title: Epidemiology and Management of Acute, Uncomplicated Septic Arthritis and Osteomyelitis: Spanish Multicenter Study.
abstract: Acute osteoarticular infection (OAI) is a potentially severe disease. The aim of this study was to evaluate the etiology, clinical characteristics and therapeutic approach of OAI in children in Spain.
  
  
  
  Medical records from children <14 years with OAI from 25 hospitals between 2008 and 2012 were reviewed. Confirmed osteomyelitis (OM) and septic arthritis (SA) required a positive bacterial isolate; otherwise, they were considered probable. Probable SA with <40,000 cells/mm in joint fluid was not included.
  
  
  
  A total of 641 children were evaluated. Two hundred and ninety-nine cases (46%) were OM, 232 (36%) SA, 77 (12%) osteoarthritis and 33 (5%) spondylodiscitis. Children with OM were older (63 vs. 43 months for SA; P < 0.001). Magnetic resonance imaging and bone scintigraphy had the highest yield for OM diagnosis (94%). Arthrocentesis was performed in 96% of SA. A microorganism was isolated in 246 patients (38%: 33% OM vs. 55% SA; P < 0.001): Staphylococcus aureus was the most common (63%), followed by Kingella kingae (15%) and Streptococcus pyogenes (9%). Ninety-five percent of children initially received IV antibiotics, mostly cefotaxime + cloxacillin (60%) or cloxacillin (40%). Total treatment duration was 38 (±31) days for OM and 28 (±16) days for SA (P < 0.0001). Twenty percent of children with OM (46% because of complications) and 53% with SA (95% initial arthrotomy) underwent surgery. Patients with SA were compared according to initial arthrotomy (n = 123) versus arthrocentesis (n = 109), and no clinical differences were observed, except for higher rate of hip SA in the former (50% vs. 9%; P < 0.001). Children with arthrocentesis had less sequelae [6.6% vs. 1%; P = 0.03, odds ratio = 0.58 (95% confidence interval: 0.45-0.76)], but not in the multivariate analysis.
  
  
  
  This is the largest pediatric cohort of OAI in Spain. S. aureus was the most common isolate, although K. kingae was recovered in a high proportion of cases. Conservative management was applied in half of the patients. There was a low rate of sequelae, even with nonsurgical approaches.
authors.affiliation: From the *Hospital Severo Ochoa, Leganés, Madrid; †Hospital Materno-Infantil, Málaga, Spain; ‡Hospital Virgen del Rocío, Sevilla, Spain; §Hospital Niño Jesús, Madrid, Spain; ¶Hospital 12 de Octubre, Madrid, Spain; ‖Hospital Infantil La Paz, Madrid, Spain; **Hospital Josep Trueta, Girona, Spain; ††Hospital Universitari Vall d'Hebron, Barcelona, Spain; ‡‡Hospital Virgen del Camino, Pamplona, Navarra, Spain; and §§Hospital Gregorio Marañón, Madrid, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: Calvo
authors.forename: Esmeralda
authors.initials: E
authors.lastname: Núñez
authors.forename: Marisol
authors.initials: M
authors.lastname: Camacho
authors.forename: Daniel
authors.initials: D
authors.lastname: Clemente
authors.forename: Elisa
authors.initials: E
authors.lastname: Fernández-Cooke
authors.forename: Rosa
authors.initials: R
authors.lastname: Alcobendas
authors.forename: Luis
authors.initials: L
authors.lastname: Mayol
authors.forename: Pere
authors.initials: P
authors.lastname: Soler-Palacin
authors.forename: Miren
authors.initials: M
authors.lastname: Oscoz
authors.forename: Jesús
authors.initials: J
authors.lastname: Saavedra-Lozano
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures; D010019:Osteomyelitis / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy*; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents