ;
Orlicek, SL ;
Almohsen, I ;
Luedtke, G ;
English, BK .
PEDIATRIC INFECTIOUS DISEASE JOURNAL, 1996, 15 (01) :78-83
[2]   MULTI-JOINT PNEUMOCOCCAL PYARTHROSIS IN A PATIENT WITH A CHEMOTACTIC DEFECT [J].
ANDERSEN, BR ;
MAYER, ME ;
GEISELER, PJ ;
NIEBEL, JP .
ARTHRITIS AND RHEUMATISM, 1983, 26 (09) :1160-1162
[3]   ACUTE HEMATOGENOUS OSTEITIS [J].
ANDERSON, JR ;
ORR, JD ;
MACLEAN, DA ;
SCOBIE, WG .
ARCHIVES OF DISEASE IN CHILDHOOD, 1980, 55 (12) :953-957
[4]   Three-year multicenter surveillance of pneumococcal meningitis in children: Clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use [J].
Arditi, M ;
Mason, EO ;
Bradley, JS ;
Tan, TQ ;
Barson, WJ ;
Schutze, GE ;
Wald, ER ;
Givner, LB ;
Kim, KS ;
Yogev, R ;
Kaplan, SL .
PEDIATRICS, 1998, 102 (05) :1087-1097
[5]  
BARAFF LJ, 1993, PEDIATRICS, V92, P1
[6]   SEPTIC ARTHRITIS IN CHILDHOOD - A 13-YEAR REVIEW [J].
BARTON, LL ;
DUNKLE, LM ;
HABIB, FH .
AMERICAN JOURNAL OF DISEASES OF CHILDREN, 1987, 141 (08) :898-900
[7]   MECHANISMS OF HOST DEFENSE AGAINST INFECTION WITH STREPTOCOCCUS-PNEUMONIAE [J].
BRUYN, GAW ;
ZEGERS, BJM ;
VANFURTH, R .
CLINICAL INFECTIOUS DISEASES, 1992, 14 (01) :251-262
[8]  
BURMAN LA, 1985, REV INFECT DIS, V7, P133
[9]   PNEUMOCOCCAL ARTHRITIS AND OSTEOMYELITIS IN CHILDREN [J].
CHUSID, MJ ;
STY, JR .
CLINICAL PEDIATRICS, 1981, 20 (02) :105-107
[10]   INTERRELATIONSHIP BETWEEN PHARMACOKINETICS AND PHARMACODYNAMICS IN DETERMINING DOSAGE REGIMENS FOR BROAD-SPECTRUM CEPHALOSPORINS [J].
CRAIG, WA .
DIAGNOSTIC MICROBIOLOGY AND INFECTIOUS DISEASE, 1995, 22 (1-2) :89-96