1 - Infectious Diseases Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
2 - Pediatric Orthopedic Unit, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal
3 - Centro Tecnológico e Biomédico, Radiodiagnóstico, Hospital de Dona Estefânia, CHULC - EPE, Lisbon, Portugal 4Nova Medical School, Faculdade de Ciências Médicas
- ESPID 2021 de 24 a 29 de maio de 2021 online
Resumo:
Background: Acute osteoarticular infections (OAI) in infants under three months of age (<3M) are rare and remain a diagnostic challenge because of the paucity of signs and symptoms with significant risk for orthopedic complications and functional sequelae. Our aim is to provide insight on clinical features, microbiology, treatment and outcome in OAI <3M since these are seldom described.
Methods: A longitudinal observational study of infants <3M with OAI admitted to a tertiary care pediatric hospital, from 2008 to 2018. Infants were compared with a cohort of children >3M. Clinical, microbiological, imaging and outcome data were analyzed.
Results: We identified 22/261 cases of OAI <3M, 50% males with a median age of 38.9 days (IQR 14,5-60,0). 81.8% presented pseudoparalysis, 68.2% local inflammatory signs and 45.5% fever. The diagnosis was septic 40.9% arthritis, 31.8% osteomyelitis and 27.3% concurrent septic arthritis and osteomyelitis. The most affected bones and joints were femur (53.8%), humerus (23.1%), knee (46.7%) and hip (33.3%). Microbiologic aetiology was determined in 86.4%: S. aureus (57.9%), Group B streptococcus (26.3%) and E. coli (10.5%). Comparing groups, infants <3M had more often bone involvement (59.1% vs 33.1%, p=0.013), concomitant diagnosis (50% vs 21.6%, p= 0.012), previous vascular accesses (31.8% vs 0%, p=0,000), bacteriemia (40.9% vs 14.9%, p=0.015) and radiographic alterations (36.4% vs 16.3%, p= 0.022). Also, they were treated with longer antibiotic courses, with similar complications, but more sequelae (14.3% vs 3.2%, p=0.036) at 12-months follow-up, which were necrosis of the femoral head (2), angular deformity (1) and lower limb length discrepancy (2).
Conclusions: S. aureus is still the most common cause of OAI in infants <3M. Even though complications are similar, sequelae were more frequent and more severe in young infants.
Palavras Chave: infants, newborns, osteoarticular infections, Staphylococcus aureus