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Global epidemiology of childhood bone and joint infection: a systematic review

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Abstract

Purpose

Childhood bone and joint infection (BJI) is a potentially severe disease that may have permanent sequelae, including growth impairment and limb deformity. It has been characterised in the literature with a focus on Western epidemiology; there are currently no reports detailing global epidemiology and bacteriology. This omits key data from determining temporal trends, appropriate antibiotic therapy, and resource allocation. This review aims to identify studies that characterise the incidence of childhood bone and joint infection or provide detailed bacteriology within their region.

Methods

A systematic review of the literature was performed from 01/01/1980 to 31/12/2020. Data has been analysed to give incidence of disease per 100,000 children, primary pathogen by country where available, and risk ratio (RR) for disease by ethnicity. This is applicable for areas that experience race-related inequitable burden of disease.

Results

Forty-four articles met the inclusion area; of these, seven were population-wide studies, primarily from Europe or the United States, and the remainder were cohort studies. Incidence could be derived from 26 studies compromising over 34, 000 children. Information on bacteriology was available from 39 publications (10, 957 cases). Methicillin-sensitive Staphylococcus aureus is the most common pathogen in the West. Recently, disease secondary to Kingella kingae and methicillin-resistant S. aureus has increased. Salmonella remains a dominant pathogen in African regions. Increased risk of disease is observed in Aboriginal, New Zealand Māori, Pacific, Indigenous Fijian, and Bedouin children.

Conclusion

The current state of the literature detailing incidence of childhood BJI focuses on disease patterns from the West. There is a paucity of high-quality publications in the developing world. Despite these limitations, global trends in burden of disease show race-related inequitable risk of BJI. Temporal and regional variation in bacteriology can be demonstrated.

Level of evidence: III.

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Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of Auckland, Waikato Hospital, Pembroke Street, Hamilton West, 3204, New Zealand

    Sarah Hunter & Joseph F. Baker

  2. Department of Orthopaedic Surgery, Hawke’s Bay Hospital, University of Auckland, Auckland, New Zealand

    Heidi Chan

  3. Department of Surgery, University of Auckland, Auckland, New Zealand

    Joseph F. Baker

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  1. Sarah Hunter
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Correspondence to Sarah Hunter.

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Hunter, S., Chan, H. & Baker, J.F. Global epidemiology of childhood bone and joint infection: a systematic review. Infection 50, 329–341 (2022). https://doi.org/10.1007/s15010-021-01741-3

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