Osteoarticular Infections in Pediatric Hospitals in Europe: A Prospective Cohort Study From the EUCLIDS Consortium

Andreas Trobisch; Nina A Schweintzger; Daniela S Kohlfürst; Manfred G Sagmeister; Matthias Sperl; Andrea J Grisold; Gebhard Feierl; Jethro A Herberg; Enitan D Carrol; Stephane C Paulus; Marieke Emonts; Michiel van der Flier; Ronald de Groot; Miriam Cebey-López; Irene Rivero-Calle; Navin P Boeddha; Paul-Michael Agapow; Fatou Secka; Suzanne T Anderson; Uta Behrends; Uwe Wintergerst; Karl Reiter; Federico Martinon-Torres; Michael Levin; Werner Zenz; EUCLIDS consortium

doi:10.3389/fped.2022.744182

Osteoarticular Infections in Pediatric Hospitals in Europe: A Prospective Cohort Study From the EUCLIDS Consortium

Front Pediatr. 2022 May 4:10:744182. doi: 10.3389/fped.2022.744182. eCollection 2022.

Authors

Andreas Trobisch^{1

2

3}, Nina A Schweintzger¹, Daniela S Kohlfürst¹, Manfred G Sagmeister¹, Matthias Sperl⁴, Andrea J Grisold⁵, Gebhard Feierl⁵, Jethro A Herberg⁶, Enitan D Carrol⁷, Stephane C Paulus⁷, Marieke Emonts^{8

9

10}, Michiel van der Flier^{11

12}, Ronald de Groot¹¹, Miriam Cebey-López^{13

14}, Irene Rivero-Calle^{13

14}, Navin P Boeddha¹⁵, Paul-Michael Agapow⁶, Fatou Secka¹⁶, Suzanne T Anderson¹⁶, Uta Behrends¹⁷, Uwe Wintergerst¹⁸, Karl Reiter¹⁹, Federico Martinon-Torres^{13

14}, Michael Levin⁶, Werner Zenz¹; EUCLIDS consortium

Affiliations

¹ Department of Pediatrics and Adolescent Medicine, Division of General Pediatrics, Medical University of Graz, Graz, Austria.
² Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
³ Research Group for Neonatal Infectious Diseases, Medical University of Graz, Graz, Austria.
⁴ Department of Orthopedics and Traumatology, Pediatric Orthopedic Unit, Medical University of Graz, Graz, Austria.
⁵ Diagnostic and Research Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria.
⁶ Section of Pediatric Infectious Disease, Imperial College London, London, United Kingdom.
⁷ Department of Clinical Infection Microbiology and Immunology, University of Liverpool Institute of Infection, Veterinary and Ecological Sciences, Liverpool, United Kingdom.
⁸ Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom.
⁹ National Institute for Health Research (NIHR) Newcastle Biomedical Research Centre Based at Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, United Kingdom.
¹⁰ Pediatric Infectious Diseases and Immunology Department, Newcastle upon Tyne Hospitals Foundation Trust, Great North Children's Hospital, Newcastle upon Tyne, United Kingdom.
¹¹ Department of Pediatrics, Division of Pediatric Infectious Diseases and Immunology and Laboratory of Infectious Diseases, Radboud Institute of Molecular Life Sciences, Nijmegen, Netherlands.
¹² Department of Pediatric Infectious Diseases and Immunology, Wilhelmina Children's Hospital University Medical Center Utrecht, Utrecht, Netherlands.
¹³ Translational Pediatrics and Infectious Diseases Section- Pediatrics Department, Santiago de Compostela, Spain.
¹⁴ Instituto de Investigación Sanitaria de Santiago (IDIS), Genetics- Vaccines- Infectious Diseases and Pediatrics Research Group (GENVIP), Santiago de Compostela, Spain.
¹⁵ Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Netherlands.
¹⁶ Medical Research Council Unit the Gambia, Banjul, Gambia.
¹⁷ Department of Pediatrics and of Pediatric Surgery, Technische Universität München, Munich, Germany.
¹⁸ Department of Pediatrics, Hospital St. Josef, Braunau, Austria.
¹⁹ Department of Pediatric Intensive Care, University Children's Hospital at Dr. von Haunersche Kinderklinik, Ludwig-Maximilians-Universität München, Munich, Germany.

Abstract

Background: Pediatric osteoarticular infections (POAIs) are serious diseases requiring early diagnosis and treatment.

Methods: In this prospective multicenter cohort study, children with POAIs were selected from the European Union Childhood Life-threatening Infectious Diseases Study (EUCLIDS) database to analyze their demographic, clinical, and microbiological data.

Results: A cohort of 380 patients with POAIs, 203 with osteomyelitis (OM), 158 with septic arthritis (SA), and 19 with both OM and SA, was analyzed. Thirty-five patients were admitted to the Pediatric Intensive Care Unit; out of these, six suffered from shock, one needed an amputation of the right foot and of four left toes, and two had skin transplantation. According to the Pediatric Overall Performance Score, 36 (10.5%) showed a mild overall disability, 3 (0.8%) a moderate, and 1 (0.2%) a severe overall disability at discharge. A causative organism was detected in 65% (247/380) of patients. Staphylococcus aureus (S. aureus) was identified in 57.1% (141/247) of microbiological confirmed cases, including 1 (0.7%) methicillin-resistant S. aureus (MRSA) and 6 (4.2%) Panton-Valentine leukocidin (PVL)-producing S. aureus, followed by Group A Streptococcus (18.2%) and Kingella kingae (8.9%). K. kingae and PVL production in S. aureus were less frequently reported than expected from the literature.

Conclusion: POAIs are associated with a substantial morbidity in European children, with S. aureus being the major detected pathogen. In one-third of patients, no causative organism is identified. Our observations show an urgent need for the development of a vaccine against S. aureus and for the development of new microbiologic diagnostic guidelines for POAIs in European pediatric hospitals.

Keywords: EUCLIDS; Europe; S. aureus; pediatric osteomyelitis; pediatric septic arthritis.

Copyright © 2022 Trobisch, Schweintzger, Kohlfürst, Sagmeister, Sperl, Grisold, Feierl, Herberg, Carrol, Paulus, Emonts, van der Flier, de Groot, Cebey-López, Rivero-Calle, Boeddha, Agapow, Secka, Anderson, Behrends, Wintergerst, Reiter, Martinon-Torres, Levin, Zenz and the EUCLIDS consortium.