Bone and Joint Infections in Children

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Osteomyelitis

Osteomyelitis is inflammation of the bone caused by infection with bacterial or fungal organisms. Osteomyelitis often is categorized into three different types: (1) acute hematogenous osteomyelitis; (2) osteomyelitis secondary to contiguous spread of infection after trauma, puncture wounds, surgery, or joint replacement; and (3) osteomyelitis secondary to vascular insufficiency [1]. Acute hematogenous osteomyelitis is seen most often in children. Osteomyelitis caused by contiguous spread of

Pyogenic arthritis

Infection of the joint space in children usually is a complication of bacteremia. Viruses, fungal organisms, and Mycobacterium tuberculosis are uncommon causes of joint space infection (see Table 2). Children also may develop reactive arthritis as a consequence of bacterial infection elsewhere in the body.

Summary

The numbers of bone and joint infections resulting from vaccine-preventable infections, such as Hib and S. pneumoniae, have decreased in recent years. S. aureus remains an important cause of pyogenic arthritis and osteomyelitis, and the prevalence of CA-MRSA is increasing. Transition from intravenous to oral antibiotic therapy remains the treatment of choice for uncomplicated pediatric bone and joint infections if the family is reliable and close follow-up can be ensured.

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