Bacterial bone and joint infections in children with leukaemia or following haematopoietic cell transplant: A systematic review of published cases

Abstract

BackgroundBone and joint infections (BJI) are common in immunocompetent children, however in children with acute leukaemia the epidemiology, optimal diagnostic pathway and medical and surgical treatment is poorly described. We review the presentation, management and outcomes of BJI in this special population. MethodsSystematic literature review of BJI in children with acute leukaemia was performed using Medline, EMBASE and PubMed databases from 1946 to June, 2023. Titles and abstracts were independently screened by 3 reviewers. Studies were included if they reported data on children (≤18 years) with leukaemia who had a diagnosis of osteomyelitis (radiological diagnosis) or septic arthritis (culture proven or managed as infection by treating clinician). ResultsTwenty-two articles describing 33 episodes of confirmed or suspected bacterial BJI were included. Of these, microbiological diagnosis was confirmed in 27 episodes (82%) and included Gram-positive (9/33), Gram-negative (8/33), mycobacterial (5/33), Mycoplasmatota (1/33) and polymicrobial (4/33). The femur was the most common site of infection (33%) and there were 18 episodes (55%) of multifocal disease. Duration of treatment varied from 3 weeks to 2.5 years in patients with culture confirmed infection (82%) and from 3 to 8 weeks in patients with culture-negative infection (18%). Clinical cure was documented in 31 episodes (94%). ConclusionBone and joint infections in children with acute leukaemia are often caused by atypical pathogens, with a higher predilection for multifocal disease and/or involvement of unusual sites in comparison with immunocompetent children. It is unclear whether this population requires prolonged antibiotic treatment due to periods of intensive chemotherapy or neutropenia. Monitoring response to therapy may be challenging as inflammatory markers such as CRP and ESR may take longer to normalise, making it difficult to assess for clinical cure.