title: Deep venous thrombosis in children with musculoskeletal infections: the clinical evidence.
abstract: BACKGROUND
  Clinical manifestations of deep venous thrombosis (DVT) tend to overlap with those of deep-seated musculoskeletal infections (MSIs). Consequently, the incidence of DVT as a complication of MSI may be underestimated. The objective of this study was to evaluate the incidence, clinical features, and outcomes of MSI-related DVT in children.
  
  
  METHODS
  We systematically reviewed relevant studies retrieved from PubMed and Scopus databases.
  
  
  RESULTS
  Overall, 93 children with MSIs who developed DVT were identified from 28 retrospective studies. The majority were boys. Osteomyelitis was the most frequent MSI (69/74, 93%). Staphylococcus aureus was the predominant pathogen (83/93, 89%); 61% of these isolates were methicillin-resistant S. aureus (MRSA). Pulmonary involvement, presumably due to septic emboli, was observed in 65% of the included children. Four children died due to multiple organ failure and two due to respiratory distress. In two of the three studies providing comparative data, MRSA infections were observed significantly more frequently in children who developed DVT compared to those who did not. Yet, the respective differences observed for methicillin-susceptible S. aureus (MSSA) infections were non-significant in these three studies.
  
  
  CONCLUSIONS
  Despite the inclusion of many case reports and the retrospective design of the evaluated studies, our findings suggest that boys seem to be more frequently affected by MSIs complicated by DVT. Moreover, MRSA seems to be more frequently associated with DVT compared to MSSA. Pulmonary involvement appears to be a frequent complication. Prospective studies are needed in order to further clarify this issue.
authors.affiliation: Department of Pediatrics, Democritus University of Thrace and University General Hospital of Alexandroupolis, Thrace, Greece.
authors.forename: Elpis
authors.initials: E
authors.lastname: Mantadakis
authors.forename: Eleni
authors.initials: E
authors.lastname: Plessa
authors.forename: Evridiki K
authors.initials: EK
authors.lastname: Vouloumanou
authors.forename: Lambros
authors.initials: L
authors.lastname: Michailidis
authors.forename: Athanassios
authors.initials: A
authors.lastname: Chatzimichael
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Falagas
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D055624:Methicillin-Resistant Staphylococcus aureus; D010019:Osteomyelitis / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology / Q000401:mortality; D020246:Venous Thrombosis / Q000209:etiology* / Q000401:mortality