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PEDIATRICS Vol. 102 No. 6 December 1998, pp. 1376-1382

Pediatric Pneumococcal Bone and Joint Infections

Received Mar 3, 1998; accepted May 7, 1998.

John S. Bradley*, Sheldon L. KaplanDagger , Tina Q. Tan§, William J. Barsonparallel , Moshe Arditi, Gordon E. Schutze#, Ellen R. Wald**, Laurence B. GivnerDagger Dagger , Edward O. MasonDagger , and The Pediatric Multicenter Pneumococcal Surveillance Study Group (PMPSSG)

From the * Children's Hospital and University of California, San Diego, California; the Dagger  Baylor College of Medicine and Texas Children's Hospital, Houston, Texas; the § Children's Memorial Hospital, Chicago, Illinois; the parallel  Columbus Children's Hospital, Columbus, Ohio; the  Children's Hospital, Los Angeles, California; the # University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, Arkansas; the ** Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; and the Dagger Dagger  Brenner Children's Hospital, Winston-Salem, North Carolina.

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.  Key words:  septic arthritis, osteomyelitis, antibiotic therapy, penicillin resistance, Streptococcus pneumoniae.




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