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Evaluation of the current use of imaging modalities and pathogen detection in children with acute osteomyelitis and septic arthritis

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Abstract

Diagnostic tools for the management of acute osteomyelitis (OM) and septic arthritis (SA) have improved over the last decade. To investigate the influence and availability of magnetic resonance imaging (MRI) and nucleic acid testing (NAT), a retrospective cohort study was done. Patients admitted with acute OM or SA between 2005 and 2014 were identified using ICD-10 discharge codes. Ninety-six children were identified: OM, n = 45; SA, n = 42; and OM + SA, n = 9. Diagnostic imaging was performed in 100% of OM or OM + SA and 95% of SA patients. MRI was performed in 85% of OM patients, 26% of SA patients and 100% OM + SA patients. In patients with OM or SA, concomitant joint/bone involvement was detected in 24 and 36% of patients, respectively. In 58% of patients, a pathogen was detected (Staphylococcus aureus, Streptococcus pyogenes and Streptococcus pneumoniae being most common). Blood and tissue culture were positive in 41 and 86% for OM patients and in 14 and 41%, respectively, for SA patients. In 42% of patients, no pathogen was identified, of which 40% had no material for blood or tissue culture/NAT taken.

Conclusion: Optimal use of imaging modalities including MRI and systematic pathogen detection including NAT should be advocated to limit use of broad spectrum antibiotics and treatment duration.

What is Known:

• Magnetic resonance imaging and sonography have the best sensitivity for detection of acute osteomyelitis and septic arthritis in children.

• Systematic use of blood cultures, tissue cultures and nucleic acid testing improves pathogen detection in children with acute osteomyelitis and septic arthritis.

What is New:

• The added value of imaging modalities other than magnetic resonance and sonography for detection of osteomyelitis and septic arthritis is limited, and their routine use should be questioned.

• Despite availability of optimal pathogen detection methods, missed opportunities to improve pathogen detection are frequent.

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Abbreviations

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

Hib:

H. influenzae serotype b

ICD:

International Classification of Diseases

MRI:

Magnetic resonance imaging

NAT:

Nucleic acid testing

OM:

Osteomyelitis

OM + SA:

Osteomyelitis and septic arthritis

SA:

Septic arthritis

WBC:

White blood count

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Author information

Authors and Affiliations

  1. Infectious Diseases Unit, University of Basel Children’s Hospital, Basel, Switzerland

    Nora Manz, Ulrich Heininger & Nicole Ritz

  2. Orthopaedic Unit, University of Basel Children’s Hospital, Basel, Switzerland

    Andreas H. Krieg

  3. Paediatric Pharmacology, University of Basel Children’s Hospital, Basel, Switzerland

    Nicole Ritz

  4. Department of Paediatrics, The University of Melbourne, and Infectious Diseases Unit, Royal Children’s Hospital Melbourne, Parkville, Australia

    Nicole Ritz

Authors
  1. Nora Manz
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  2. Andreas H. Krieg
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  3. Ulrich Heininger
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  4. Nicole Ritz
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Contributions

Nora Manz carried out the data analysis, drafted the initial manuscript and approved the final manuscript as submitted. Andreas Krieg reviewed the manuscript and approved the final manuscript as submitted. Ulrich Heininger conceived the study, reviewed the manuscript and approved the final manuscript as submitted. Nicole Ritz conceived the study, supervised the analysis, reviewed and revised the manuscript and approved the final manuscript as submitted.

Corresponding author

Correspondence to Nicole Ritz.

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Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval/informed consent

Due to the retrospective, descriptive study design, no patient consent was obtained. The study was approved by the ethics committee of North-West-Switzerland (EKBB, number 2014/184).

Additional information

Communicated by Piet Leroy

Ulrich Heininger and Nicole Ritz had shared authorship

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Manz, N., Krieg, A.H., Heininger, U. et al. Evaluation of the current use of imaging modalities and pathogen detection in children with acute osteomyelitis and septic arthritis. Eur J Pediatr 177, 1071–1080 (2018). https://doi.org/10.1007/s00431-018-3157-3

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  • DOI: https://doi.org/10.1007/s00431-018-3157-3

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