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Bone and joint infections in infants under three months of age
Nicolas Mediamolle1, Cindy Mallet2, Camille Aupiais3
1Paediatric Department-Division of infectious disease, Armand Trousseau Hospital, AP-HP, Paris, France.
Insights
Bone and joint infections (BJI) in infants under three months are rare. Streptococcus agalactiae is the most common cause, and while severe orthopaedic outcomes are infrequent, they necessitate long-term infant follow-up.
Area of Science:
- Pediatric Infectious Diseases
- Orthopedic Surgery
- Neonatal Care
Background:
- Bone and joint infections (BJI) in infants under three months old are uncommon, making clinical data scarce.
- Understanding the characteristics and outcomes of BJI in this vulnerable population is crucial for timely diagnosis and management.
Purpose of the Study:
- To describe the clinical and paraclinical features of infants under three months hospitalized with BJI.
- To analyze the outcomes and identify potential risk factors for severe sequelae in this age group.
Main Methods:
- Retrospective analysis of data from the French National Hospital Discharge Database (2004-2015).
- Inclusion of 71 infants under three months with confirmed BJI from three Parisian pediatric teaching hospitals.
- Data collection included demographics, infection sites, clinical presentation, causative pathogens, laboratory markers (C-reactive protein), and long-term orthopedic outcomes.
Main Results:
- The median age of affected infants was 25 days, with the hip and knee being the most common infection sites (32% each).
- Common symptoms included pain (94%), limited mobility (87%), and fever (52%). Streptococcus agalactiae (45%) was the predominant pathogen, followed by Staphylococcus aureus (22%) and Escherichia coli (18%).
- 15.5% of cases were nosocomial; 11.3% of infants developed severe orthopedic conditions requiring long-term follow-up.
Conclusions:
- Streptococcus agalactiae is the leading cause of BJI in neonates and young infants.
- While severe orthopedic sequelae are rare, they can be significant, emphasizing the need for vigilant monitoring and extended follow-up in affected infants.
Aim:
Studies on bone and joint infections (BJI) in infants under three months are rare. We described the clinical and paraclinical features and outcomes of infants hospitalised with BJI under three months of age.
Methods:
The French National Hospital Discharge Database provided data on BJIs in infants under three months of age from January 2004 to 2015 in three Parisian Paediatric teaching hospitals.
Results:
We included 71 infants under three months of age with BJI, the median age was 25 days, and the interquartile range (IQR) was 17-43 days. The most common infection sites were the hip (32%) and knee (32%). Symptoms included pain (94%), limited mobility (87%) and/or fever (52%). There were 11 (15.5%) cases of nosocomial BJI. A pathogen was identified in 51 infants (71.8%), including Streptococcus agalactiae (45%), Staphylococcus aureus (22%) and Escherichia coli (18%). The initial median C-reactive protein test rate was 31 mg/L (IQR 17-68). Of the 34 infants followed for more than one year, four developed severe orthopaedic conditions such as epiphysiodesis, limb length discrepancy, bone necrosis and/or impaired limb function.
Conclusion:
Streptococcus agalactiae was the most common cause of BJI in infants under three months. Orthopaedic sequelae were rare, but severe, and required long-term follow-up.
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