Pediatric pneumococcal bone and joint infections

Objective, To describe the clinical and microbiological characteristics of infants and children with bone and joint infections caused by penicillin-su sceptible and penicillin-nonsusceptible strains of Streptococcus pneumoniae . Design. Multicenter, prospective patient accrual; retrospective chart revie w of identified patients. Setting. Eight children's hospitals in the United States. Participants, Forty-two children with bone and/or joint infections prospect ively enrolled in the United States Pediatric Multicenter Pneumococcal Surv eillance 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, antibiot ic 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%) strain s isolated from children who received antibiotics within 4 weeks before hos pitalization were not susceptible to penicillin, compared with 4 of 15 (27% ) strains isolated from children without previous antibiotic exposure. Clin ical response to therapy was similar between children infected by penicilli n-susceptible strains compared with those infected by penicillin-nonsusecpt ible 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 p rescribed single agents for parenteral therapy in definitive treatment were ceftriaxone (36%), penicillin (15%), and clindamycin (15%), Oral therapy f ollowed parenteral therapy in 56% of children. The mean (+/- standard devia tion) duration of total antibiotic therapy in children with osteomyelitis w as 57.5 +/- 48.6 days (range, 23-196 days) and 29.2 +/- 11.8 days (range, 1 2-67 days) for arthritis, Late sequelae (lang-term destructive changes of t he 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 infectio n in our patients were similar to previously published series collected fro m single institutions before the emergence of significant antibiotic resist ance in S pneumoniae, Our analysis suggests that children infected by penic illin-nonsusceptible strains have a similar clinical response to therapy wh en compared with children infected by penicillin-susceptible strains.