Diagnosis Of Osteoarticular Infections Research Articles

Alternatives for the Detection and Diagnosis of Osteoarticular Infections: An Exploratory Review.

The precise diagnosis of osteomyelitis, a bone infection, remains a significant challenge for healthcare professionals. This difficulty stems from the highly variable nature of its clinical presentation and disease course. Patients can exhibit a wide range of symptoms, making it easy to misdiagnose the condition. In turn, inaccurate diagnoses lead to inappropriate treatment regimens, potentially hindering a patient's recovery and causing unnecessary complications. Nuclear medicine offers a ray of hope in this fight against diagnostic ambiguity. It provides valuable tools, such as radiopharmaceutical imaging, that can significantly improve the accuracy of osteomyelitis diagnosis. However, limitations exist. This article explores the need for alternative diagnostic approaches within the specific context of Costa Rica. This exploration is particularly relevant due to the current regional shortage of gallium-67 (⁶⁷Ga), a radiopharmaceutical commonly used in osteomyelitis diagnosis. The article delves into the nature, function, and limitations of various nuclear medicine techniques, encompassing both independent radiopharmaceuticals like ⁶⁷Ga and those conjugated with specific targeting molecules to pinpoint areas of infection within the body. Given the scarcity of ⁶⁷Ga in Costa Rica, it becomes crucial to explore and implement viable alternative diagnostic techniques within the healthcare system. This article emphasizes the need for further investigation into these alternatives, with the goal of improving diagnostic accuracy and ensuring optimal patient care. By implementing these alternatives, healthcare professionals in Costa Rica can effectively combat the challenges posed by osteomyelitis and pave the way for better patient outcomes.

Surveillance of osteoarticular infections caused by Staphylococcus aureus in a paediatric hospital in Mexico City.

Staphylococcus aureus is the main aetiologic agent of osteoarticular infections (OAIs) in paediatric patients. The aim of this prospective unicenter study was to describe the phenotypic and genotypic characteristics of S. aureus isolates obtained from OAIs in paediatric patients admitted to tertiary care hospital. Through a surveillance program called OsteoCode, a multidisciplinary team was created and we identified 27 patients with OAIs caused by S. aureus from 2019 to 2021. The susceptibility profile, virulence factors, biofilm formation, pulsed-field gel electrophoresis (PFGE), clonal complex (CC) and sequence type (ST) were determined. In addition, the clinical characteristics and evolution of the patients presented six months after the diagnosis of OAIs were described. Ninety-two percent of the isolates were methicillin-sensitive S. aureus (MSSA). In methicillin-resistant S. aureus (MRSA), SCCmec-II and SCCmec-V were detected. The pvl gene was only observed in MSSA (18.5%) and was associated with highest fever (p=0.015), multiple localization (p=0.017), and soft tissue sites of infection beyond the bone (pyomyositis, pulmonary abscess) (p=0.017). Biofilm formation was detected in 55.6% of isolates. The most common CC were CC5 and CC30 which represent the most common linages for bone and joint infections worldwide. The isolates were distributed in different STs, and ST672 was predominant. MRSA were associated with a longer duration of intravenous treatment and a prolonged hospital stay (p=0.023). Recurrent infection occurred in five children and orthopaedic complications in 33.3% of patients. This is the first study that reflects the epidemiology of S. aureus in OAIs in paediatric patients in Mexico; a clear predominance of MSSA distributed in different STs was observed. Our findings highlight that a multidisciplinary team is required for the diagnosis and treatment of OAIs.

Treatment and Clinical Outcomes of Osteoarticular Infections Among Pediatrics Admitted to Jimma University Medical Center, Ethiopia: A Prospective Observational Study.

BackgroundDespite the high burden of osteoarticular infections in sub-Saharan Africa, there is a paucity of data regarding the osteoarticular infections management approach and clinical outcomes in the region. Hence, this study aimed to evaluate a management protocol, clinical outcomes, and its determinants among pediatric patients with osteoarticular infections.MethodsA pediatric patient admitted to Jimma University Medical Center (JUMC), Ethiopia, with a diagnosis of osteoarticular infections was enrolled prospectively from April 30 to October 30, 2019. Clinical characteristics, management modality, and in-hospital complications were recorded from admission to discharge. Data were analyzed by using SPSS v.23 and the p-value <0.05 was considered statistically significant.ResultsAmong a total of 150 pediatric patients enrolled in this study, osteomyelitis was diagnosed in 111 (74%), while the rest 39 (26%) had septic arthritis. The majority 105 (70%) of the study participants were male with a mean age of 8.79 ± 4.2 years. The culture was performed for only 3.6% of the patients. Almost all (98.7%) of the patients received intravenous (IV) antibiotics, and ceftriaxone was the most common IV antibiotic used as a monotherapy 66 (44.6%) or in combination with metronidazole 47 (31.8%) or gentamicin (12.8%). Almost half (45.3%) of the patients had poor treatment outcomes. Factors associated with poor treatment outcome were comorbidity [AOR=3.3, 95% CI (1.08–10.16)] and use of combination antibiotics [AOR=2.9, 95% CI (1.16–7.3)]. Rural residence [AOR=0.39, 95% CI (0.168–0.92)] and surgical interventions [AOR=0.29, 95% CI (0.006–0.144)] were associated with good treatment outcomes.ConclusionAlmost half of pediatric patients with osteoarticular infections had poor treatment outcome. Health providers should increase the accessibility of microbiological tests and diagnostic imaging, which can guide treatment decisions and improve outcomes of patients with osteoarticular infections.

Evaluation of the impact of the Spanish Consensus Document on the approach to osteoarticular infections in Spain through the Paediatrics Osteoarticular Infections Network (RIOPED)

IntroductionIn 2014 the Consensus Document produced by the Spanish Paediatric Societies (SEIP-SERPE-SEOP) was published to help in the diagnosis and treatment of osteoarticular infections (OAI). In 2015 the RIOPed was considered as a multidisciplinary national network for the investigation into OAI. The aim of this study was to assess the level of adaption to the recommendations established in the Consensus during one year of follow-up. Material and methodsA prospective, national multicentre study was carried out in 37 hospitals between September 2015 and September 2016. The study included patients >16 years-old with a diagnosis of OAI, confirmed by microbiological isolation, or probable: septic arthritis (SA) with >40,000 white cells in synovial fluid, or osteomyelitis (OM)/spondylodiscitis (SD) with a compatible imaging test. The results were compared with those obtained in a retrospective study conducted between 2008 and 2012. ResultsA total of 235 cases were included, of which 131 were OM, 79 SA, 30 OA, and 15 SD. As regards the complementary tests that the Consensus considered mandatory to perform, radiography was carried out on 87.8% of the cases, a blood culture on 91.6%, and culture of the synovial fluid in 99% of SA. A magnetic resonance (MR) was performed on 71% of the OM cases. The choice of intravenous empirical antibiotic treatment was adapted to the recommendations in 65.1% of cases, and in 62.3% for the oral treatment. Surgery was performed in 36.8% of SA cases (85.7% arthrotomy), with a significant decrease compared to the retrospective study (P=.014). Only 58.5% of cases followed the recommendations on the duration of the treatment; however, a lower duration of intravenous treatment was observed. ConclusionsIn general, the level of adaptation to the recommendations that were set by the Expert Group, is good for the complementary tests, and acceptable as regards the choice of antibiotic treatment, although inadequate in almost 40% of cases. A decrease in hospital stay was achieved.

Frequency of Multifocal Disease and Pyogenic Arthritis of the Hip in Infants with Osteoarticular Infection in Three Neonatal Intensive Care Units

To describe the clinical features of osteoarticular infection in infants cared for in neonatal intensive care units (NICUs) and to assess the presence of multifocal infection. Retrospective medical record review with structured data abstraction of infants with osteomyelitis or pyogenic arthritis or both in NICUs at 3 children's hospitals over a 29-year period. Of the 45 cases identified, 87% occurred in prematurely born infants, with a median gestational age of 27.4weeks (IQR, 26, 31weeks). Median postnatal age at diagnosis of infection was 33days (IQR, 20, 50days). Osteomyelitis was present without joint involvement in 53% and with joint involvement in 44% of cases. Methicillin-susceptible Staphylococcus aureus (71%) was the predominant pathogen, despite prevalent methicillin-resistant S aureus in community-associated infections. More than 1 bone was infected in 34% of cases. The femur (in 50% of patients) was the most frequently involved bone and the hip (in 20% of patients) was the most frequently involved joint. Bacteremia persisted for 4 or more days in 54% of patients with a positive blood culture despite active antimicrobial therapy. Among infants with osteoarticular infection in NICUs, multifocal disease is common and frequently is unsuspected. Search for additional sites of infection including the hip is warranted following the diagnosis of osteoarticular infection at a single site. Involvement of contiguous joints should be suspected in cases of osteomyelitis; conversely the presence of pyogenic arthritis usually indicates extant osteomyelitis in a contiguous bone.

Interest of a Three Phase Bone Scintigraphy Protocol in the Diagnosis and Management of Osteoarticular Infections in Children. About 31 Cases

Introduction: Osteoarticular infection is a particularly common pathology in children. The diagnosis is sometimes difficult especially in front of a poor symptomatology and a little disturbed biological assessment. The aim of this work is to assess the contribution of bone scintigraphy in the diagnosis of osteoarticular infections in children. Patients and Method: This is a retrospective study spread out between December 2012 and February 2019, involving children referred to the nuclear medicine department of Hassan II University Hospital Center of Fez for suspected osteoarticular infection. All the children benefited from a bone scan with a triple phase acquisition followed by a study of the entire bone skeleton, after an IV injection of 10 MBq /Kg of MDP-Tc99m. Results: We selected 31 children. The average age was 9.43 years old with a male predominance. The clinical signs mainly found in our patients were fever, bone pain and functional impairment of the affected limb. The main location was the lower limb (74.2%). Bone scan was positive in 70.9% of patients, including 9 cases of septic arthritis, 7 cases of osteomyelitis, 4 cases of sacroiliitis and one case of lumbar spondylodiscitis. Conclusions: Three-phases bone scintigraphy protocole with MDP-Tc99m completed with a whole body bone scan should remain the examination of choice in osteoarticular infections in children. This exam makes it possible to retain an accurate diagnosis in an early stage of OAI while the other medical imaging modalities exams being negative. Thus allowing to prevent severe complications with an affordable financial cost and an acceptable irradiation rate.

Osteoarticular Infections in Newborns: Prognostic Factors and Outcome

Purpose: To analyze clinical, laboratory, microbiologic, imaging and therapeutic data that contribute to outcome in newborn infants with osteoarticular (OSA) infection. Methods: Clinical course, imaging and follow-up data of 15 newborns with the diagnosis of OSA infection were retrospectively reviewed. Results: 15 newborns with 23 acute osteoarthritis foci were included: risk factors were identified in 73%, lower extremities were affected in 8 (53%) and more than half of the children had two-or multifocal involvement. The predominant causative agent was Staphylococcus aureus. While plain radiography showed osteolytic bone lesions in only 33%, scintigraphy was consistent with osteomyelitis in 74% of study infants. Magnetic resonance imaging revealed an inflammatory process even when other imaging modalities did not detect any OSA signs. All newborns underwent surgical and antibiotic treatment; the average time from admission to surgical treatment was 3.6 days. No bone and joint deformities or limb-length disturbances were found in the mean follow-up period of 8.5 years. Conclusion: Our study confirms that the most important prognostic factors in predicting a long-term favorable outcome are early diagnosis and therapy consisting of a combination of both surgical and appropriate antibiotic treatment.

Quorum Sensing - Dependent Virulence Factors and Biofilm Formation of Pseudomonas Aeruginosa Isolates from Retrieved Orthopedic Implants

Background: Quorum sensing (QS) plays a crucial role in medical device-related infections. However, epidemiological analysis of QS- dependent virulence factors among Pseudomonas aeruginosa (P. aeruginosa) isolates from orthopedic implants-related infections has rarely been reported. Objective: to assess some QS-dependent virulence factors (as pyocyanin, elastase, protease, rhamnolipid, and biofilm production) in P. aeruginosa isolates from retrieved different orthopedic implants. Methodology: Twenty-four P. aeruginosa isolates obtained from 300 retrieved orthopedic implants with proven diagnosis of osteoarticular infection directly related to orthopedic implants were investigated for production of QS-dependent virulence factors. The pyocyanin production was assayed using King A media, rhamnolipid production was checked utilizing cetyltrimethylammonium bromide (CTAB) agar test. Elastin lytic activity was assayed using elastin Congo red, total protease was estimated using the modified skimmed milk assay technique, and the biofilm forming ability was assayed by microtiter plate assay. N-acyl homoserine lactones (3-oxo-C 12 -HSL, C 4 -HSL) were detected by Cross-feeding bioassay. Polymerase chain reaction (PCR) was used to assess the presence of the QS genes lasI, lasR, rhlI, and rhlR in P. aeruginosa isolates. Results: Seventeen isolates (70.8%) displayed the QS-dependent phenotypes and seven isolates were found to be lacking all tested virulence factors. The lack of production of pyocyanin, Rhamnolipid, las B elastase, total protease, and biofilm formation by the seven isolates proposed that they might have a defective QS system. Among the Seven isolates exhibiting impaired QS-dependent phenotypes, AHLs autoinducers were present in three isolates, though the residual four isolates were lacking both autoinducers and therefore are considered QS-deficient. PCR analysis declared that two isolates contained lasI, lasR, rhlI and rhlR genes while one isolate lacked lasR gene, and one isolate was lacking the four tested genes. Conclusion: Although QS seems to be a crucial regulator of virulence factors and biofilm formation in P. aeruginosa, it is equipped to produce implant infection in humans despite an impaired QS system. These results do not challenge the concept that QS plays a foremost role in P. aeruginosa pathogenicity, but highlight that along with known virulence factors, perhaps there are other virulence factors, that may not be strictly under QS control.

Stresses in Pediatric Hospital Medicine.

One of the most difficult questions facing a hospitalist is when to transition to oral antibiotics. Osteoarticular infections continue to be one of the diagnoses that pit infectious disease (ID) , hospitalists, and surgeons against each other, with varying degrees of comfort with duration of oral versus intravenous antibiotics. A group out of Singapore has been using C-reactive proteins (CRPs) to help make the decision and have some exciting findings. 1 #### The study This was a retrospective case series of all pediatric patients aged 6 weeks to 18 years admitted to the KK Women’s and Children’s Hospital from 2007 to 2013 with a diagnosis of osteoarticular infection. Intravenous antibiotics were used until clinical improvement was noted, and the CRP level decreased by half over a period of 4 days, at which time they switched to oral antibiotics. Patient follow-up was conducted via chart review for a period of 18 months to assess for complications. #### The key findings A total of 37 patients were included, 24 with osteomyelitis only, 11 with septic arthritis only, and 2 with both. Of these, 34 patients transitioned to oral antibiotics after a 50% decline in CRP over 4 days. One of these patients developed complications (2.94%). The …

Gammagrafía con 99mTc-ceftizoxima en ratas normales y en ratas con absceso inducido

This study aimed to investigate the biodistribution of the 99mTc-ceftizoxime in normal rats and in rats bearing septic and sterile induced abscess. Three groups of rats were studied. a) Six normal rats b) 15 rats with E. coli induced abscess and c) 15 rats with sterile zymosan induced abscess. Septic abscess was induced with 2 x 10(8) colony forming units of E. coli and sterile one with 0.1 mL of 5% sterile Zymosan. 24 h after the abscess induction, 12 MBq of 99mTc-CFT were injected iv. and whole body images were collected at 30 min, 1, 2, 4 and 6 h p.i. Areas of interest were drawn and lesion/background index was calculated. The 6 normal rats were scanned at the same times, killed at 6 h p.i and kidney, liver, spleen, lung, heart and muscle activity were measured. Each organ was weighed, cut and its activity measured. Parallelly, the biological activity of the labeled antibiotic and its binding to the E. coli and S. aureus bacteria were analyzed. High biliary excretion was seen in all rats. Organ measurement showed the maximal uptake in kidney and very low uptake in muscles. Mean +/- s.d abscess/background ratio at 30 min, 1, 2, 4 and 6 h were 2.60 +/- 0.36, 2.67 +/- 0.66, 2.6 0 +/- 0.58, 2.78 +/- 0.84, 3.24 +/- 1.00 for septic abscess and 2.37 +/- 0.39, 2.10 +/- 0.38, 1.97 +/- 0.34, 1.82 +/- 0.25, 1.65 +/- 0.23 for aseptic abscess. The 99mTc-CFT uptake was significantly higher in the septic abscess than in sterile one (p < 0.05). The 99mTc-CFT uptake in the septic abscess remains stable or increases until along the 6 h. The 99mTc-CFT uptake in the aseptic abscess decreases along the time. The scintigraphy with 99mTc-CFT seems able to differentiate sterile inflammation from infection. High biliary excretion limits its application in abdomen. Main application could be diagnosis of osteoarticular infection.

Diagnosis of Orthopedic Infection in Clinical Practice Using Tc-99m Sulesomab (Antigranulocyte Monoclonal Antibody Fragment Fab’2)

The aim of the study was to analyze the use of Tc-99m-labeled antigranulocyte monoclonal antibody fragment Fab'2 (SMab, Leukoscan) in the diagnosis of acute osteomyelitis and articular prosthesis infection. One hundred seventeen patients (118 studies) have been included, 92 women and 25 men. Thirty-seven had a suspicion of osteomyelitis and 81 with suspicion of infection of a hip (35 patients) or a knee (45 patients) prosthesis. The mean age was 64 years. A 3-phase bone scan and a SMab scan were obtained in all patients. Antigranulocyte scans were obtained within 3 and 8 hours postinjection of 20 mCi (740 MBq) of Tc-99m-labeled antibody. Diagnosis of infection was based on bone biopsy in 8 cases and on at least 2 positive cultures in the remaining cases. Infection was ruled out with negative cultures or 1-year patient follow up with negative C-reactive protein and normal erythrocyte sedimentation rate. Sensitivity, specificity, accuracy, and negative predictive value of Tc 99m-SMab scintigraphy were: 75%, 95%, 87%, and 92% for long bone osteomyelitis and 80%, 89%, 87%, and 91% for articular prosthesis infection, respectively. Positive predictive values were 83% and 63%, respectively. Tc-99m-antigranulocyte monoclonal antibody fragment Fab'2 scintigraphy seems to be a useful method in the diagnosis of osteoarticular infection.