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Pediatric pneumococcal bone and joint infections. The Pediatric Multicenter Pneumococcal Surveillance Study Group
J S Bradley1, S L Kaplan, T Q Tan
1Children's Hospital and University of California, San Diego, California, USA.
Insights
Pediatric bone and joint infections caused by penicillin-nonsusceptible Streptococcus pneumoniae showed similar clinical responses to treatment compared to susceptible strains. This finding is crucial for guiding antibiotic therapy in children.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Orthopedic Surgery
Background:
- Streptococcus pneumoniae is a significant cause of bone and joint infections in children.
- The emergence of penicillin-nonsusceptible strains necessitates understanding their clinical impact.
Purpose of the Study:
- To characterize bone and joint infections in children caused by penicillin-susceptible and penicillin-nonsusceptible Streptococcus pneumoniae.
- To compare clinical outcomes and microbiological features between infections caused by susceptible and nonsusceptible strains.
Main Methods:
- Multicenter prospective study involving 42 children across eight US children's hospitals.
- Retrospective chart review collected data on demographics, clinical presentation, treatment, and outcomes.
- Analysis included comparison of outcomes between children infected with penicillin-susceptible and penicillin-nonsusceptible S. pneumoniae strains.
Main Results:
- Fourteen of 42 children had infections caused by penicillin-nonsusceptible S. pneumoniae.
- Children with previous antibiotic exposure were more likely to have nonsusceptible strains (50% vs 27%).
- Clinical response to therapy, including hospitalization duration, fever duration, and sequelae rates, was similar for both susceptible and nonsusceptible strains.
Conclusions:
- Demographic and infection site characteristics were similar to historical data before widespread antibiotic resistance.
- Children infected with penicillin-nonsusceptible S. pneumoniae strains showed comparable clinical responses to those infected with susceptible strains.
- Treatment strategies for pediatric bone and joint infections should consider the similar clinical outcomes regardless of penicillin susceptibility.
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-nonsusceptible 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 (long-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.